Updates in Urgent Care “Year in Review.”

As we are all aware, medicine is constantly in flux and we have found the following updates to clinical practice applicable in the world of Urgent Care.  These updates are offered as informational and could have changed at the time you read these or before our post and should only be relied upon as a guide.  All practitioners should always do thorough research when treating patients to verify the following updates are still applicable.

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-Lyme Prevention

Now that tick season is in full swing,…don’t forget tick prevention with doxycycline 200 mg one time dose. Patient must meet criteria of:

-Tick can be identified as I. scapularis tick

-Tick was attached 36 hours or greater

-Patient lives or traveled to endemic Lyme disease area

(CT, DE, MA,MD,ME,NH,NJ,NY,PA,RI,VA,VT,WI)

-Doxycycline is not contraindicated

-Doxycycline can be taken within 72 hours of tick removal

https://www.cdc.gov/ticks/tickbornediseases/tick-bites-prevention.html

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-New flu intranasal vaccine for 2018 season approved

The CDC Advisory Committee on Immunization Practices voted to reinstate Flu Mist, the Live Attenuated Influenza Vaccine (LAIV). This will now be an option for flu vaccinations for eligible patients for the 2018-19 flu season.

https://www.aafp.org/news/health-of-the-public/20180226acipmtg-laiv.html

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–Increase in Urgent Care Centers

Urgent Care Centers have seen growth of 19% from 2010-2015.

http://www.modernhealthcare.com/article/20170515/NEWS/170519910

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–Laundry pod ingestion

Thanks to the teen “Tide Pod Challenge” urgent care and ERs are seeing more laundry pod poisonings. Remember although ingestion is the most likely route, eye (use isotonic saline to irrigate)  and skin exposure can occur. 1-800-222-1222 Poison Control

https://www.cbsnews.com/news/tide-pod-challenge-ingesting-detergent-risks/

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-IDSA Guidelines on infectious diarrhea

IDSA recommends fluid and electrolyte replacements as staples to any diarrheal treatment. They recommend diagnosing the specific type of diarrhea cause and categorize the severity. Based on the clinical findings of suspected organisms, testing or treatment may be necessary. Prevention of diarrheal illness through the use of vaccines and avoidance of potentially contaminated food is ideal.

http://www.idsociety.org/Guidelines/Patient_Care/IDSA_Practice_Guidelines/Infections_By_Organ_System-81567/Gastrointestinal/Diarrhea/

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-New Bacterial Vaginosis Medicine Approved

Single dose medication secnidazole approved for use of BV in women, which was equally effective to the current treatment metronidazole (oral or vaginal), the down side is cost increases.

https://www.empr.com/news/bacterial-vaginosis-antibiotic-solosec-secnidazole-granules-symbiomix/article/689338/

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-New Blood Pressure Guidelines from the American College of Cardiology

-Normal 120/80

-Elevated SBP 120-129 AND DBP < 80

-Stage 1- SBP 130-139 OR DBP 80-89

-Stage 2 SBP 140+ OR DBP 90+

-Hypertensive Crisis SBP >180 AND/OR DBP >120 with patients need immediate changes in their medications or hospitalization based on signs of end organ damage

http://www.acc.org/latest-in-cardiology/articles/2017/11/08/11/47/mon-5pm-bp-guideline-aha-2017