News - Page 3 of 4

Behind the Stethoscope: The Heart of ERx

Julie Hilton, MSN, ACNP/FNP-BC Joined ERx: November, 2023 Joined NCCH staff: 1998 Current Position: Assistant Director NCCH, Willcox, AZ What inspired you to pursue a career in medicine? Initially, my intention was to pursue a career as a veterinarian. Growing up in rural Colorado, my life revolved around horses and livestock, and I aspired to specialize in equine veterinary medicine. However, circumstances led to a move to Arizona, where the absence of a veterinary school disrupted my plans. Consequently, I explored seven different academic majors before settling on nursing. Although my father believed I was capable of becoming a neurosurgeon, I took time to determine my desired path. Initially, my interests leaned towards liberal arts, but a pivotal moment occurred while I was in an emergency room in Flagstaff with my father, who was experiencing a deep vein thrombosis (DVT). Observing the nurses, I expressed to my mother that I believed I could perform that role and find it fulfilling. This realization marked the definitive decision. My mother questioned my choice due to the extensive mathematics and science involved, subjects in which I had not previously shown great interest. However, this challenge only fueled my competitive nature, solidifying my resolve. Why did you choose to work in a rural ER? I didn’t actually choose to work in the ER. When I first started here (NCCH), all my experience was in the NICU. I had never worked with adults. I only knew about three medications and it was very scary – I ended up being self-taught at first. I remember telling Nick I would never take care of adults, and now here I am in the ER and I love it because there’s so much variety. Then I got a job as a flight nurse and I told them I…

By Karen Wink

Newsletter

Case Based Learning for March 2025

36-year-old male patient, past medical history of asthma not taking any medications for it, presents to the ER for cc of ”body aches.” Reports myalgias, cough, shortness of breath, intermittent fevers and chills for several days. Taking Motrin and Tylenol for symptoms with temporary relief. Has sick contacts at home. Denies any other complaints at this time. PMH: asthma PSH: Denies HR 134, BP 113/74, RR 22, SpO2 98%, Temp 99°F PE: appears fatigued, tachycardia, appears fatigued, lungs clear, otherwise normal Workup: CXR normal, viral panel negative, WBC 18.9, ANC 16.4, CO2 22 Diagnosis: Cough, back pain, shortness of breath Plan: Discharged on doxycycline, ibuprofen, acetaminophen (ER note reports uncertain cause of infection and empiric coverage with doxycycline) RETURN TO ER 2 days later patient presents via ambulance with cc of non-productive cough and fatigue. Patient worried he has mono as his son recently had it. Paramedics report a “sore” on the buttock. Treated 250mg fluid bolus prior to arrival HR 130, BP 113/69, RR 23, SpO2 97% Temp 99.5°F PE: tachycardia, lungs clear. Then taken into resusc bay for quick exam of buttocks showing 1.5cm x 1cm dark bullae to right inguinal/perineal region, no pain beyond boundaries, no crepitus, no dusky appearance of skin DDx: most likely cellulitis, folliculitis, necrotizing soft tissue infection; less likely PNA, mono, viral Sepsis workup and treatment initiated. Labs and cultures ordered, 30mL/kg fluid bolus, Zosyn and Vancomycin WORKUP: WBC 15.63, H/H 13.4/38.1, CMP Na 139, Cr 1.3, Glu 127, Lactate 1.7, CRP 33.8 mg/dL, blood cultures sent General Surgery contacted within 1 hour. Surgery planning on seeing in the morning as LRINEC score 5, WBC improving, exam only bullae to area. IVIG added to treatment regimen. Surgery contact and taken emergently to the OR. Total of 3 surgeries during 17 day…

By Karen Wink

Newsletter

Our ERx Communities – Tonasket, WA

The Okanogan River is a tributary of the Columbia River and runs about 115 miles long starting in southern British Columbia. Along its banks is Tonasket, Washington, which is one of ERx Clinical Partners communities. We work closely with the local hospital to provide emergency and hospitalist medical care. Our partnership with North Valley Hospital is over a decade old. In that time, we have built a partnership that has secured community trust in the Emergency Department and in acute care at NVH. Currently we are looking for an emergency medicine physician and an APP experienced in inpatient care to join our team. If you are considering a move to rural medicine, we would like to invite you to take a look at this beautiful area. The Okanogan River being one of the many reasons to consider this area. It is well-noted as a great place to fish for small-mouth bass and walleye.The river is also a habitat for diverse wildlife. This is all to say that if outdoor spaces are your answer to self-care, ERx has the place for you. Here are more details about the positions: ER physicians; https://zurl.to/Z57D?source=CareerSite APP Hospitalists: https://zurl.to/fqYg?source=CareerSite More about the area Okanogan County offers everything outdoor lovers want — rugged mountain peaks, high adrenaline adventure vacations, rural charm, endless outdoor adventure, wineries, concerts and fine dining! All this with the cost of living running 46% less than Seattle and a third less than Denver. Highlights: Low cost of living Wonderful small town with great farmers market 300 km of groomed Nordic ski trails More than 600 miles of trails suitable for snowmobiling Downhill skiing Mountain biking trails Whitewater Trail rides and rodeos Fishing and boating on the Columbia River, Okanogan River, and Beaner Lake. For more information about the Okanogan County Area of…

By Karen Wink

Newsletter

Behind the Stethoscope: The Heart of ERx

In 2025, we are highlighting the medical directors of our ERx team. Their commitment to rural health care is the driving force behind our organization Mark Scott, D.O. Medical School Year: 1991 Joined ERx: July 2018 Current Positions: Director of North Valley Hospital What inspired you to pursue a career in medicine? I decided that I wanted to be a physician as a young boy, influenced by the patriarch of our extended family, my grandpa. He practiced family medicine in Auburn, IN. Then, it was normal to practice in an office in your home, complete with minor procedures, a small pharmacy, and x-ray development by my mom (a young girl) in the basement. I honored his altruism and professionalism, while noting the respect with which he was held in the community and our family. He graduated medical school in 1932. I graduated from the same medical school in 1991, then completed an IM/EM residency there. Why did you choose to work in rural Emergency Medicine? I came to North Valley Hospital hoping for a lower stress setting to practice emergency medicine. I had spent years in a busy urban ED, feeling the dreadful stress of averaging 34 patients on a day shift while dealing with a dysfunctional staff and an overbearing bureaucratic administration. What are some of the unique challenges and rewards of working in a rural ER setting? At NVH, I found a culture of hard working health professionals who take pride in their work, respect each other, and really work hard as a team to provide great care. I am usually able to spend plenty of time with my patients. During times of volume surges, I have been so impressed with the way hospital staff pulls together so that we can continue to care for patients quickly…

By Karen Wink

Newsletter

Case Report: Acute Angle-Closure Glaucoma in a 43-Year-Old Male

Introduction Acute angle-closure glaucoma (AACG) is an ocular emergency resulting from a rapid increase in intraocular pressure (IOP) due to obstructed aqueous humor outflow. It is commonly associated with a shallow anterior chamber angle, predisposing individuals to blockage. Without timely intervention, AACG can lead to permanent vision loss or blindness. This report describes the presentation, diagnosis, and management of AACG in a patient presenting to the emergency room (ER). Patient Presentation A 43-year-old male with no significant past medical history presented to the ER on a Sunday afternoon with blurred vision and pain in the right eye that began the day before. He initially hoped the symptoms would resolve on their own but sought medical attention after consulting a healthcare provider. He reported a sharp, constant headache behind the right eye rated 6/10, accompanied by nausea and blurred vision, described as though a film was over the right eye. He also noticed mild redness in the right eye but denied discharge, pain with eye movement, photophobia, fever, chills, respiratory, gastrointestinal, or genitourinary symptoms. Physical Examination Vital Signs: T 98.7°F, P 85 bpm, R 16/min, BP 151/87 mmHg, SpO₂ 97% on room air.Visual Acuity: Right Eye 20/40, Left Eye 20/20. Extraocular Movements (EOM): Full range of motion without pain. External Eye Exam: Eyelids everted—no foreign bodies. Mild conjunctival erythema, no discharge. Corneal Staining: Fluorescein stain showed no corneal uptake. Funduscopic Exam: Right Eye: Cloudy cornea, retina not visualized. Left Eye: Retina visualized, no gross abnormalities. Intraocular Pressure (IOP): Right Eye 76-80 mmHg, Left Eye 14-17 mmHg. Slit Lamp Exam: Not available in the ER. Working Diagnosis Acute Angle-Closure Glaucoma (AACG) Treatment Provided in ER Acetazolamide (Diamox): 500 mg PO (IV formulation unavailable) Timolol 0.5%: 2 drops in the right eye Apraclonidine and Prednisolone ophthalmic solutions were not available. Ophthalmology Consultation: Arranged…

By Karen Wink

Newsletter

Behind the Stethoscope: The Heart of ERx

In 2025, we would like to highlight the medical directors of our ERx team. Their commitment to rural health care is the driving force behind our organization. Sara Ragsdale, DO Medical School Year: 1998, University of Kansas Health Sciences Joined ERx: 2013 Current Positions: Director of Providence St.Joesph Hospital in Chewelah, WA Director of Columbia Health in Dayton, WA Co-director of Providence Mt Carmel Hospital in Colville, WA What inspired you to pursue a career in medicine? “I am guessing it was because my mom was sick. She died when I was young. When I was eight, I decided I wanted to be an OB/GYN. My dad still has the picture when I drew “What I wanted to do when you grew up.” There is a stick figure person standing next to a table with a lady that has a giant pregnant belly, so I even knew what an OB/GYN was.” Why did you choose to work in rural Emergency Medicine? “I chose my family medicine residency based on location and stayed in Kansas City. They’re totally prepared to do family medicine in the city, which is working in the clinic. This was my least favorite part of family medicine. Looking back, I wish I would’ve done a different residency but at the time I wanted to be close to my family and so with a new baby. When you do ER in a big hospital as the family medicine resident, they assume you don’t want or need to do a lot of ER procedures. The orthopedic residents do all the reductions, the anesthesia residents do all the intubations and the cardiology residents do all the cardioversions. I had the opportunity to moonlight in a rural hospital. It was amazing. I was able to do all the fun stuff because…

By Karen Wink

Case-based-Learning

January 2025 Case Study – Abdominal Pain

ABDOMINAL PAIN HPI: This is a 67-year-old female who presents to the ER at 06:15 complaining of nausea, vomiting, sweating, a feeling of general malaise, and dizziness. She was brought in by family. The patient states she was awakened from sleep at approximately 03:45 with a feeling of bilateral upper quadrant abdominal pain, nausea and vomiting. She has sweating with the vomiting. She has had multiple episodes of vomiting and began to feel dizzy starting approximately 30 to 45 minutes prior to arrival. She states she feels weak all over and just doesn’t feel “right.” She denies any new or restaurant foods in the past 48 hours. She denies eating any “left-overs” in the past 48 hours. She was unable to take her morning medications due to her inability to keep anything down. She denies any bloody or dark vomit or stools. She denies anyone else in the household being ill. COVID immunizations are up to date. ROS: She denies any, fever, chills, change in her vision, diplopia, change in hearing, ear pain, rhinorrhea, sore throat, difficulty swallowing, chest pain, shortness of breath (except with vomiting), abnormal heart beat, physical difficulty breathing, abdominal distention, dysuria, hematuria, incontinence of urine or stool, retention of urine or stool, back pain, muscle pain, focal weakness, focal numbness, environmental or food allergies. DRUG ALLERGIES: COMPAZINE, PENICILLIN, BACTRIM. MEDS: Glyburide/Metformin 5mg/500mg, 2 tablets, P.O., BID Reglan 10mg, P.O., QID PRN Amlodipine 5mg, P.O, Q Day Omeprazole 20mg, P.O., Q Day PMHX: Hypertension Diabetes Mellitus, Type II, diet and medication controlled. Gastroparesis GERD GALLSTONES DYSFUNCTIONAL UTERINE BLEEDING LEFT WRIST FRACTURE – Age 8 PSHX: CHOLECYSTECTOMY – three months ago VAGINAL HYSTERECTOMY – Age 57 Ovaries still In-Situ ORIF – Left Wrist Age 8 SOCIAL HX: Tobacco – Never Alcohol – One glass of wine per…

By Karen Wink

Uncategorized

In the News

ERx physician team members, Dr. Josh Minyard and Dr. Naile Barzaga were featured in The Mariposa Gazette this November. Dr.Minyard leads our emergency medicine team at John C Fremont Hospital in Mariposa, CA. Dr.Barzaga is an integral part of our hospitalist team at JCFH. The Mariposa Gazette is California’s oldest weekly newspaper of continuous publication. They cover news in Mariposa County, CA.

By Karen Wink

Newsletter

90 critical access hospital CEOs to know in 2024

ERx Clinical Partners would like to congratulate Hank Hanigan, the CEO of Whitman Hospital and Medical Center in Colfax, WA for being selected as one of Becker’s “Hospital Review’s” 90 critical access hospital CEOs to know in 2024. Becker’s based its selection on executives that were highly skilled in expanding service lines, recruiting and retaining providers, and forming partnerships, all of which contribute to their hospitals’ essential roles within their communities. Additionally, these CEOs prioritize high-quality care, patient safety, and financial stability, while also bringing vital services, top physicians, and collaborative relationships with larger healthcare systems to their organizations. Link to the full article: “Becker’s 90 to Know”.

By Karen Wink

Ourteam

Meet Our Team – Jamey Pritchard

We are thrilled to welcome Jamey Pritchard as the new Chief Operating Officer at ERx Clinical Partners. With over 15 years of experience in the critical access ER staffing industry, Jamey has a proven track record in physician recruiting and operations management. Jamey is a U.S. Air Force veteran who has served in various leadership roles as an Operations Manager. Over the last 15 years, he has worked in the critical access staffing industry in roles ranging from Physician Recruiting to Sr. Director of Physician Recruiting, and most recently as the owner and CEO of a physician staffing company. At ERx Clinical Partners, he will be responsible for overseeing all operations including recruiting, scheduling, credentialing, and fostering relationships with our hospital partners. We are confident that Jamey’s expertise, leadership, and passion for providing outstanding providers for rural communities will greatly benefit ERx and our partners. Please join us in welcoming Jamey to our team!

By Karen Wink