Journal of Urgent Care Medicine

Medication Issues in Urgent Care

Urgent message: Polypharmacy—taking multiple medications to treat several chronic medical problems—puts patients at increased risk of developing additional health issues when they are prescribed even more medications for acute conditions in an urgent care center. JASMEET SINGH BHOGAL, MD It is not uncommon for patients, especially elderly patients, presenting to an urgent care center to have multiple medical problems. This makes it more likely that they are taking multiple medications as well. In fact, according …

Evaluating Chest Pain in Urgent Care— “Catch 22 and the Three Bears”: Part 1

Lee A. Resnick, MD, FAAFP What can Joseph Heller and Goldilocks teach us about managing no-win situations in urgent care? As it turns out, if you look under the covers of Baby Bear’s bed, you might find something meaningful, perhaps even something that’s “just right.” Take the classic no-win situation when patients present to urgent care with chest pain. Without a definitive and reliable test to guide our decision making, we are stuck with the …

Clinical Challenge 2: January, 2015

Case A 68-year-old man with a long history of uncontrolled hypertension and hyperlipidemia presented with unilateral decreased vision for the last 3 weeks. On exam, you saw a fundus with diffuse retinal hemorrhages and swelling.

Clinical Challenge: January, 2015

Case An 80-year-old man woke up with a localized area of erythema on his forehead. He didn’t think much of it, until the lesion slowly became white and then started turning blue over a few hours. He says that the lesion is painful and is getting larger and darker. He denies the presence of headaches, muscle pain, abdominal pain, sweating, and tremors.

Periostitis in secondary syphilis

Urgent message: Be on the lookout for periostitis in patients with syphilis who present with extremity pain. MAY MOHTY, MD, FAAP, FAAUCM, and CASEY PHILIPSBORN, MSIV Syphilis (from the Greek word Syphlos, meaning crippled) is an infectious disease caused by the spirochete species Treponema pallidum. Patients can present with manifestations of any of the three stages of syphilis, ranging from a painless ulcer to an asymptomatic rash, to general paresis and dementia, among a myriad …

The ‘Control’ Paradox

Lee A. Resnick, MD, FAAFP Influenza is off to a fast start this year and volumes are ballooning. ‘Tis the season to be swamped in urgent care, and without a good approach, urgent care clinicians can quickly become overwhelmed, burned out, and irritable. Pile on the stress of the holidays and the demands of family and loved ones and you’ve got a recipe for disaster. Work-life balance is important for all of us, yet feels …

Abstracts in Urgent Care: January, 2015

Fatigue and inappropriate antibiotic prescription Key point: As the day goes on, resistance to prescribe potentially inappropriate antibiotics seems to fade. Citation: Linder JA, Doctor JN, Friedberg MW, et al. Time of day and the decision to prescribe antibiotics. JAMA Intern Med. 2014 Oct 6; doi: 10.1001/jamainternmed.2014.5225. [Epub ahead of print] Previous research has shown that resistance to making the easier choice tends to fade as fatigue increases. Physicians make many difficult decisions during …

Repair of Lacerations of the Face and Scalp: Part 2

Urgent message: Evaluation and treatment of injuries of the cheek, ear, nose, lips and tongue are explored to help urgent care clinicians more confidently manage these presentations. TOYIN FAPOHUNDA-ADEKOLA MD, MBA In Part 1 of this series, we covered the evaluation and management of scalp, brow, and eyelid lacerations. In Part 2, we will explore injuries of the cheek, ear, nose, lips and tongue. As previously discussed, careful evaluation of neurovascular function and appreciation of …

Abstracts in Urgent Care: December, 2014

Pulse oximetry and decision-making on hospitalization Key point: Use of pulse oximetry to decide on necessity of hospitalization may need to be reconsidered. Citation: Schuh, S, Freedman S, Coates A. et al. Effect of oximetry on hospitalization in bronchiolitis, JAMA. 2014; 312(7):712-718. Pulse oximetry has been used to help decide when an infant with bronchiolitis should be hospitalized. The authors of this study postulated that providers may be relying too heavily on it, resulting in …

Clinical Challenge: December, 2014

THE CASE This x-ray was taken on a woman who fell off a ladder. View the image taken (Figure 1) and consider what your diagnosis would be.