Postoperative Complications in the Urgent Care Setting

Urgent message: Patients who have had recent surgical procedures may present to urgent care centers for reasons ranging from seeking reassurance to presentation of life-threatening complications. Tracey Quail Davidoff, MD Introduction Patients often experience complications—or, at least as often, fear they’re experiencing complications—after a surgical procedure. While the surgeon is often the best person for them to consult, this may not be possible for a variety of reasons. Outpatient surgical centers are opening almost at …

Shortness of Breath in a Postprocedural Pneumothorax

Urgent message: Patient histories can be helpful in guiding the examination and raising red flags for possible diagnosis. However, it is essential to resist the urge to accept a patient’s self-diagnosis at face value. Katlin F. Mattson, M3 and Shailendra Saxena, MD Case Presentation A 65-year-old female with a history of metastatic endometrial cancer, COPD, and asthma presented with increasing shortness of breath. Four days prior, the patient had undergone a chest wall …

A 55-Year-Old Man with 3 Hours of Epigastric Pain

Case A 55-year-old man presents to urgent care with 3 hours of epigastric pain which began gradually and is constant. He has associated diaphoresis and minimal dyspnea. There is family history of hypertension and high cholesterol. Personal medical history is significant for diabetes mellitus and hypertension. The patient reports that he stopped smoking 2 years ago. Upon exam, you find: General: Alert, breathing comfortable, skin clammy Lungs: CTAB Cardiovascular: RRR, without m,r,g Abdomen: Soft and …

Abstracts In Urgent Care – February 2019

Check the Temps: A Timely Throwback Key points: Peripheral temperatures (ie, temporal, tympanic, oral, and axillary) are inaccurate and cannot reliably exclude the presence of fever. If absolute certainty regarding febrile status is critical (eg, neonates, immunosuppressed patients), a (gentle) rectal temperature is the preferred method of temperature acquisition in the urgent care setting. For all others, a tympanic temperature reading <37.5°C appears to best exclude true fever with reasonable certainty. Finally, all this comes …

A 2-Year-Old with a Nodule on His Face—and Other Concerning Symptoms

A mother and father bring their 2-year-old son to your urgent care center because of a smooth nodule on his face, which they noticed the previous day. They also reveal they noticed a small lump on his testicle about a week ago, and that they’ve been going through diapers faster than usual because he seems to be urinating more frequently over the past few days. View the photo taken, and consider what your diagnosis and …

A 10-Year-Old Girl with Foot Pain After Falling from a Tree

Case A 10-year-old girl presents with pain after falling from a tree, landing on her right foot. On examination, the pain emanates from the second through fifth metatarsals and proximal phalanges. View the images taken and consider what the diagnosis and next steps would be. Resolution of the case is described on the next page.

Unexpected Viral Illness in an Urgent Care Setting: The Re-Emergence of Mumps, Measles, and Varicella

Urgent message: Urgent care providers often see acute public health emergencies due to easy patient accessibility. It is important to identify communicable disease rapidly to control any risk of a community outbreak. This article will focus on mumps, measles and varicella (chickenpox). Carmen N. Burrell, DO, Melinda J. Sharon, MPH, and Megan Kessell, BA In recent years, outbreaks of uncommon infectious diseases have occurred in schools and communities, due to increasing travel exposures, decreasing vaccination …

An 11-Year-Old Boy with Forearm and Wrist Pain After a Fall

The patient is an 11-year-old boy who presents complaining of pain in his left and right forearm and wrist after falling from a height of approximately 5 feet. His parents report that he was attempting to hang upside down by his knees from a chin-up bar in his school’s gymnasium when he slipped. View the images taken and consider what the diagnosis and next steps would be. Resolutions of the case is described on the …

A 27-Year-Old Man with a Lesion on One Hand

A 27-year-old man presents complaining of a single skin lesion on his hand. He reports that it first appeared as a smooth nodule that ulcerated and spread in a lymphangitic fashion. He grew worried when he started to have a fever. The only unusual activity he’d done in the last few weeks was clean out one of his large saltwater aquariums to prepare for purchasing new fish. View the photo and consider what your diagnosis …

Abstracts In Urgent Care – January 2019

A Brief Introduction Happy New Year! 2018 is now behind us and it was another great year for urgent care. We are fortunate to work in one of the most dynamic and rapidly growing fields in medicine. I find it thrilling that the future of urgent care is ours to define and design. According to data from the UCA, last year nearly 150 million patients received care in U.S. urgent care centers (UCCs). These patients …

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