Suspected Pertussis in Infants and Adolescents—What to do?

Urgent message: Familiarity with the schedule for immunization against pertussis, as well as expertise in diagnosing and prescribing treatment, should be within the urgent care provider’s capabilities—as should the ability to distinguish which patients require transfer to a higher-acuity setting. Ellen Laves, MD Microbiology and Immunity Pertussis is a toxin-mediated disease caused by the gram-negative coccobacillus Bordetella pertussis. Toxins produced by B pertussis impair ciliary clearance of pulmonary secretions through the paralysis of normally …

A 44-Year-Old Man with Cough of Several Weeks’ Duration

Urgent message: Lung cancer—the leading causes of cancer-related deaths in the United States—may first present with relatively benign symptoms and findings, such as those seen in urgent care. A pulmonary nodule may be the first manifestation of lung cancer in tobacco users. Early diagnosis and intervention, as well as ensuring a patient has appropriate and timely access to follow-up, is a critical measure in decreasing mortality. Introduction Lung cancer is the second most common …

A 57-Year-Old Man with a Chief Complaint of Syncope 3 Hours Ago

Case The patients is a 57-year-old man with a complaint of syncope 3 hours before arrival. He states he was sitting on the couch and the next thing he knew he was waking up. No preceding dizziness. No seizure activity, biting of the tongue, blood in the mouth, or post ictal symptoms. No cp, sob, leg pain, head pain, or back pain. He drank 2 glasses of water and felt better, but was encouraged to …

A 40-Year-Old Female with Progressively Worse Cough and Fever

Case The patient is a 40-year-old woman who presents with cough and fever that has been getting worse “for a few days.” She is a former smoker, and has diabetes mellitus. View the images taken and consider what the diagnosis and next steps would be. Resolution of the case is described on the next page.

A 37-Year-Old Man with Multiple Symptoms Following a Trip to Japan

Case The patient is a 37-year-old man who presents to urgent care complaining of fever, nausea, and abdominal pain. He had attributed these symptoms to a recent trip to Japan, where he ate lots of new foods along with old favorites like sushi. However, he became concerned when a pruritic, serpiginous lesion appeared on his flank. View the photo taken, and consider what your diagnosis and next steps would be. Resolution of the case is …

Abstracts In Urgent Care – April 2019

Rethinking IV Antibiotics for Cellulitis Key point: Oral antibiotics are noninferior to parenteral antibiotics for uncomplicated cellulitis. Erythema of cellulitis commonly expands somewhat, even if treated with appropriate antibiotics, for the first 1-2 days after starting treatment. Citation: Aboltins CA, Hutchinson AF, Sinnappu RN, et al. Oral versus parenteral antimicrobials for the treatment of cellulitis: a randomized non-inferiority trial, J Antimicrob Chemother. 2015;70(2):581-586. Patients with cellulitis are often referred from urgent care to the emergency …

An 18-Month-Old with an Itchy Rash and Wheezing

Case The patient is an 18-month-old girl brought to your urgent care center by her parents. They report that she has been scratching her abdomen. When they lifted her shirt, they found multiple hyperpigmented macules widespread across the front and back of her trunk. She also has 1 hour of wheezing. View the photo taken, and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page. …

Abstracts in Urgent Care-March 2019

Practice of Urgent Care: More Patients, More Decisions, More Fatigue Key point: We should be aware, as clinicians, that as we progress through our shifts, decision fatigue mounts. One manifestation of decision fatigue is an incremental decline in antibiotic stewardship. It is also important to understand that taking breaks seems to combat the harmful effects of decision fatigue. Citations: Linder JA, Doctor JN, Friedberg MW, et al. Time of day and the decision to prescribe …

A 55-Year-Old Man with a 2-Day History of Respiratory Symptoms, Palpitations, and Dizziness

Case A 55-year-old male presented to urgent care with a chief complaint of coughing, shortness of breath, wheezing, chest palpitations, and dizziness for the past 2 days. The patient denied chest pain. He has a significant past medical history of diabetes mellitus II and takes metformin 500 mg once a day. The patient’s blood pressure is 88/60 mmHg, heart rate is 115, O2 sat 98%, weight 275 pounds, BMI 50.3. In addition: General: alert and …

Infection Masquerading as a Fall in the Elderly

Urgent message: Falls in the elderly may be mechanical or due to an underlying etiology, making the urgent care evaluation tricky. The provider will need to evaluate the sequelae of the fall as well as searching for the hidden cause. Introduction Medical complaints from the elderly population will pose more of a challenge when the chief complaint is fall. The source can range from a neurologic etiology, a cardiac abnormality, or a metabolic or …

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