Journal of Urgent Care Medicine

Management of Venous Thromboembolism in Urgent Care

Urgent message: Clinical evaluation that includes pretest probability tools and judicious use of diagnostic tests is a requirement for patients who present in the urgent care setting with symptoms suggestive of VTE. MELVIN LEE, MD, CCFP, RMC Early diagnosis of venous thromboembolism (VTE) is important to prevent the morbidity and mortality associated with it.Introduction VTE is subdivided into pulmonary embolism and deep venous thrombosis (DVT). DVT is most common in lower extremities. Those involving …

Evaluation and Management of Pain (Part 1): Acute Pain

Urgent message: Urgent care providers have a clinical, legal, and moral obligation to provide appropriate treatment for patients with pain. The first article in a two-part series addresses strategies for managing acute pain. TRACEY Q. DAVIDOFF, MD The interpretation of pain by patients is very subjective and not easily measured. That makes management of pain in the urgent care setting difficult. Current pain scales are often inaccurate or not truly reflective of a patient’s real …

Evaluation and Management of Neck Pain in Urgent Care

Urgent message: The differential diagnosis of neck pain is broad. A systematic and effective approach is required to rule out life-threatening conditions. RANIER NG, DO, and MICHAEL ROWANE, DO, MS, FAAFP, FAAO Neck pain is a frequently encountered complaint in urgent care. About two-thirds of the population will experience neck pain at some point in their lives.1 Many patients experience a sense of debilitation with every movement of their neck. Patients may perceive neck pain …

An Urgent Care Approach to Excessively Crying Infants

Urgent message: Infants who cry excessively pose a challenge to physicians and parents. A systematic approach to the history and physical exam can guide the diagnostic approaches to determine if a benign – or serious – condition is responsible. Toni Clare Hogencamp, MD Crying is a primitive form of communication that infants rely on to communicate their distress. Because infants cannot verbalize their discomfort, they must rely on their cry to communicate with caregivers. Estimates …

Management of Palpitations in Urgent Care

Urgent message: Patients with palpitations often present to urgent care clinics. Making the correct diagnosis requires knowledge of underlying pathophysiology and thorough differential diagnosis. EBRAHIM BARKOUDAH, MD, and JEFFREY P. COLLINS, MD Case Record A 75-year-old woman with no prior history of cardiac disease complained of “palpitations” but neither lightheadedness nor syncope. She denied excess caffeine intake or use of illicit drugs and had no other significant past medical history on triage. The patient’s initial …

Management of Acute Hyperglycemia in Urgent Care (Part 1)

Urgent message: Acute hyperglycemia is a common and potentially challenging problem in urgent care that deserves to be managed appropriately based on the best available evidence and suitable consideration of the associated complexities. ANTHONY J. PICK, MD, CDE, DAVID L. PICK, MD, FAAFP, and LOWELL R. SCHMELTZ, MD Hyperglycemia is common in acute care settings such as emergency rooms (ERs) or urgent care centers. Stress-induced hyperglycemia can result from an acute process, such as infection, …

Lymphadenopathy in urgent care: evaluation and management

Urgent message: Lymphadenopathy is a common presenting issue in urgent care. Most cases are benign, but be on the alert for “red flags” that could signal malignancy. MARIA V. GIBSON, MD, PHD, and DANIEL A. CHERRY, MD Consider how you would manage the following patient presenting with lymphadenopathy. A 39-year-old male truck driver presented to the urgent care clinic with a 2- to 3-week history of “swollen glands” in both sides of his groin. They …

An Urgent Care Provider’s Guide to Managing Dental Emergencies

Urgent Message: Patients with tooth-related complaints increasingly are presenting to urgent care centers. Managing these cases can be a challenge because physicians often receive limited training in this area. KATHERINE HURST MSC, MD, and RICHARD E. WALTON DMD, MS Tooth or tooth-related complaints are common presenting issues in patients seen at urgent care centers because of the limited availability of dental services in the evenings and on weekends. More patients also are seeking emergency dental …

Urinary Tract Infection in the Pediatric Patient

Urgent message: Diagnosing UTI in a child is challenging in the urgent care setting. Fever, abdominal or back pain, frequency or new onset of incontinence all should raise your index of suspicion. KIMBERLY GIBSON, MD Cases such as the following are common in urgent care and they present unique challenges: J.S., a 2-year-old girl, presents to an urgent care clinic on a Saturday afternoon for evaluation of low-grade fever and fussiness. Her parents have been …

Ureterolithiasis: Leaving No Stone Unturned

Urgent message: Symptoms from stones in the ureter can mimic other conditions, making for a diagnostic dilemma in urgent care. Imaging is the key to accurate assessment and appropriate treatment. WILLIAM GLUCKMAN, DO, MBA, FACEP and KATE ABERGER, MD Ureterolithiasis, which literally translates to stones in the ureter, is sometimes referred to improperly as “kidney stones,” which are properly known as nephrolithiasis. Although stones do form within the kidney, they do not typically cause acute …