Journal of Urgent Care Medicine

An Itchy Back with New Moles: A Case Report of Occult Malignancy

Joshua Russell, MD, MSc, FCUCM, FACEP Key words: paraneoplastic syndrome, gastric cancer, seborrheic keratosis, case report ABSTRACT Introduction: Lesar-Trélat sign (LTS) is an infrequent paraneoplastic phenomenon associated with an array of malignancies. Given that the primary manifestation is a seemingly benign dermatologic issue, such patients may choose urgent care as their initial site of clinical evaluation. Clinical presentation: A 43-year-old man with no significant past medical history presented to UC with complaints of itching and …

Abstracts in Urgent Care – March 2023

Ivan Koay MBChB, MRCS, FRNZCUC, MD Are Urine Dipsticks Accurate in Diagnosing UTIs in Infants? Take-home point: Point-of-care (POC) urinalysis (ie, urine dipstick) is moderately sensitive and highly specific for diagnosing urinary tract infection in febrile infants. The optimum cut-point for excluding UTI is leucocytes (1+), and the optimum cut-point for confirming UTI is nitrites (trace). Citation: Waterfield T, Foster S, Platt R, et al. Diagnostic test accuracy of dipstick urinalysis for diagnosing urinary tract …

Key Signs and Symptoms of Severe Illness in Urgent Care: Cervical Necrotizing Fasciitis and Necrotizing Mediastinitis

Urgent message: Cervical necrotizing fasciitis and necrotizing mediastinitis may ultimately occur in patients presenting with symptoms of odontogenic infection. While severe illnesses rarely present in urgent care, it is important to establish a prompt diagnosis and implement rapid medical management for these patients, in order to improve survival. Vitoria Regina Nunes Maia, MS and Lindsey E. Fish, MD ABSTRACT Cervical necrotizing fasciitis (CNF) is a rapidly progressive infection that can be fatal. This condition can …

Conquering the Fear of Penicillin Allergy: The Boogeyman of Urgent Care

I had time to see one more patient as my shift was winding down. “Wound check. That should be a quick one,” I said to myself. Famous last words. I soon learned that the young woman with the dog bite on her hand was returning for her fourth visit in as many days for the same issue. She sat fidgeting on the exam table and was visibly irritated when I walked in the room. “It’s …

Retrospective Study on the Impact of Increased Value-Add Time on Patient Experience in Pediatric Urgent Care Centers

Urgent message: Increase in the proportion of value-add time during an encounter was associated with an increased rate of positive perceptions of timeliness and overall patient experience in pediatric urgent care centers. Aimy Patel, MD; Brian R. Lee, MPH, PhD; Amanda Montalbano, MD, MPH; and Amanda Nedved, MD Citation: Patel A, Lee BR, Montalbano A, Nedved A. Retrospective study on the impact of increased value-add time on patient experience in pediatric urgent care centers. J …

A Cause of Dizziness Not to Be Missed

Urgent message: Most cases of vertigo are benign. This includes etiologies such as benign paroxysmal position vertigo, labyrinthitis, and psychogenic causes. However, there are serious, “can’t miss” etiologies which should be considered during the urgent care evaluation of a dizzy patient. Cody McCoy, DO and Michael Weinstock, MD Citation: McCoy C, Weinstock M. A cause of dizziness not to be missed. J Urgent Care Med. 2023;17(5):13-16. Key words: dizziness, vertigo, disequilibrium, BPPV INTRODUCTION Dizziness presents …

A Comparison of Chief Complaints, Specific Diagnoses, and Demographics of Pediatric Urgent Care Visits Before and During the COVID- 19 Pandemic: A Retrospective Study

Zaharoula A. Viennas, MD; Julie Martin, MAEd, MMS, PA-C; Benjamin Klick, MD; Tammy Speerhas, DNP, FNP-C, RN, CEN, CME; Turaj Vazifedan, DHSc; Danielle Millspaugh, DNP, FNP-C; Jennifer Ferris, MD; Margret Bedle, MD; Lauren Paluch, DMSc, PA-C; and Theresa Guins, MD Urgent message: Research has shown distinct differences in patterns of children presenting to emergency rooms during COVID-related lockdowns. However, data specific to urgent care have been lacking previously. Citation: Viennas ZA, Martin J, Klick B, …

A 28-Year-Old with Tibial Pain After Prolonged Exercise

A 28-year-old male presents complaining of anterior shin pain. He shares that he is a runner training for a marathon, and that the pain began toward the end of an 18-mile run. There was no direct trauma. View the images taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.

A 52-Year-Old Male with Shortness of Breath and a History of Multiple Cardiologic Issues

A 52-year-old male with a history of hypertension, hyperlipidemia, and recent myocardial infarction (1 month ago) presents to urgent care with shortness of breath for the past week. He denies fever, chest pain, or cough. On examination, the patient is breathing comfortably and saturating well on ambient air. Review the ECG taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the following page.

A 7-Year-Old Boy with New Facial Rash

A woman brings her 7-year-old son to the urgent care center with a rash that had developed “over the past few weeks.” On examination, there are smooth, pink papules around the mouth. The mother reports that the patient has a history of asthma, for which he uses inhalation budesonide daily as maintenance therapy. Otherwise he is healthy, has no systemic symptoms, and is well-appearing. View the photo taken and consider what your diagnosis and next …