Journal of Urgent Care Medicine

Abstracts in Urgent Care – January 2022

Pediatric Burns and Cool, Clear Water Limit Screen Time After Concussion? Gastroenteritis in Children Diagnosing Giant Cell Arteritis POCUS and Ectopic Pregnancy Detecting C diff Vaccinating Adolescents Against COVID-19 Ivan Koay MBChB, FRNZCUC, MD First Aid for Pediatric Burn Patients Take-home point: Many children with burns receive inadequate cooling after burns when presenting for emergency care. Citation: Frear C, Griffin B and Kimble R. Adequacy of cool running water first aid by healthcare professionals in …

How Useful Is Ultrasound in Diagnosing Extrauterine Gravidities?

Urgent message: Ultrasound can provide essential data in the urgent care evaluation of gynecological and obstetrical problems, such as suspected ectopic pregnancy (and is the test of choice for first-trimester pregnant women with abdominal pain or vaginal bleeding). Andrew Alaya, MD, MSc and Harold Pelikan, MD INTRODUCTION An ectopic pregnancy or extrauterine gravidity (EUG) is a pregnancy that implants outside of the uterus. In 90% to 95% of EUGs, the pregnancy lies in the fallopian …

Use of a Quality Improvement Tool for the Evaluation of Healthcare Disparities in Urgent Care: A Case Example for Bacterial Pneumonia

Urgent message: While healthcare disparities have been studied in several healthcare settings, it is unclear whether they persist in urgent care. This study may serve as a quality improvement tool to assess whether these disparities persist in an urgent care clinic. Derrick Murcia and Lindsey Fish, MD Citation: Murcia D, Fish L. Evaluation of healthcare disparities in urgent care: a case example for bacterial pneumonia. J Urgent Care Med. 2022;16(4):23-27. Epub ahead of print September …

Time to Presentation for Acute Otitis Media During the COVID-19 Pandemic

Urgent message: Concern over the potential spread of COVID-19 may (or may not) have affected the timeliness with which parents chose to present with children who had symptoms concerning for acute otitis media, thereby throwing the concept of “delayed” antibiotic prescribing into question. Emily J. Montgomery, MD; Brian R. Lee, PhD, MPH; Amanda Montalbano, MD, MPH; Amanda Nedved, MD Citation: Montgomery RJ, Lee BR, Montalbano A, Nedved A. Time to presentation for acute otitis media …

A 27-Year-Old Male with Chest Pain and No Reported Medical History

Chamber Abnormalities: Pathologic or Not? A 27-year-old male with no reported medical history presents with chest pain. He relays several weeks of intermittent symptoms which started after lifting heavy boxes. The pain is sharp, located in the mid-chest and is otherwise non-tearing, non-pleuritic, non-positional and not associated with exertion. On examination, the patient is in no acute distress, and appears lean without cachexia or wasting. The pain is reproduced with shoulder extension. It resolves with …

A Legal Quandary: Poor Care…or Malpractice?

Urgent message: Failure to consider subtleties and the context in which a patient presents can lead to insufficient differential diagnoses and, therefore, mis- or missed diagnoses that leave the patient at risk for poor outcomes and the provider at risk for litigation. Michael Weinstock, MD and Charles Pilcher, MD Back pain is usually back pain, whether it’s from a muscular strain or another self-limiting, non-serious cause. But there is potential danger lurking below the surface, …

A 68-Year-Old Woman with a Rash of Several Weeks’ Duration

The patient is a 68-year-old woman who presents with a rash she says developed on her trunk over a span of several weeks. On examination, there were multiple confluent, orange-red plaques on the trunk and arms with “islands of sparing” within them. The rash had a primarily truncal distribution and was pruritic. She was feeling well otherwise. View the image and consider what your next steps and diagnosis would be. Resolution of the case is …

A 15-Year-Old Boy with a Painful Elbow After a Baseball Game

The patient is a 15-year-old boy who presents to urgent care with a painful medial right elbow he and his parents attribute to pitching in a baseball game earlier in the day. View the images taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.

An Underrecognized Epidemic: Toxic Positivity in Medicine

Joshua Russell, MD, MSc, FCUCM, FACEP A colleague, Dr. Mitchell we’ll call him, told me about a PA that he was supervising recently who made a great catch in a patient with a swollen, blue finger: Achenbach syndrome. When the PA presented the presumptive diagnosis, Dr. Mitchell, unfamiliar with the condition, had to Google it before seeing the patient. Our PA was right, though. The patient walked out of clinic, happy to have a benign …

Approach to the Transgender Adolescent and Specific Health Considerations

Urgent message: It is common for transgender patients to have a history of poor experiences with healthcare providers. As such, they may be less likely to have an ongoing clinical relationship with a primary care provider, making urgent care a likely destination when a need arises. Familiarity with issues facing adolescent transgender patients, in particular, can benefit both the provider and the patient. Timothy McGinnis and Emily Montgomery, MD THE CASE A 15-year-old transgender male …