Practice Management
A 75-year-old female with a history of hypertension and diabetes presents with 1 day of dizziness and nausea. She is markedly bradycardic with a heart rate of 32 beats per minute and blood pressure of 88/52 on arrival. She was awake, alert, and oriented.
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Urgent Message: For patients with presumed asthma exacerbation, clinicians must maintain a high index of suspicion for other etiologies, including pneumothorax. This may help avoid delays in potentially life-saving interventions when symptoms persist despite treatment or when physical exam findings are atypical. Badi Eghterafi, DO; Nazanin Hazhir Karzar, MD Keywords: asthma, wheezing, chest pain, pneumothorax, spontaneous pneumothorax Abstract Introduction: Large spontaneous pneumothorax is an uncommon but critical complication in patients with asthma. Clinicians evaluating presumed …
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A 51-year-old male presents to urgent care after falling while skiing. He reports catching an edge in a patch of slushy snow, causing him to pitch forward and land forcefully onto his left anterior chest. He immediately experienced localized pain over the left chest, worsened by deep inspiration and coughing. He denies shortness of breath, syncope, and neck or head trauma. On exam, vital signs are normal. There is focal tenderness over the left anterior …
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A 64-year-old female presents to urgent care complaining of right thumb pain. The patient states she removed a wooden splinter from her thumb herself about 2 weeks prior, she denies any other trauma or systemic symptoms. The patient has a history of Type II diabetes and her last A1C 2 months prior was 9.3. Physical examination reveals the patient is afebrile with normal vital signs. There is a small, scabbed wound on the palmar surface …
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A 42-year-old male presents to urgent care with complaints of cough, throat pain, and vomiting that developed earlier that morning. He returned from a family vacation to the US Virgin Islands 7 days ago and two days later, he began feeling ill with initial symptoms of high fever, myalgia, and severe headache. Over the past 3 days, he has noticed the development of a widespread rash on his trunk. The rash initially appears faint and …
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Urgent Message: While Bell palsy is the most common diagnosis for patients with unilateral facial weakness/paralysis, it is important for urgent care clinicians to be able to quickly differentiate it from other more serious diagnoses. Keywords: facial palsy; stroke mimic; Bell palsy; central facial weakness; peripheral facial palsy; urgent care evaluation Luke Wisniewski, OMS3; Finley Kocher, OMS3; Muhammad Akhtar, MD Abstract Introduction: Bell palsy is the most common diagnosis for patients with unilateral facial weakness/paralysis …
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Urgent Message: While most pediatric musculoskeletal complaints are usually benign and self-limited, the urgent care clinician must consider more serious underlying causes of pain in the differential diagnosis. Keywords: pediatric osteomyelitis; atraumatic ankle pain; limping child; bone infection; ESR; CRP; MRI diagnosis Erin Loo, PA-C, MHA, FCUCM Abstract Introduction: Pediatric patients commonly present to urgent care (UC) with musculoskeletal complaints. However, a wide differential should be considered, including musculoskeletal injury, synovitis, autoimmune conditions, cellulitis, avascular …
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Urgent Message: Pediatric urgent care providers commonly experience pressure to satisfy parental expectations, which may alter clinical decision making, increase stress levels, and/or impart barriers to administering quality care. Keywords: parental pressure; antibiotic prescribing; shared decision-making; pediatric urgent care; patient satisfaction; clinical decision-making Daniel Moscato, MS, PA-C; Sara Winter, MS, PA-C Abstract Background: Patient-centered care focuses on strengthening patient participation in their own healthcare. Although advantages to such care exist, intended shared decision making between …
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Urgent Message: The prediction model developed for this study suggests that point-of-care ultrasound implementation could have both clinical utility and fiscal viability in an average urgent care center. Future work should validate the prediction model in a real-world urgent care setting. Key Words: point-of-care ultrasound; POCUS utilization; urgent care ultrasound; return on investment; financial modeling; implementation planning John Weissert; Joshua Russell, MD, MSc, ELS, FCUCM, FACEP; Tatiana Havryliuk, MD Abstract Introduction: Point-of-care ultrasound (POCUS) use …
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Do We Need to Manage Presyncope Similar to Syncope? Take Home Point: Patients with unexplained presyncope and syncope in this study had similar rates of serious cardiac outcomes at 30 days following their initial emergency department (ED) visit. Citation: Suh EH, Sacco DL, Winskill C, et al. Serious Cardiac Outcomes and Physician Estimation of Risk in Emergency Department Patients With Presyncope Versus Syncope. Ann Emerg Med. 2025 23:S0196-0644(25)01155-2. doi:10.1016/j.annemergmed.2025.08.014 Relevance: Patients with presyncope and syncope …
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