Journal of Urgent Care Medicine

Is Pain the Fifth Vital Sign? Higher Triage Patient-Reported Pain Score Does Not Predict Increased Admission or Transfer Rates

Urgent message: Efforts to have pain declared a “fifth vital” sign began nearly 25 years ago. Since then, several national accrediting and governmental agencies have taken up the cause of viewing pain as a distinct problem to be addressed as such. However, few data relevant to emergency and urgent care presentations exist. Mark Pruitt, DO, Ya Wen, DO, Michael Pallaci, DO, and Godwin Dogbey, PhD INTRODUCTION Traditionally, there have been four vital signs: temperature, …

A Small Step for JUCM, a Giant Leap for Urgent Care: JUCM’s latest initiative in publishing original research and leading an academic transformation as Urgent Care “comes of age”

Long before the first flowers of the new year bloom, an even earlier indicator of winter’s end manifests itself: teenagers plotting and perseverating over Spring Break plans. Partially a rite of passage and in other ways an early indicator of a youth’s future fate, much can be predicted about an adolescent’s trajectory by their choice of destination and activity during this vernal vacation. Sure, it’s not a perfect science. However, it’s safe to say that …

A 72-Year-Old Female with Lesions on Her Lower Legs

The patient is a 72-year-old woman who complains of multiple skin lesions on her lower legs. She says she first noticed them several months ago, appearing in a net-like pattern, then becoming painful ulcerations, and finally leaving atrophic scars. She is concerned because she had already had several bouts of deep vein thrombosis. View the image taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the …

Rhabdomyolysis in the Urgent Care: An Unexpected Case of Myalgias

Urgent message: Rhabdomyolysis has a wide range of presentations, from asymptomatic to life-threatening. The most dramatic presentation can result in acute renal failure, electrolyte imbalances, and/or disseminated intravascular coagulation (DIC). Jordan Miller, DO, Ari Leib, MD, and Andre Bonnet, DO EPIDEMIOLOGY Approximately 26,000 cases of rhabdomyolysis are reported in America yearly, with 10% to 50% progressing to acute renal failure.1,2 Mortality rates range from 7% to 80% and are higher in patients who develop multiorgan …

A 54-Year-Old Female with Nonproductive Cough and Rhinorrhea

The patient is a 54-year-old female woman who presents to urgent care with a 3-day history of nonproductive cough with associated rhinorrhea. She does endorse some chest pain after coughing episodes, which resolve with NSAIDs. She otherwise denies nausea, vomiting, diaphoresis, or exertional symptoms. Personal medical history is remarkable for hypertension. View the ECG and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.

Bariatric Surgery Complications in the Urgent Care Center

Urgent message: Obesity continues to be a significant health problem in the United States, with more and more patients opting for a surgical solution to their own weight loss challenges. As this trend continues, urgent care providers can expect to see more patients with post bariatric surgery complaints, ranging from the typical and benign to pulmonary emboli, anastomotic leaks, and respiratory failure account. Tracey Quail Davidoff, MD, FCUCM Obesity has become one of the …

Abstracts in Urgent Care

Take a Seat—Your Patients Will Thank You Buddy Taping vs Plaster Casting in Boxer’s Fractures Efficacy of Baclofen in Back Pain Rapid Testing for Gonorrhea and Chlamydia Five- vs 10-day Treatment for Strep Throat A Better Screening Test for ACL Rupture Yijung Russell, MD Sitting During an Encounter Is an Easy Way to Increase Patient Satisfaction Key Point: If a provider sits during an encounter, the patient feels that they care more, listen more, inform …

Urgent Care Is the Best Place for Patients with ‘Hypertensive Urgencies’: Why We Should Stop Sending Patients with Asymptomatically High Blood Pressure to the ED

Most public health campaigns, with a few notable exceptions, have been abject failures. One undeniably successful example, however, has been awareness of the dangers of high blood pressure. As recently as the early 1970s, when the Framingham Study was published, there was still considerable disagreement in the medical community about the risks of untreated hypertension. But in the face of mounting evidence, it soon became clear that persistently elevated blood pressure was dangerous to a …

When Is Tachycardia in a Patient with URI Symptoms a Sign of Something More Serious?

Urgent message: Brugada syndrome is a genetic disorder associated with increased incidence of ventricular tachyarrhythmias and sudden cardiac death. There have been cases associated with fever, viral infections, and pneumonias—all conditions urgent care clinicians treat in abundance. This case report demonstrates how urgent care providers can diagnose a potentially lethal disorder when patients are being seen for febrile illnesses. Kathleen B. Raschka, MD Case Presentation A 55-year-old male with a history of hypertension, hyperlipidemia, and …

A 42-Year-Old Male with a New Symmetrical Rash on His Legs

The patient is a 42-year-old man who presents with a symmetrical rash of palpable purpura on his legs. He also complains of a fever and arthralgia, but denies any headache or neck pain. He also discloses current infection with the hepatitis C virus. View the image taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.