Journal of Urgent Care Medicine

Pediatric Urgent Care—Specialized Medicine on the Front Lines

David Mathison, MD, MBA Thirty years ago, there was widespread concern that specialty medicine was “a problem.” Consumers were self-selecting specialty (vs primary) care for routine ailments, thus driving up the cost of healthcare. Without restrictions, consumers could choose neurologists for headaches, orthopedists for ankle sprains, and dermatologists for acne—all very appropriate with complexity, but unnecessary and costly for routine problems. Hence came the dawn of managed care armed with gatekeepers, referral requirements, and …

Abstracts in Urgent Care-November 2019

An Update on Vaccine the 2019-2020 Flu Season Key points: The CDC recommends annual influenza vaccination for everyone 6 months of age and older, with any licensed influenza vaccine that is appropriate for the recipient’s age and health status (IIV, RIV4, or LAIV4) with no preference expressed for any one vaccine over another. All regular dose vaccines are quadrivalent this year. Fluzone (high-dose trivalent vaccine) may provide more protection to those ages 65 and up, …

When Pregnant Patients Present to the Urgent Care Center

Urgent message: Care of the pregnant patient in urgent care can be complex, as every test or treatment needs to take into account both the mother and her unborn child. Conditions which would be considered benign and self-limited in healthy patients take on a different level of concern, and must be managed differently, in the pregnant patient. James Hicks, MD INTRODUCTION There appears to be a wide variety of comfort levels within any particular urgent …

An 11-Year-Old Girl with Red, Itchy Rash

Urgent message: Urticaria from cold exposure should be considered to prevent future anaphylaxis and angioedema with re-exposure. KELSEY REED, MSN, APRN, FNP-C CASE PRESENTATION An 11-year-old girl presents to urgent care with complaints of repetitive episodes of sudden onset of itchy red rash with ill-defined borders which has occurred three times in the past 1.5 weeks following exposure to cold water. Twice, the hives occurred after swimming in a pool and once in a local …

A Teenage Girl Who Suddenly Bruises Easily

A 17-year-old girl presents to urgent care complaining of easy bruising, especially on her legs. She couldn’t recall having any injuries, even minor bumps, that might have caused the red and purple ecchymoses that had appeared. She insisted no one else had caused her harm. She also complained of headache and nausea. A high school student, she was about to complete her final exams and was concerned she would have bruises on her legs during …

A 78-Year-Old with Dizziness and No Chest Pain, Shortness of Breath, or Diaphoresis

The patient is a 78-year-old man who says he has felt dizzy for several hours. He denies chest pain, shortness of breath, or diaphoresis. Upon exam, you find: General: Alert and oriented; breathing comfortably Lungs: Clear bilaterally Cardiovascular: RRR without m/r/g Abdomen: Soft and nontender, no pulsatile mass Extremities: No pain or swelling, pulses normal and equal in all 4 extremities Review the ECG and consider what your diagnosis and next steps would be. …

Abstracts in Urgent Care-October 2019

Report Pulmonary Illness Possibly Involving Vaping to State, Local Health Departments Key point: The CDC is working with state health departments to characterize severe pulmonary disease in patients who use e-cigarettes, also known as vaping. Citations: Centers for Disease Control and Prevention. CDC urges clinicians to report possible cases of unexplained vaping-associated pulmonary illness to their state/local health department. Available at: https://emergency.cdc.gov/newsletters/coca/081619.htm. Accessed September 6, 2019. Caporale A, Langham MC, Wensheng G, et al. Acute …

Evaluation of Infectious Conjunctivitis by Clinical Evaluation and Novel Diagnostics

Urgent message: Urgent care is often the first stop for patients experiencing acute eye complaints, including conjunctivitis. The capability to accurately distinguish between infectious conjunctivitis of a viral nature vs that of a bacterial nature is essential to administering appropriate treatment and avoiding inappropriate use of antibiotics. Isabelle Dortonne, MD, Patrizia Colmenares, OD, Trevor Lyford, BA, OSC, and John Sheppard, MD, MMSc INTRODUCTION The vast majority of acute conjunctivitis is viral in nature, with 65% …

An Unusual Etiology of Chronic Subdural Hematoma: Case Report and Review of the Literature

Urgent message: Absence of an obvious cause of symptoms should not mislead the clinician away from the likely diagnosis based on those symptoms. In this case, for example, the patient was ultimately diagnosed with a symptomatic chronic subdural hematoma associated with repetitive straining secondary to cough and constipation. Joel Kaye, BS, MS4 and Dana Tarina, MD Introduction Chronic subdural hematoma (CSDH) is an encapsulated collection of old blood in the space between the arachnoid membrane …

A 46-Year-Old Obese Man with a Painful Skin Lesion

The patients is an obese 46-year-old man who complains of a painful skin lesion located between folds of skin that were touching each other. He reports looking in the mirror at home and seeing the area was very red and erythematous. He also says sometimes it feels like a burning sensation on his skin. This was most evident after being outside in the hot, humid weather. View the image taken and consider what your diagnosis …