Practice Management
A 53-year-old male butcher visits urgent care for a painful red rash that developed on his hand 3 days prior. There is no history of recent travel, but he accidentally cut himself when processing meat 1 week ago. Exam reveals that the patient is febrile at 100.2° F. Otherwise, his vital signs are within normal limits, and he is well appearing. On dermatologic examination, erythematous vesiculated papules, plaques, and associated edema are visible on the …
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A 55-year-old male with past medical history of alcohol use disorder presents to urgent care with frequent falls. He denies chest pain or shortness of breath. An ECG is obtained. View the ECG and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.
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Urgent Message: Prophylactic antibiotic prescribing for patients with clean lacerations is a common but unnecessary practice. Rates of prescribing did not differ based on type of provider or physician specialty in this study of 20 urgent care centers. Michael Smart, PhD; Jennifer Bush, MSN, APRN, FNP-C/ENP-C Keywords: antimicrobial stewardship; prophylactic antibiotics; laceration repair; urgent care Abstract Background: Oral prophylactic antibiotics for clean lacerations that require suture repair are commonly prescribed when they are unneeded. We …
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Review of Evidence for Links of Autism with Maternal Acetaminophen Use Take Home Point: Existing evidence does not clearly link maternal acetaminophen (paracetamol) use during pregnancy with autism or attention deficit hyperactivity disorder (ADHD) in children. Citation: Sheikh J, Allotey J, Sobhy S, et al. Maternal paracetamol (acetaminophen) use during pregnancy and risk of autism spectrum disorder and attention deficit/hyperactivity disorder in offspring: umbrella review of systematic reviews. BMJ. 2025;391:e088141. doi:10.1136/bmj-2025-088141 Relevance: Recent public discussion …
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Urgent Message: Pediatric after‑hours care clinics experienced a significant rise in radiographically confirmed pneumonia over a 2‑year period, paralleling national increases in Mycoplasma pneumoniae infections. Morgan McBee, MD; Leslie Spence, MD; Jeanne Hill, MD; Leah S. McBee, MD Keywords: pediatrics; community-acquired pneumonia; mycoplasma pneumonia; after-hours care; radiography, thoracic Abstract Introduction: Pediatric community-acquired pneumonia typically occurs at a rate of approximately 20 visits per 1,000 children in the population. Multiple reports and data from the Centers …
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Urgent Message: Careful history and examination are required when assessing patients presenting with rectal pain. Clinicians should maintain a high index of suspicion for accidental foreign-body ingestion when assessing unexplained rectal discomfort. Ivan Koay, MBChB, MRCS, FCUCM, FRNZCUC, MD; Cameron Olphert, BSc (Hons), MSc Key Words: rectal pain; foreign body; proctoscopy; fishbone ingestion; hemorrhoids; gastrointestinal issues Abstract Clinical Presentation: A 50-year-old male with a history of type 2 diabetes mellitus and hemorrhoids presented to urgent …
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A 45-year-old woman presents to urgent care with a persistent productive cough for the past few months. Over the past week, she has noticed more sputum production, which is thick and dark in color, as well as fatigue and dyspnea on exertion. She denies fevers, pharyngitis, abdominal pain, or gastrointestinal upset. She denies tobacco use or occupational exposures to any inhaled chemicals. Physical exam reveals that the patient is afebrile with vital signs within normal …
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A 49-year-old male presents to urgent care with 3 days of progressively worsening fever and a widespread painful rash. He also reports dry mouth and painful lesions on his gums. The patient has a history of acute myeloid leukemia, and he received an allogeneic bone marrow transplant 2 weeks prior to onset of symptoms. Physical examination reveals a fever of 101.3°F (38.5°C), several ulcerated lesions on the buccal mucosa, and a violaceous papular rash to …
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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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