Journal of Urgent Care Medicine

Lumbar Hernia: An Unusual Cause of Back Pain

Urgent message: Back pain is a common complaint in the urgent care setting. Common causes of musculoskeletal back pain include overuse and work-related injury. Other causes can include disc herniation, metastasis, osteoporosis, arthritis, spinal stenosis, and nephrolithiasis. Crystal N. Bharat MD, Ronald Dvorkin, MD, and Glenn G. Gray MD Case Presentation A 65-year-old female complained of 1 day of low back pain radiating to her left flank, which was aggravated with movement. Symptoms began while …

Abstracts in Urgent Care – November 2017

Brain Study Suggests a Link Between CTE and Football—Even Among Youths Key point: A high proportion of deceased players of American football showed pathological evidence of chronic traumatic encephalopathy, suggesting that CTE may be related to prior participation in football. Citation: Mez J, Daneshvar DH, Kiernan PT, et al. Clinicopathological evaluation of chronic traumatic encephalopathy in players of American football. JAMA. 2017;318(4):360–370. This widely referenced JAMA study presents a convenience sample of 202 deceased players of …

Regulatory Creep: An Urgent Care Response

Connecticut Democrats Seek Regulations for Urgent Care Centers. When this alert hit my inbox, I must say it was a bit alarming. Whenever I see “urgent care” and “regulations” in the news it’s unsettling to say the least. I am probably not alone. The regulatory rumblings have come and gone before, but this one has me more concerned. Here’s a little background: Connecticut legislators and the state Department of Public Health (CDPH) have been interested …

Abstracts in Urgent Care October 2017

Validating a Quantitative EEG-Based Brain Function Index Key point: A novel EEG-based point of care, handheld, and noninvasive head injury assessment device, utilizing an index based on EEG measures reflective of concussion, was demonstrated to provide a quantitative index of brain function impairment in mild traumatic brain injury (mTBI). Citation: Hanley D, Prichep LS, Badjatia N, et al. A brain electrical activity (EEG) based biomarker of functional impairment in traumatic head injury: a multisite validation …

Acute Occlusion of the Abdominal Aorta in a Patient with Severe Peripheral Vascular Disease and Untreated Atrial Fibrillation

Urgent message: Acute aortic obstruction should be suspected in all patients with back pain and a history of peripheral vascular disease and atrial fibrillation, as over 50% of these cases are misdiagnosed, resulting in high mortality rates in affected patients. Kristopher Palmer, DO and JM Alderson, DO Introduction Aortic occlusion is a rare but potentially fatal vascular phenomenon that must be considered in all patients with peripheral vascular disease (PVD) complaining of severe pain. Here, …

Clinical Challenge 3: October 2017

A 40-year-old woman visits your urgent care center several days after first noticing a rash of pruritic smooth papules on her trunk and intertriginous areas. She reports that she had been spending a lot of time in the pool with her children before they returned to school. Now she also has a fever and swollen glands, and complains of general malaise. View the photo and consider what your diagnosis and next steps would be. Resolution …

Clinical Challenge 2: October 2017

A 42-year-old woman with a history of anxiety presents, complaining of intermittent palpitations over the past 2 weeks. She says she has not taken any medication and denies chest pain, shortness of breath, diaphoresis, fever, or dizziness. Upon exam, you find: General: Alert and oriented X 3 Lungs: Clear to auscultation bilaterally Cardiovascular: Regular and tachycardic without murmur, rub, or gallop Abdomen: Soft and nontender without rigidity, rebound, or guarding Extremities: No pain or swelling, …

Clinical Challenge: October 2017

The patient is a 25-year-old male who presents with pain over the distal phalanx of the middle finger. He says he hit it with a hammer while hanging a picture frame in his new apartment a short while ago. Pain is evident upon palpation over the distal phalanx of the middle finger, but there are no cuts or breaks in the skin. Neurovascular status is intact. View the image taken (Figure 1) and consider what …

Approach to the Child with Chest Pain

Urgent message: Chest pain is both more common and, typically, less concerning in children than in adults. If anything, however, this underscores the importance of guarding against a false sense of safety in low-risk causes, and maintaining vigilance for life-threatening etiologies. SABAH F. IQBAL, MD, FAAP and HANSEL OTERO, MD The case: A 12-year-old healthy African-American boy presents to urgent care with 2 days of midsternal chest pain, which is worse when he’s taking big …

Doing the MACRA’ena—Part II

In my last column, I tried to explain the complicated math involved in calculating the potential financial impact of MACRA/MIPS on urgent care centers. I made the case for a significant return on investment for a typical urgent care with a typical mix of Medicare patients. Of course, all of the potential return depends on implementation of practical and efficient quality improvement programs that meet the measurement and reporting expectations outlined by the Centers for …