Journal of Urgent Care Medicine

A 5-Month-Old with Symptoms Beyond the Presenting Complaint

Urgent message: Treating preverbal children can be challenging under every-day circumstances for pediatricians who know the child and the family. Urgent care providers who may not have the benefit of that history must be especially vigilant for all available signs and symptoms to make diagnoses based on the full scope of the presentation. Michael Weinstock, MD Case Presentation (Please note: The Case Presentation is drawn directly from the treating physician’s notes, without editing or correction, …

Urgent Care Evaluation of Arrhythmias

Urgent message: Initial evaluation of a patient with an arrhythmia in the urgent care setting can be as difficult as it is critical to the patient’s survival—one key concern being sudden cardiac death, which occurs in roughly 328,000 cases annually. Riaz Fabian, DO Introduction Cardiac arrhythmias are a group of conditions in which a patient has an abnormal heart rate or rhythm. They are caused by any disruption of the electrical conduction system of the …

A 3-Year-Old with Lesions on His Thumb

A mother brings her 3-year-old son to urgent care with multiple skin lesions on his thumb, which he frequently sucked for comfort. The grouped configuration of lesions was painful and had developed over the last 5 days to become vesicles. Upon exam, you note that the boy has a nearly healed cold sore on his lip, pain in his wrist, and an elevated temperature. View the photo and consider what your diagnosis and next steps …

A 21-Year-Old Male with Persistent Ankle Pain Following Trauma

The patient is a 21-year-old male who presents with persistent ankle pain 4 weeks after suffering a trauma. He fell while scaling the exterior of his dormitory, trying to gain entry into a second-floor window because he’d locked his keys inside. View the image taken (Figure 1) and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.

Nurse-Only Visits in Urgent Care: An Analysis of Outcomes and Patient Satisfaction Relative to Traditional Care

Urgent message: As shown in an in-house study by one urgent care operator, protocol-driven, nurse-only care of specific presenting complaints may be one way to help curb healthcare spending while not compromising on quality of care or threatening patient-satisfaction scores. Kyle Coon and Brett Whyte, MD Abstract Basic healthcare costs are rising at a staggering and, it’s widely considered, unsustainable rate. As a result, lower-cost alternatives that maintain quality and satisfaction are being explored across …

A 22-Year-Old Man with an Itchy Patch of Skin

A 22-year-old man presents to urgent care with a round, hyperpigmented patch on his arm. He reports that it’s “itchy,” and that it appeared soon after taking a second dose of a sulfonamide he’s taking for a persistent sinus infection. View the photo and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.

An 82-Year-Old Man with Palpitations

An 82-year-old man presents with complaints of palpitations. He denies chest pain, shortness of breath, dizziness, fever, vomiting, or confusion. Upon exam, you find: General: Alert and oriented Lungs: CTAB Cardiovascular: Regular and tachycardic without murmur, rub, or gallop Abdomen: Soft and nontender without rigidity, rebound, or guarding View the ECG and consider what the diagnosis and next steps would be. Resolution of the case is described on the next page.

A 42-Year-Old Man with Thumb Pain After a Fall

A 42-year-old man arrived at your urgent care center complaining of thumb pain a day after taking a fall while skiing. You find that the pain is worse with movement in any direction; in addition, he exhibits limited ability to grip anything using his thumb. View the image taken (Figure 1) and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page. <1–nextpage–> Differential Diagnosis Avulsion …

Boerhaave Syndrome in a 41-Year-Old Female

Urgent message: While Boerhaave syndrome is a rare finding, a relatively high number of cases may present in the urgent care setting. As such, awareness of and vigilance for related symptoms are essential to taking a proper history and, ultimately, early diagnosis of acute, subacute, or chronic Boerhaave syndrome. John Shufeldt, MD, MBA, JD, FACEP, Amber Hawkins, and Carli Nichta, MS4 Introduction Boerhaave syndrome is a spontaneous esophageal rupture indicated in some cases by …

Abstracts in Urgent Care – December 2017

GLENN HARNETT, MD Innovative Rapid Tests Show Promise in Influenza Key point: Novel DIAs and rapid NAATs had markedly higher sensitivities for influenza A and B in both children and adults than did traditional RIDTs, with equally high specificities. Citation: Merckx J, Wali R, Schiller I et al. Diagnostic accuracy of novel and traditional rapid tests for influenza infection compared with reverse transcriptase polymerase chain reaction: a systematic review and meta-analysis. Ann Intern Med. 2017;167(6):394-409. …

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