Journal of Urgent Care Medicine

Urgent Care Evaluation for Snakebite Envenomation

Urgent message: Snakebite envenomation is relatively rare, but immediate action upon presentation to the urgent care center—including quick and accurate identification, appropriate care, and sound decisions regarding transfer to the ED—maximize the chance for optimal outcomes. Andrew Vang, DO Introduction Snake venom poisoning is a complex medical emergency that is seen infrequently, but when encountered requires rapid recognition and urgent management. The following discussion will focus on appropriately identifying snakebites from indigenous venomous species in …

Quality Improvement Report: Improving Telephone Follow-Up in an Urgent Care Setting

Urgent message: Follow-up after a patient visit is essential to the continuum of care and to the perception of customer service. Especially in the urgent care setting, where providers may have no ongoing relationship with a patient, the most basic office practices (eg, collecting accurate and accessible contact information) can seem deceptively simple but are of critical importance. Jimmie Toler, MSN, NP-C, Emily E. Johnson, PhD, and Barbara J. Edlund, PhD, ANP, BC Introduction Continuum …

Do the MACRA’ena?

Corny titles aside, MACRA/MIPS is creating a great deal of uncertainty and anxiety among physician practices, and urgent care centers are no exception. I have seen a lot of urgent care news sources, including this journal, referencing the latest updates from CMS (or recent articles published by other organizations), but urgent care-specific analysis is in short supply. I frequently hear colleagues say, “Medicare is such a small percent of my business, it’s just not worth …

Intermittent Abdominal Pain and Vomiting in a Teenager: One More Urgent Cause to Consider

Urgent message: Superior mesenteric artery syndrome should be included in the differential diagnosis in children with abdominal pain and weight loss with rapid increase in linear growth. Ralph Mohty, MS3, and Michael Esmay, MD Introduction Abdominal pain is one of the most common complaints in childhood. A minor self-limited condition such as constipation or viral gastroenteritis is usually the cause, but more serious conditions need further evaluation and management.1 Chronic abdominal pain is a term …

Abstracts in Urgent Care- September 2017

Finding New Pathways that Protect Head Injury Patients Key point: Using an EEG-based biomarker in adult patients has potential benefit. Citation: Hanley D, Prichep LS, Bazarian J, et al. Emergency department triage of traumatic head injury using a brain electrical activity biomarker: a multisite prospective observational validation trial. Acad Emerg Med. 2017;24(5):617-627. Prior studies estimate that traumatic head injury (TBI) accounts for over 2.5 million ED visits annually in the U.S., also revealing that ED …

An 18-Year-Old Woman with Sudden Rash, Vomiting, and Cramping

Case An 18-year-old woman was swimming in the Atlantic Ocean off the coast of Florida when suddenly she experienced a sharp, stinging pain on her arm. That evolved into a severe ache shortly, accompanied by a painful red lesion. She vomited on her way to your urgent care center, and still feels nauseous. She is also complaining of muscle cramps. View the photo and consider what your diagnosis and next steps would be. Resolution of …

Faith Healer: Relieving the Burden of Control

“Grant me the serenity to accept the things I cannot change; courage to change the things I can; and wisdom to know the difference.” I’m not usually one to quote religious text, but this excerpt from the Serenity Prayer resonates. Perhaps the most pointed and overwhelming challenge facing physicians today is the loss of control over our profession. The last three decades have seen dramatic erosion of the status, ownership, and independence of physicians. The …

A 38-Year-Old Woman with Shoulder Pain

Case A 38-year-old female patient presents with acute shoulder pain following a fall on an outstretched arm during a spring skiing vacation. There is a normal appearance to the shoulder, but significant pain even with minimal attempts at range of motion. The clavicle and elbow are nontender. Neurovascular status is intact. View the image taken (Figure 1) and consider what your diagnosis and next steps would be. Resolution of the case is described on the …

The Red-Hot Joint

Urgent message: Septic arthritis can lead to significant morbidity if not treated in a timely manner. Bacteria within the synovial space can lead to rapid joint destruction and irreversible loss of function. When patients present to the urgent care center with a red, hot, swollen, painful joint, every attempt must be made to rule out this disease entity to prevent significant morbidity and mortality. Introduction Patients frequently present to urgent care with a red, swollen, …

An Unexpected Cause of Amenorrhea

Urgent message: The simplest explanation for a mundane symptom may not always reflect the correct diagnosis. Urgent care providers should consider all the possibilities in order to reach the correct conclusion as early as possible, or risk missing a more serious underlying diagnosis. Introduction Sometimes a simple complaint results in a common diagnosis, but other times a rare diagnosis will be discovered. The following case illustrates the importance of considering a wide differential and obtaining …

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