Journal of Urgent Care Medicine

Chest Pain, Bradycardia, and ECG Changes in Acute Cholecystitis

Urgent message: Urgent care clinicians should consider the possibility of cholecystitis when evaluating patients with cardiac symptoms. A delay in diagnosis may lead to serious complications, including sepsis. ALONA D. ANGOSTA, PhD, APRN, NP-C, and BRYAN HOLMES, NREMTP Introduction Patients with acute cholecystitis typically complain of right-upper-quadrant pain that radiates to the right shoulder and back, fever, and leukocytosis.1 The pain may also be associated with nausea or vomiting. However, acute cholecystitis can mimic cardiac …

Repair of Lacerations of the Face and Scalp: Part 1

Urgent message: Management of face and scalp lacerations requires an appreciation of the unique anatomy, sound repair technique, and consideration of patient expectations for cosmesis. TOYIN FAPOHUNDA-ADEKOLA MD, MBA Lacerations of the scalp and face are commonly seen in the urgent care setting. While these injuries can cause anxiety for both patient and practitioner, the basic tenets and techniques for repair are already well known. Following a systematic approach and appreciating the unique anatomic considerations …

The Role of Urgent Care in Reducing Hospital Readmissions

Lee A. Resnick, MD, FAAFP Early outpatient follow-up after hospital admission has been documented to be an important factor in reducing hospital readmission rates. Readmissions are also well known to cost billions of dollars annually. The problem with readmissions spans all socioeconomic classes and impacts all payors, public and private. As of 2013, the CMS began penalizing hospitals for readmissions, thus efforts are being made to limit these rates as much as possible. Numerous studies …

Treating Autistic Patients in the Urgent Care Setting

Urgent message: As the number of patients with autism spectrum disorders continues to increase, it is important that urgent care providers proactively educate themselves about how best to provide acute care for these individuals. ELIZABETH MANGONE and JOHN SHUFELDT, MD, JD, MBA, FACEP A 14-year-old autistic male presents with both parents. The patient is non-verbal and hypersensitive to touch. The parents state that he was stung by a bee and seems to be having respiratory …

A Rational Approach to ‘Suspected’ Ebola Virus Disease in Urgent Care

Lee A. Resnick, MD, FAAFP Fear and anxiety are high in the wake of the first Ebola Virus Disease (EVD) cases on American soil. As with any new, deadly, and transmissible infectious disease, confusion and missteps rule the day. The U.S. public health and disease control entities are certainly not perfect, but the reasonable clinician will see that the ability of these entities to prevent an outbreak is actually quite high. The Disease EVD causes …

Clinical Challenge: November, 2014

The Case This x-ray was taken on a 72-year-old man who presented to urgent care after falling off a step stool while trimming branches. He landed directly on his left shoulder and was unable to lift his arm over his head due to severe pain. He thought his shoulder was dislocated. View the image taken (Figure 1) and consider what your diagnosis would be.

Abstracts in Urgent Care: November, 2014

Generic medication appearance Key point: When providing generic prescriptions, warn patients about generic medication colors and shapes. Citation: Kesselheim AS, Bykov K, Avorn J, et al. Burden of changes in pill appearance for patients receiving generic cardiovascular medications after myocardial infarction: Cohort and nested case–control studies. Ann Intern Med. 2014; 161:96-103. Researchers in this study attempted to determine if changes in color or shape of a generic drug led to discontinuation of that drug. Patients …

Antibiotic Management of Acute Uncomplicated Cystitis and Pyelonephritis in Women

Urgent message: Proper empiric antibiotic treatment in women with acute uncomplicated cystitis and pyelonephritis can prevent unnecessary morbidity and provide urgent relief from these common genitourinary infections. MOZELLA WILLIAMS, MD Genitourinary infections in women are encountered frequently in the urgent care setting. Timely diagnosis and proper empiric antibiotic treatment will usually forestall serious complications and provide speedy relief. Over a lifetime, 50% of women will experience an acute uncomplicated cystitis, also known as a lower …

Clinical Challenge 2: October 2014

The Case This x-ray was taken on a young basketball player with foot pain and no specific injury. View the image taken (Figure 1) and consider what your diagnosis would be.

The Power of Innocence in Medicine

Lee A. Resnick, MD, FAAFP Medicine, from time to time, calls for reflection. The hangover from arduous shifts, the mind-numbing regulatory “whack-a-mole,” the technology treadmill and the career second-guessing, all contribute to an epidemic of lost perspective in our profession. In an effort to manage an avalanche of competing interests, physicians often sacrifice themselves to the point of burnout and self-destructive behavior. Without perspective, these burdens soon overwhelm even the hardiest among us. We become …