Practice Management
A 60-year-old male presents to urgent care with progressive dyspnea for 2 weeks associated with lower extremity edema. The patient is afebrile and slightly tachypneic with rales at the bilateral bases. 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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A 28-year-old female presents to urgent care with mild left lower quadrant (LLQ) abdominal pain that began earlier in the day. The discomfort is dull, intermittent, and non-radiating. She denies vaginal bleeding, fever, nausea, vomiting, or urinary symptoms. Her last menstrual period was approximately 2 months ago, although she reports a history of irregular cycles. She appears well and is hemodynamically stable. An abdominal exam reveals mild LLQ tenderness without rebound or guarding. A pelvic …
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A 75-year-old male presents to the walk-in clinic with the chief complaint of an asymptomatic rash on the left temple of his face that developed over the past 2 months. On examination, a shiny deep red papule is visible with scaly macules (actinic keratoses) surrounding. The patient is on rituximab for chronic lymphocytic leukemia (CLL). View the image taken and consider what your diagnosis and next steps would be. Resolution of the case is described …
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Urgent Message: While the initial clinical presentation of a high-pressure paint gun injury may not elicit concern, it is truly high-risk and requires emergent recognition and surgical intervention. Key words: High-Pressure Injection Injury, Paint Gun Injury, Finger Trauma, Pyogenic Tenosynovitis, Occupational Injury, Subcutaneous Paint Infiltration, Finger Compartment Syndrome, Finger Emergency Abstract Introduction: High-pressure injection injuries of the hand are rare but represent true surgical emergencies. Despite often appearing deceptively mild on initial presentation, these injuries …
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An 11-year-old male presents to urgent care complaining of bilateral heel pain, right worse than left. The patient denies recent trauma and reports experiencing increased pain when running. He has not tried any treatment and denies any history of similar episodes in the past. Physical examination reveals bilateral pes planus and decreased dorsiflexion of the feet with weightbearing lunge against the wall. Pain is elicited with calcaneal compression test. The patient is noted to be …
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An 80-year-old male with hypertension and hyperlipidemia presents to urgent care for 1 day of sharp, substernal chest pain radiating to his right arm with associated shortness of breath and diaphoresis. His wife notes that he is often nonadherent with his medications. An ECG is ordered. 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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A 42-year-old woman with widespread scaly lesions presents to urgent care. On exam, the provider noted superficial crusts and exfoliative plaques seen on the face, neck, and chest. The patient reported that the lesions were painful, but she had no systemic symptoms and felt fine otherwise. The rash emerged a couple of months prior. The patient had no recent history of travel or infections and was not currently on any medications. The urgent care took …
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Urgent Message: Across a tristate urgent care and convenient care network, systemic steroid use occurred in nearly one-sixth of encounters (15.5%)—72.5% for likely avoidable indications and 66% for acute respiratory infections. The finding highlights the need to establish systemic steroid metrics to drive stewardship efforts. Paul Hansen, MD; Yang Wang, PhD; Muhammad Naseer, MD Abstract Background: The College of Urgent Care Medicine released a position statement advocating for corticosteroid stewardship best practices in 2022, …
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Urgent Message: Though atraumatic neck pain is a common condition in the urgent care setting, spinal epidural abscess is relatively uncommon and may present without classic symptoms, which makes it a challenging diagnosis to make. Early recognition, timely imaging, and thorough documentation are essential to prevent a devastating outcome and to mitigate medicolegal risk. Key Words: Neck Pain, Spinal Infection, Cervical Epidural Abscess, Spinal Epidural Abscess, Medicolegal Risk, Anchoring Bias Eileen Chu, MD, MS; Lucille …
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Urgent Message: While acute gastroenteritis is typically self-limiting, inappropriate or excessive use of over-the-counter antimotility agents like loperamide can lead to serious complications—such as bowel obstruction or ileus—highlighting the critical need for patient education on safe medication use. Badi Eghterafi, DO; Nazanin Hazhir Karzar, MD Key Words: Gastroenteritis, Over The Counter Medications, Loperamide, Case Report, Bowel Obstruction Abstract Introduction: Acute gastroenteritis (AGE) is a common condition characterized by rapid-onset diarrhea, often accompanied by nausea, vomiting, …
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