Case A 23-year-old man presents to an urgent care with pain at the distal end of his left clavicle that began the previous day after he fell onto his left shoulder while mountain biking. His pain is constant and sharp and worse when moving his left arm and shoulder. He does not have fever, vomiting, chest pain, shortness of breath, or abdominal pain, and he has no head injury, no head or neck pain, and …
Read MoreAbstracts in Urgent Care – September 2016
SEAN M. McNEELEY, MD The American College of Gastroenterology Publishes New Guidelines for Treating Diarrheal Disease Key point: New guidelines on treating diarrheal disease are available from the American College of Gastroenterology. Citation: Riddle MS, DuPont HL, Connor BA. ACG clinical guideline: diagnosis, treatment, and prevention of acute diarrheal infections in adults. Am J Gastroenterol. 2016;111:602–622. The authors of this report note that the Centers for Disease Control and Prevention reports 47.8 million cases of …
Read More
Midline Neck Mass
Urgent message: Swelling of the neck is a common problem seen in the urgent care setting. Etiologies range from infectious to lymphatic to malignant. If serious conditions are not diagnosed and treated in a timely manner, complications may lead to airway compromise, sepsis, or even death. How this article helps you: alerts you to uncommon presentations of neck masses. Introdution Swelling in various areas of the neck is frequently seen in urgent care centers. Most …
Read More
Abdominopelvic Pain, Part 1: Approach to Men in the Urgent Care Setting
Urgent message: Abdominopelvic pain is one of the most complex issues encountered in the urgent care settings. Clinicians must make evaluations and decisions rapidly, and it is imperative that they make the appropriate diagnosis to prevent negative outcomes. How this article helps you: assists you in detecting potentially life-threatening problems. Introduction Abdominopelvic pain is something that every urgent care provider can relate to. Although urgent care statistics are not readily available, the Centers for Disease …
Read More
Original Research: Early Diabetes Screening in the Urgent Care, Part 1
Urgent message: Undiagnosed type 2 diabetes mellitus affects more than 9 million Americans. This first part of a two-part article focuses on evaluation of diabetes screening for the adult urgent care patient in whom diabetes has not been diagnosed, using effective early disease-detection strategies to reduce the long-term burden of diabetes. How this article helps you: by providing data to assist you in deciding about screening in your center. Introduction There are now more than …
Read More
Facial Papules in an Adult
A 35-year-old man with a history of human immunodeficiency virus presents with smooth, skin-colored pearly papules with central umbilication on his cheeks, chin, and lateral neck. View the image taken (Figure 1) and consider what your diagnosis would be.
Read More
Painful Metacarpophalangeal Joint After a Skiing Fall
A 32-year-old man presents to an urgent care center with pain at the metacarpophalangeal (MCP) joint of the thumb, from an injury sustained the previous week when he was skiing and fell onto his hand with his thumb extended. The patient has pain at the MCP joint with range of motion, but he says that he does not have any numbness. He has no fever, no breaks in the skin, no wrist pain, and no …
Read More
Constipation in a 67-Year-Old Man
A 67-year-old man presents with constipation that has been present for the preceding 2 days. He reports that he has had constipation in the past that resolved with the use of over-the-counter stool softeners, but this therapy has not worked with this episode. He has generalized abdominal pain that was mild initially but increased over the preceding day, which prompted his visit to the urgent care center. He describes the character of the pain as …
Read More
Productive Cough and Chills in an Adult
A 37-year-old woman without a significant past medical history presents after 3 days of a cough that produces yellow sputum with some streaks of blood. She has not checked her temperature but says she has “felt warm” and has some chills. She does have associated shortness of breath, but she reports that she has not had chest pain, leg pain or swelling, sweating, or headache. She has a history of hypertension, and she takes an …
Read MoreUrgent Care 2.0: A Paradigm Shift?
In my last column, I presented ways that urgent care medicine can mature as a discipline and a health-care service. I discussed opportunities for expanding our value in a changing system. This month I suggest that one such opportunity, already in the pipeline, could dynamically augment urgent care’s role in what many consider to be the number one public health crisis: type 2 diabetes. The annual incidence of prediabetes and diabetes in U.S. adults is …
Read More