Journal of Urgent Care Medicine

Evaluation and Management of Ankle Injuries in Urgent Care

Urgent message: Acute ankle injuries can progress to chronic issues. It is essential that the urgent care clinician be aware of the mechanisms of common ankle injuries, their pathophysiology, essential diagnostic tests, and which injuries require transfer for a higher level of care. LISA SCHUERMAN, RN, MSN, APNP Introduction The ankle is one of the most common sites for acute musculoskeletal injuries, with sprains accounting for 75% of ankle injuries. The ankle joint is composed of the tibia, fibula, and talus. …

Analytics and Performance Metrics: The Good, the Bad, and the Ugly

It seems like metrics and analytics are the buzzwords to watch in 2016. Everyone— from health-care administrators to carwash operators—is looking for ways to measure best practices, key business drivers, and employee performance to stand out. Even my beloved Cleveland Browns became the first team in professional football to hire a chief strategy officer to apply analytics in picking players who give the team its best chance of winning. Health care itself is into analytics, …

Sudden-Onset Left-Sided Chest Pain

A 32-year-old man with a history of pneumothorax presents to the urgent care after a sudden onset of left-sided chest pain that started 30 minutes earlier when he was inhaling while smoking a cigarette. He reports shortness of breath, dizziness, and diaphoresis. View the image taken (Figure 1) and consider what your diagnosis would be.

Generalized Abdominal Pain with Nausea

A 67-year-old man presents, reporting constipation that has lasted 3 days. He has a constant, generalized dull abdominal pain that is intermittently worse, occurring in what he describes as waves. He has nausea and reports that he has vomited once. He reports no blood in the urine or stool, and no weight loss, dysuria or urinary frequency, or dizziness. View the image taken (Figure 1) and consider what your diagnosis would be. Differential Diagnoses Small …

Ankle Injury Sustained During an Amateur Football Game

A 25-year-old man presents to the urgent care center after a backyard game of football in which he twisted his ankle. Because of alcohol intoxication, he cannot remember the mechanism of injury. He reports isolated right ankle pain and is unable to bear weight. On physical examination, he has pain with palpation of the ankle, but there are no gross signs of deformity. An ankle x-ray has already been done by the time you see …

Thoracic Pain After a Fall

A 51-year-old man presents to an urgent care center with sharp left thoracic pain that began suddenly after he fell after tripping on a banana peel that had been left on his kitchen floor. He has pain with breathing as well as with range of motion of the chest wall. He reports no head trauma, head or neck pain, fever, vomiting, or dizziness. View the image taken (Figure 1) and consider what your diagnosis would …

Chronic Cough and Shortness of Breath

A 74-year-old man without a significant past medical history presents to an urgent care center reporting 3 days of coughing productive of green sputum, shortness of breath that worsens with exertion, and chills. He says he has a chronic morning cough but states that the sputum has changed color and that his dyspnea has increased. He says he has not had any fever, chest pain, or lower extremity pain or swelling. View the image taken …

Abstracts in Urgent Care: February, 2016

SEAN M. McNEELEY, MD Azithromycin Versus Doxycycline for Chlamydia Key point: Azithromycin is a little less effective than doxycycline for chlamydia. Citation: Geisler WM, Uniyal A, Lee JY, et al. Azithromycin versus doxycycline for urogenital Chlamydia trachomatis infection. N Engl J Med. 2015;373:2512–2521. This study of a population in a youth correctional facility compared the effectiveness of azithromycin with doxycycline in the treatment of chlamydia. A total of 567 participants were randomized to regimens of …

Shin Pain

Urgent message: Lower extremity injuries are very common in adolescent athletes. Urgent care providers must remember that shin pain is not always simply shin splints. CHRISTOPHER TANGEN, DO, and RYAN SHILIAN, DO Also known as medial tibial stress syndrome, shin splints are described as the painful inflammation of the tibial periosteum, which is generally caused by repetitive physical activity.1 Repetitive injuries can cause incomplete fractures, or microfractures, of the tibia. These tibial stress reactions can predispose the bone to acute fractures. Case Presentation …

Urgent Care Management of Geriatric Falls

Urgent message: Falls are a common reason for geriatric patients to present for medical care. In this population, even seemingly minor falls can lead to significant injury, and falls may occur in the first place because of serious underlying medical illnesses. It is critical for the urgent care provider to distinguish which of these patients can be treated in the urgent care setting and which require transfer to a higher level of care. REBEKAH BLICKENDORF, …

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