Journal of Urgent Care Medicine

Spontaneous Pneumothorax

Urgent message: In patients with chest pain, check chest films carefully to avoid missing an uncommon diagnosis. Joseph Toscano, MD Introduction The traditional differential diagnosis for chest pain includes spontaneous pneumothorax. Chest x-ray is necessary for confirming the diagnosis, and sometimes the findings can be subtle. As in dealing with any infrequently encountered condition, clinicians should consider the diagnosis and closely examine every chest film they order to avoid missing this uncommon diagnosis. Case Presentation …

A 9-year-old Boy with Respiratory Symptoms

Urgent message: ‘Fresh eyes’ may be needed to reconsider an initial diagnosis or re-evaluate treatment in patients who present with unresolved symptoms. Joseph Toscano, MD The Case A 9-year-old boy presented to an urgent care clinic with a several-day history of dry cough and intermittently noisy and difficult breathing, especially at night. He had no fever or chest pain, no nasal discharge or headache, and no rash or pruritis. His past medical history included no …

Treating Common Upper Respiratory Tract Infections in an Era of Increasing Antibiotic Resistance

Urgent message: Thorough evaluation and thoughtful prescribing can help ensure responsible, effective care and patient satisfaction. Joseph Toscano, MD Introduction Upper respiratory tract infections (URTIs) are among the most common reasons patients seek assistance in urgent care practice. The common cold, otitis media, acute sinusitis, and acute pharyngitis are well known to patient and provider alike. Acute bronchitis is a lower respiratory tract infection, with features similar to URTIs. These infections are most often self-limited …

Minor Traumatic Brain Injury: Applying the Evidence to Urgent Care

Urgent message: While few data specific to the urgent care setting exist, applying the medical evidence gleaned from other acute care settings can enable the clinician to effect positive outcomes in patients presenting with symptoms indicative of minor TBI. Joseph Toscano, MD Head trauma is among the most important problems evaluated in acute-care medicine. Estimates from the Centers for Disease Control and Prevention indicate that each year in the Unites States, approximately 1.4 million individuals …

Understanding Clinical Decision Rules Regarding Minor Traumatic Brain Injury

Urgent message: Patients with minor traumatic brain injury can be difficult to assess. Identifying those at risk for poor outcomes is critically important in the urgent care setting. Joseph Toscano, MD The term traumatic brain injury (TBI) describes various injury patterns that result from force being absorbed by the brain after a rapid acceleration or deceleration or head impact. TBIs can span a spectrum from minor changes to fatal catastrophes and can affect patients in …