Journal of Urgent Care Medicine

Nonhealing Wounds, Part 1: Diagnosis in the Urgent Care Center

Urgent message: Nonhealing wounds not only are prevalent but also are complex in terms of wound management and treating the accompanying comorbid disease. By both recognizing the diagnosis and understanding how to treat these wounds, urgent care providers have the opportunity to differentiate life-threatening illness from lifeinhibiting disease and improve outcomes for patients. An estimated 6 million people in the United States have a nonhealing wound, with a 1% lifetime incidence for the total population.1,2 This number is expected to increase with the …

Zika Virus—Near Pandemic Proportions?

Urgent message: The clinical manifestations of Zika virus infection are generally mild in adults; the primary concern is the potential link to microcephaly in children of infected pregnant women. There is no cure, so prevention is paramount. MIZUHO SPANGLER, DO, and MICHAEL B. WEINSTOCK, MD Introduction The Zika virus epidemic is gaining a lot of media attention, deservedly so; there have been large outbreaks of infection in Brazil, South America, and the Caribbean, with numbers …

Sudden-Onset Severe Headache

Urgent message: Patients with imminently life-threatening conditions can present to an urgent care appearing to be in good health or even with a viable alternative explanation for their symptoms. It is important to be vigilant for red flags of serious illness. ARASH MIRZAIE, MS4, and MICHAEL WEINSTOCK, MD Headache is one of the most common presenting complaints in ambulatory settings. Urgent care providers must rapidly evaluate and diagnose a variety headache types in a time-limited …

Urgent Care Evaluation of Diarrhea

Urgent message: Diarrheal illness presents with varying degrees of severity and a broad range of etiologies. The urgent care center provider’s ability to gather key information from the medical history and physical examination, determine when laboratory testing is beneficial, and recognize indications for treatment is essential for the effective and efficient treatment of this common symptom. NATHAN M. FINNERTY, MD, and MICHAEL WEINSTOCK, MD Introduction Diarrheal illness is a common presenting complaint to all urgent care centers. In the United …

LITERATURE REVIEW: Early Administration of Azithromycin and Prevention of Severe Lower RTI

Citation: Bacharier LB, Guilbert TW, Maugeret DT, al. Early administration of azithromycin and prevention of severe lower respiratory tract illnesses in preschool children with a history of such illnesses. JAMA. 2015;314:2034-2044. Reviewed by: Michael B. Weinstock, MD Background/question: The authors wanted to know if antibiotics administered early in the course of a respiratory tract infection (RTI) in children with recurrent, severe RTIs decreased progression of disease. Study: This is a randomized, double-blind, placebo-controlled trial at …

A 34-Year-Old Man with Left Side Pain

In Bouncebacks, which appears periodically in JUCM, we provide the documentation of an actual patient encounter, discuss patient safety and risk-management principles, and then reveal the patient’s bounceback diagnosis. This month’s case reflects the actual documentation from an urgent care visit, and the patient’s bounceback the next day to the emergency department. Can you spot the red flags without knowing the outcome? MICHAEL B. WEINSTOCK, MD, and MIZUHO SPANGLER, DO Introduction Apicture tells a thousand …

Shoulder Pain in the Urgent Care

Urgent message: Shoulder pain is not always “just another musculoskeletal complaint.” It may be referred pain indicating life-threatening conditions. Many patients use urgent care centers as sources of primary care. Thus when we make an important diagnosis because of our methodical, stepwise approach to examination, we have the opportunity to be the providers who ultimately expedite diagnosis and care for these patients. MIZUHO SPANGLER, DO, and MICHAEL B. WEINSTOCK, MD Shoulder pain is the third …

The Case of a 32-year-old Woman With Headache

When an Uncommon—Potentially Catastrophic—Diagnosis Is Masked by a Common Complaint In Bouncebacks, which appears quarterly in JUCM, we provide documentation of an actual patient encounter, discuss patient safety and risk management principles, and then reveal the patient’s “bounceback” diagnosis. This Bouncebacks case is unique in that it also went to trial, excerpts from which are also presented. This case is adapted from the Bouncebacks! Medical and Legal (Anadem Publishing) by Michael B. Weinstock, MD, and …

The Case of an 18-Year-Old Male with Hand Pain

Urgent message: A thorough history and physical exam are essential to positive outcomes and risk reduction when managing patients with hand injuries. Michael B. Weinstock, MD and Ryan Longstreth, MD, FACEP Bouncebacks, in which we recount scenarios of actual patients who were evaluated in and discharged from an emergency department or urgent care facility and then “bounced back” for further treatment, appears semi-monthly in JUCM. Case presentations on each patient, along with case-by-case risk management …

A 45-Year-Old Man with Cough and Sore Throat: A Two-Step Approach to Avoiding a Bounceback

Urgent message: The clinician must address unexpected findings with further questions or testing. Michael B. Weinstock, MD and Ryan Longstreth, MD, FACEP This is the first article in a series that will appear every other month in JUCM, in which we will recount scenarios of actual patients who presented to an emergency department or urgent care facility, were evaluated and discharged, and then “bounced back.” Each of these cases is detailed in the book Bouncebacks! …