Journal of Urgent Care Medicine

Assessing Patients in the Wake of Motor Vehicle Accidents

Urgent message: Patients presenting to urgent care in the wake of a motor vehicle accident have self-selected their treatment setting. However, it is imperative to maintain vigilance for potentially serious and even life-threatening injuries that may not be apparent. Gloria I. Kim, MD and Jill C. Miller, MD According to the National Center for Health Statistics, motor vehicle accidents (MVAs) accounted for nearly 5 million ED visits in 2006. The diverse injuries may be temporary, …

Common Lacerations of the Head

Urgent message: Effective management of head lacerations starts with hemorrhage control but also requires an understanding of appropriate use of anesthesia, the possibility of closed head or nerve injury, and vigilance for non-accidental trauma. Clayton Josephy, MD, Samuel M. Keim, MD, MS, and Paper Rosen, MD Introduction Laceration repair is a common and important responsibility of physicians in the emergency and urgent care settings. A recent review of national trends in ED visits revealed that …

Toward Ensuring Patient Safety in Urgent Care

Urgent message: Creating a safety culture in the urgent care clinic starts with proper hand washing before even seeing a patient and ends with transitioning care out of the practice – and includes close attention to every detail in between. The second of two parts. Phillip Disraeli MD, FAAFP The Institute of Medicine’s 1998 Report to Err is Human grabbed media attention by estimating that 98,000 deaths each year can be attributed to adverse events …

Toward Ensuring Patient Safety in Urgent Care

Urgent message: As urgent care’s role in the continuum of care continues to evolve, the practitioner must take steps to create a culture that supports proper patient identification, drug safety, and adherence to lab standards. Phillip Disraeli MD, FAAFP In the 1988 report To Err is Human, the Institute of Medicine defined patient safety as “freedom from accidental injury.” The ensuing media coverage focused on the 98,000 deaths that IOM estimated occur each year due …

Management of Hypertensive Urgency in an Urgent Care Setting

Urgent message: Effective management of patients presenting to urgent care with acute high blood pressure starts with differentiating between hypertensive emergency and hypertensive urgency and ends with appropriate treatment and counseling. Sanjeev Sharma, MD, Christy Anderson, PharmD, Poonam Sharma, MD, and Donald Frey, MD Introduction Urgent care physicians routinely encounter patients with high blood pressure, but management – particularly for those patients with precarious elevations – remains controversial. Alternative options involve the use of various …

Evaluation and Management of Lower Extremity Edema

Urgent message: The high specificity but broad range of possible causes associated with a primary complaint of lower extremity edema poses a particular challenge to the urgent care clinician. Proper assessment of the differential diagnoses is the first step toward optimal outcomes, whether they be facilitated by treatment or referral. Michael S. Miller, DO Patients presenting to urgent care with a primary complaint of edema of the lower extremities of any duration can pose a …

Management of Patients Presenting with Constipation

Urgent message: Constipation can be a sign of serious – even life-threatening – etiologies. Once non-benign causes have been ruled out, emphasis should be on evacuation and dietary and lifestyle changes to prevent recurrence. Claire West, MD, Samuel M. Keim, MD, MS, and Peter Rosen, MD Introduction Constipation is a common complaint, accounting for approximately 2.5 million doctor visits annually. With increasing difficulty in obtaining a quick appointment with a primary care physician, more and …

Managing Foot Fractures in Urgent Care

Second in a Two-part Series Urgent message: Acute injuries to the midfoot and hind foot require immediate treatment or emergent referral. Close attention to the location and mechanism of injury at the urgent care site may facilitate efficient care and prevent long-term disability. Phillip H. Disraeli MD, FAAFP In keeping with the tone of part 1 of this two-part series (JUCM, December 2008), this article will discuss the urgent care clinician’s approach to foot fractures …

Managing Foot Fractures in Urgent Care

Urgent message: Acute injuries to the foot often send patients to an urgent care center—though on occasion they don’t present for weeks, or even months, after the injury occurred. Understanding the natural history of untreated fractures in the foot is imperative to positive outcomes. The first in a two-part series. Phillip H. Disraeli MD, FAAFP This article will focus primarily on two aspects of care: 1. Proper management of and follow-up for simple nondisplaced fractures …

Assessment and Initial Care of Fingertip and Nailbed Injuries

Urgent message: Whether required due to a crushing blow or close contact with a sharp surface, proper initial care for fingertip and nailbed injuries is essential to good outcomes and can often be administered in the urgent care setting. Scott M. Zimmer, MD Fingertip injuries are one of the most common conditions seen in urgent care and emergency room settings. From door crush to table saw injuries, the proper initial care is vital in the …