Journal of Urgent Care Medicine

Key Signs and Symptoms of Severe Illness in Urgent Care: Cervical Necrotizing Fasciitis and Necrotizing Mediastinitis

Urgent message: Cervical necrotizing fasciitis and necrotizing mediastinitis may ultimately occur in patients presenting with symptoms of odontogenic infection. While severe illnesses rarely present in urgent care, it is important to establish a prompt diagnosis and implement rapid medical management for these patients, in order to improve survival. Vitoria Regina Nunes Maia, MS and Lindsey E. Fish, MD ABSTRACT Cervical necrotizing fasciitis (CNF) is a rapidly progressive infection that can be fatal. This condition can …

A Cause of Dizziness Not to Be Missed

Urgent message: Most cases of vertigo are benign. This includes etiologies such as benign paroxysmal position vertigo, labyrinthitis, and psychogenic causes. However, there are serious, “can’t miss” etiologies which should be considered during the urgent care evaluation of a dizzy patient. Cody McCoy, DO and Michael Weinstock, MD Citation: McCoy C, Weinstock M. A cause of dizziness not to be missed. J Urgent Care Med. 2023;17(5):13-16. Key words: dizziness, vertigo, disequilibrium, BPPV INTRODUCTION Dizziness presents …

A Common Complaint, an Unlikely Diagnosis: Psoas Abscess in the Urgent Care Center

Urgent message: Psoas (or iliopsoas) abscess, although rare, is a cause of back pain associated with high morbidity and mortality. Proper diagnosis requires the physician to recognize signs in the history and physical examination that are suggestive of a potentially serious spinal condition prompting further workup. Fabrizia Faustinella, MD, PhD and L. Alexandre Frigini, MD Citation: Faustinella F, Frigini LA. A common compliant with an unlikely diagnosis: psoas abscess in the urgent care center. J …

Facial Nerve Blocks in the Urgent Care Center

Urgent message: Often, patients that could safely be treated for lacerations in the urgent care center are referred to the emergency room due to the quest for expediency, or even providers being out of practice with treating such wounds on site during the COVID-19 pandemic. However, doing so contributes to the degradation of acuity in urgent care while delaying care and raising costs. Anesthesia for wound repair can be achieved in many ways, typically with …

The Rising Importance of Urgent Care in the Fight Against the STI Epidemic

Urgent message: After a brief hiatus during the peak of the COVID-19 pandemic, the rate of new sexually transmitted infections has resumed at epidemic rates in the United States. With many specialty STI clinics having closed, urgent care may be better positioned than ever to help curb their spread. Glenn Harnett, MD Citation: Harnett G. The rising importance of urgent care in the fight against the STI epidemic. J Urgent Care Med. 2022;16(3):15-20. Key words: …

Managing Cough Without Codeine in the Urgent Care Setting

Urgent message: Opioid prescribing and opioid-related deaths have risen during the COVID-19 pandemic. Although supported by the CHEST Diagnosis and Management of Cough and NICE COVID-19 guidelines, it is time to reevaluate the appropriateness of using codeine in suppressing cough. Megan Penner, PharmD and Hojung Jang, PharmD Candidate CLINICAL SCENARIO A 54-year-old female with a past medical history of diabetes, hypertension, and depression presents to the urgent care center with congestion, nasal discharge, fatigue, and …

When a Fever is Not a URI: If It’s Not in the Differential, It Won’t Be in the Diagnosis

Urgent message: Fever in patients presenting to UC is often attributable to viral infections, urinary tract infections, otitis media, cellulitis, or pneumonia. When the source is not apparent after the initial evaluation, however, it is important to expand the differential in order to avoid missing less common, serious diagnoses. Samidha Dutta, DO; Caleb Marsh, OMS-IV, UP-KYCOM; Michael Weinstock, MD CASE PRESENTATION A 74-year-old man with a history of Parkinson’s disease and diabetes presented with 2 …

Is It Appendicitis? The Role of Clinical Scoring Systems, Labs, and Diagnostic Imaging

Urgent message: Ultrasound can provide essential data in the urgent care evaluation of suspicion of acute appendicitis. Facilitating a rapid diagnosis allows for immediate and appropriate decisions regarding management. Andrew Alaya, MD, MSc INTRODUCTION Appendicitis is thought to be the result of luminal obstruction due to various etiologies (such as lymph node hyperplasia, coprolites, or parasites) which lead to increased mucus production and bacterial overgrowth. This results in wall tension and eventually necrosis and potentially …

A Legal Quandary: A Diagnosis of Cellulitis…That Isn’t

Michael Weinstock, MD; Gabby Gostigian, MD; and Matthew Delaney, MD Urgent message: Failure to consider subtleties and the context in which a patient presents can lead to insufficient differential diagnoses and missed diagnoses that leave the patient at risk for poor outcomes and the provider at risk for litigation. INTRODUCTION Cellulitis from a wound infection in the urgent care is common, and so is our management: wound care and antibiotics. But consider a scenario in …

Where Should I Refer My Spinal Patient? Outcomes with Orthopedic and Neurosurgeons for Common Neck and Back Procedures

Urgent message: Neck and back pain are common issues preceding surgical intervention. Given differences in care plans, outcomes, cost, and length of stay associated with spinal surgeries, the option of referring urgent care patients to either neurosurgeons or orthopedic spine surgeons requires careful consideration. Rami Musleh, PA-C; Angela Blagojevski, MPAS, PA-C; Randy Brush, MS, PA-C; and Jessica Bruskoski, MS, PA-C INTRODUCTION Neck and back pain are two of the most common reasons for people to …