Journal of Urgent Care Medicine

Pediatric Urgent Care—Specialized Medicine on the Front Lines

David Mathison, MD, MBA Thirty years ago, there was widespread concern that specialty medicine was “a problem.” Consumers were self-selecting specialty (vs primary) care for routine ailments, thus driving up the cost of healthcare. Without restrictions, consumers could choose neurologists for headaches, orthopedists for ankle sprains, and dermatologists for acne—all very appropriate with complexity, but unnecessary and costly for routine problems. Hence came the dawn of managed care armed with gatekeepers, referral requirements, and …

When Pregnant Patients Present to the Urgent Care Center

Urgent message: Care of the pregnant patient in urgent care can be complex, as every test or treatment needs to take into account both the mother and her unborn child. Conditions which would be considered benign and self-limited in healthy patients take on a different level of concern, and must be managed differently, in the pregnant patient. James Hicks, MD INTRODUCTION There appears to be a wide variety of comfort levels within any particular urgent …

Evaluation of Infectious Conjunctivitis by Clinical Evaluation and Novel Diagnostics

Urgent message: Urgent care is often the first stop for patients experiencing acute eye complaints, including conjunctivitis. The capability to accurately distinguish between infectious conjunctivitis of a viral nature vs that of a bacterial nature is essential to administering appropriate treatment and avoiding inappropriate use of antibiotics. Isabelle Dortonne, MD, Patrizia Colmenares, OD, Trevor Lyford, BA, OSC, and John Sheppard, MD, MMSc INTRODUCTION The vast majority of acute conjunctivitis is viral in nature, with 65% …

An Updated Approach to Toddler Fractures

Urgent message: Toddler’s fractures are a common cause of limp and failure to bear weight in children under 4 years of age. Recent research shows wide variation in management of these stable fractures, favoring a less conservative approach. Amy E. Pattishall, MD The case: A 14-month-old male is brought to your urgent care by his parents immediately after an injury to his right leg at the park. The boy was riding down the slide on …

Repetitive Motion Injuries: Urgent Diagnosis, Patient-Centered Management

Urgent message: Musculoskeletal disorders result in costly, disabling outcomes for Americans—causing significant economic impact (work-related injuries, early retirement, days away from work) and representing a leading cause of chronic diseases nationwide. Frequently, the initial treating facility, which determines if the injured/ill patient is capable of returning to work or needs time away from work or modified duty, is an urgent care center. Ashley Clay, MSPAS, PA-C INTRODUCTION An estimated one in two adults older than …

Top 5 Wilderness Medicine Topics for the Urgent Care Provider

Top 5 Common Causes—and Controversial Conducts—of Heel Pain in Urgent Care

Urgent message: Nontraumatic heel pain is a common presenting complaint in urgent care. Knowing how to accurately diagnose and develop a treatment plan is important, as the course is typically prolonged. Katty Grand-Pierre, MD, CMSS, Frank Ida, BS, EMT-B, and Vincent D’Amore, MD, FACEP INTRODUCTION The heel can absorb 110% of body weight while a person is walking and 200% of body weight during running.1 While the most common cause is plantar fasciitis (PF), accounting …

Suspected Pertussis in Infants and Adolescents—What to do?

Urgent message: Familiarity with the schedule for immunization against pertussis, as well as expertise in diagnosing and prescribing treatment, should be within the urgent care provider’s capabilities—as should the ability to distinguish which patients require transfer to a higher-acuity setting. Ellen Laves, MD Microbiology and Immunity Pertussis is a toxin-mediated disease caused by the gram-negative coccobacillus Bordetella pertussis. Toxins produced by B pertussis impair ciliary clearance of pulmonary secretions through the paralysis of normally …

Initiating PrEP Services in Urgent Care

Urgent message: Urgent care centers may offer opportunities to provide preexposure prophylaxis (PrEP) services for HIV due to large numbers of patients seeking testing and treatment for sexually transmitted infection. In the same sense, the urgent care center may also serve as an important ally in providing referrals for patients not currently linked to primary care services. Yeow Chye Ng, PhD, FNP-BC, NP-C, CPC, AAHIVE, Jack J. Mayeux, MSN, APRN, NP-C, and Thuy Lynch, PhD, …

Postoperative Complications in the Urgent Care Setting

Urgent message: Patients who have had recent surgical procedures may present to urgent care centers for reasons ranging from seeking reassurance to presentation of life-threatening complications. Tracey Quail Davidoff, MD Introduction Patients often experience complications—or, at least as often, fear they’re experiencing complications—after a surgical procedure. While the surgeon is often the best person for them to consult, this may not be possible for a variety of reasons. Outpatient surgical centers are opening almost at …