Journal of Urgent Care Medicine

A 45-Year-Old Male with Palpitations

The patient is a 45-year-old male who presents with palpitations for the past 30 minutes. He denies chest pain, dizziness, or syncope. His vital signs are normal aside from tachycardia and he appears to be in no acute distress. View the ECG taken and consider what your diagnosis and next steps might be. Resolution of the case is described on the next page.

A 43-Year-Old with a New Rash on the Trunk

A 43-year-old man presents to urgent care with a rash that he noticed a couple of days ago on his trunk. On exam, there is skin atrophy and multiple smooth papules and hypopigmented oval macules. Upon palpation of the lesions, you find that the examining finger “sinks” into a pit with distinct edges, like the ring of a hernia. The patient is immunocompetent, and his medical history is unremarkable except for lichen planus. He patient …

A 16-Year-Old Boy with Arm Pain After a Baseball Game

The patient is a 16-year-old male who presents to urgent care with pain in the humerus area hours after finishing a baseball game. View the x-ray taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.

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 …

The Value of Vitals – Part I

Joshua Russell, MD, MSc, FCUCM, FACEP Recently, a PA I supervise called me about a young woman who came in for hematemesis and melena at home. The provider, let’s call him Tom, told me that the patient had normal vital signs, but he thought she should still go to the ED. I could sense some reluctance in his voice though. It was probably because the patient was just 32 years old and looked well. Understandably, …

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 …

Bullous Pemphigoid Reaction After Second Dose of COVID-19 Vaccine

Urgent message: Throughout the COVID-19 pandemic, unvaccinated people have shown higher rates of morbidity and mortality in comparison with those who are fully immunized. While most vaccination adverse reactions are mild and self-resolving, it is important to consider the timeline of vaccinations to correlate possible adverse reactions. Amanda dos Santos, MD and Michael Pallaci, DO, FACEP, FACOEP INTRODUCTION The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic continues to affect all aspects of our society and …

Abstracts in Urgent Care – October 2022

Ivan Koay MBChB, FRNZCUC, MD Achilles Tendon Rupture Predictive Value of Seamen’s Sign PT and Meniscus Tears Managing ACS in Rural Areas Following Up on Radiology Recommendations Syncope and Motor Vehicle Accidents Surgical vs Nonoperative Management of Achilles Tendon Rupture Take-home point: Surgery at 12 months postinjury was not associated with better outcomes compared with nonoperative treatment of Achilles tendon rupture. Citation: Myhrvold S, Brouwer E, Andersen T, et. al. Nonoperative or surgical treatment of …

A 55-Year-Old Female with 1 Hour of Chest Pain

A55-year-old female presents to urgent care with chest pain that started 1 hour prior. On exam, she appears diaphoretic with normal vital signs. View the initial ECG taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.

A 41-Year-Old with Dorsal Wrist Pain After a Slip-and-Fall

A 41-year-old male presents to urgent care following a slip-and-fall on a wet swimming pool surface. He complains of dorsal/posterior wrist pain. On exam you find soft tissue swelling of the posterior wrist. View the image taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.