Journal of Urgent Care Medicine

39-year-old Male with Sharp, Nonradiating Chest Pain

History: A 39-year-old male with no known past medical history presents to urgent care for evaluation of several hours of sharp, non-radiating, left-sided chest pain. The pain is non-exertional, non-pleuritic, began after his last meal and resolved without intervention approximately 30 minutes prior to arrival. No history of similar pain in the past. No associated shortness of breath, nausea, vomiting, or diaphoresis. View the ECG taken and consider what your diagnosis and next steps would …

A 55-Year-Old with a Recent History of Rash

A 55-year-old female presents to urgent care with a few weeks of a mildly pruritic rash on her trunk and arms. On examination, there are scattered erythematous, fine, scaly plaques. The coin-like plaques are round or oval in configuration and affect her extremities symmetrically. The patient denies current medications or any personal or family history of dermatologic conditions. She reports no systemic symptoms. However, she shares that she has been taking longer and more frequent …

An 18-Year-Old with Diffuse Abdominal Pain

An 18-year-old male presents to urgent care with widespread abdominal “gas pain” for several days. He denies changes in diet or changes in bowel habits. However, he recalls having a hard collision with another player during a lacrosse game prior to onset of symptoms. View the image taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.

Addressing Without Managing: Defusing the Ticking Time Bombs in Urgent Care

In the world of urgent care, it’s assumed that we exist to provide immediate, episodic care for discrete problems. The sore throat, sprained ankle, and laceration are our bread and butter. However, we do not practice in a vacuum. We share patients with other clinicians who longitudinally follow and manage their multiple comorbidities. Additionally, for the growing number of patients without a primary care provider, we commonly serve as the sole point of contact with …

Knee Immobilization for Acute Knee Injuries: A Review

Urgent message: Immobilization following acute knee injury occurs more commonly than the evidence might dictate in urgent care and other acute care settings. Evaluation of data in existing literature suggest that this common practice carries risk for adverse effects when not warranted. Matthew Bruce Baird, MD, CAQ-SM; Mallory Shasteen, MD, CAQ-SM; and Vicki Nelson, MD, CAQ-SM. Citation: Baird MB, Shasteen M, Nelson V. Knee immobilization for acute knee injuries: a review. J Urgent Care Med. …

Abstracts in Urgent Care – May 2022

Immobilizing Ankle Fractures Treating Septic Olecranon Bursitis EKG Interpretation: Human vs Machine preHEART Score and Prehospital Care Rethinking Otitis Media Management Boosters Limit Risk for COVID—but by How Much? Ivan Koay MBChB, FRNZCUC, MD Casting vs Bracing for Ankle Fractures Take-home point: Plaster casting was not superior to functional ankle bracing for certain ankle fractures. Citation: Kearney R, McKeown R, Parsons H, et al. Use of cast immobilisation versus removable brace in adults with an …

<strong>What Is the Acceptable Miss Rate for a Major Adverse Cardiac Event (MACE)? </strong><strong>A Follow-Up Survey After Release of the American College of Emergency Physicians (ACEP) Clinical Policy on Acute Coronary Syndromes</strong>

What Is the Acceptable Miss Rate for a Major Adverse Cardiac Event (MACE)? A Follow-Up Survey After Release of the American College of Emergency Physicians (ACEP) Clinical Policy on Acute Coronary Syndromes

Urgent message: Previously JUCM-published research revealed that even very low risk for a major adverse cardiac event left clinicians uncomfortable with discharging patients per 2018 ACEP guidelines. What can be learned from a follow-up study reflecting the updated version? Rebekah Samuels, OMS-III; Francesca Cocchiarale; Samidha Dutta, DO, PGY-3; Jarryd Rivera, MD; Amal Mattu, MD; Michael Pallaci, DO; Paul Jhun, MD, FAAEM; Jeff Riddell, MD; Cameron Berg, MD; and Michael Weinstock, MD. Citation: Samuels R, Cocchiarale …

A Case of Late-Onset Diabetes

Urgent message: Previously undiagnosed diabetes in elderly patients is too frequently a precursor to the diagnosis of pancreatic cancer. Incidental and unexpected diagnosis of diabetes in older patients in urgent care, especially in normal or underweight individuals, should prompt a discussion about vigilant monitoring for other symptoms of malignancy and close follow-up with a primary care provider. Joshua Russell, MD, MSc, FCUCM, FACEP CASE PRESENTATION A 72-year-old woman with a history of hypertension presented to …

A 10-Year-Old with Fever, Headache, Muscle Aches, Nausea—and a Suspicious Rash

The patient is a 10-year-old girl who presents to urgent care with 3 days of fever, headache, muscle aches, nausea, and a skin rash. She has a temperature of 102°F. On examination you find numerous erythematous macules and purpura on her palms and the soles of her feet. The patient is immunocompetent with an unremarkable medical history. Her mother recounts no recent travel from their home in North Carolina, but notes that the patient spent …

A 35-Year-Old with a Persistent, Frequent Cough

The patient is a 35-year-old woman who presents with a frequent, light cough of several months’ duration. Her medical history is unremarkable, including no history of COVID-19. She is a former “social smoker” who worked out on a treadmill sporadically before the cough began. View the image taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.