Practice Management
A 35-year-old male with a history of end-stage-renal-disease (ESRD) presents to urgent care complaining of back pain. The patient missed his dialysis session today because of the pain. An ECG is obtained. View the ECG captured below and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.
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A 15-year-old girl presents to urgent care with complaints of fever, arthralgia, abdominal pain, and a widespread rash that developed over the last 2 days. The patient says that the pain in her knees is severe and debilitating. On examination, the patient has a temperature of 100.3°F (37.9°C) as well as maroon and violaceous, purpuric papules and plaques on the legs, buttocks, and face. Laboratory examination shows elevated erythrocyte sedimentation rate and C-reactive protein, proteinuria, …
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Urgent Message: Abdominal pseudohernia is a rare diagnosis with variable presentation. Urgent care clinicians who are familiar with the condition and its variable presentations can reduce the risk of diagnostic errors and unnecessary or inappropriate diagnostic testing. Berkeley E Prewett, BSA; Stephen V Green, MD; Andrew L Juergens II, MD; Taylor K Ratcliff, MD Citation: Prewett BE, Green SV, Juergens AL, Ratcliff TK. Abdominal Pseudohernia and Urinary Retention Due to Spinal Nerve Root Compression From …
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A 30-year-old woman presents to urgent care with pain in her lower back and pelvis. She denies any injury or accident that might be causing her pain. She has just returned to full-time work after having a baby. An x-ray is ordered. Review the image and consider what your diagnosis and next steps would be. Resolution of the case is described on the following page.
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A 59-year-old male with a past medical history of hypertension presents with dyspnea and pleuritic chest pain in urgent care, and an ECG is obtained. View the ECG captured below and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.
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A 25-year-old man undergoing chemotherapy with cyclophosphamide, vincristine, doxorubicin, and dexamethasone for acute lymphoblastic leukemia arrives in urgent care because he’s developed a painful, burning palmar eruption. On examination, tender, shiny, erythematous papules and plaques were seen on the palms and fingers as well as the soles of his feet. View the image above and consider what your diagnosis and next steps would be. Resolution of the case is described on the following page.
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Urgent Message: Proximal humerus fractures most commonly occur in older patients after a fall and can be sentinel events that offer an opportunity to identify undiagnosed medical conditions or unsafe home environments. Lauren Schuermann, MS4; Shivani Kothari, MS4; W. Bradley Strauch, MD Citation: Schuermann L, Kothari S, Strauch B. Urgent Care Recognition and Management of Proximal Humerus Fractures. J Urgent Care Med. 2024; 19(2): 13-19 Questions for the Clinician at the Bedside Clinical Scenario A …
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Urgent Message: Urethral obstruction can occur due to impacted urinary calculi. This etiology should be considered in patients with known or suspected history of kidney stones who present with urinary retention. Point-of-care ultrasound can be used to evaluate for and confirm this diagnosis in male patients, in whom the phenomenon is most likely. Nicholas Maenza, DO; Jeffrey Darko, MD Citation: Maenza N, Darko J. Urinary Retention Caused by a Urethral Stone Diagnosed with Point-of-Care Ultrasound: …
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Urgent Message: There are no consensus definitions for what defines a “positive” urinalysis in the pediatric population. This secondary analysis of data from a quality improvement project in a network of pediatric urgent care centers used a machine learning approach to determine which variables on urinalysis most strongly predict a subsequently positive urine culture. Kari Flicker, BS; Jessica Parrott, DNP, CPNP-PC, CNE; Tammy Speerhas, DNP, FNP-C; Turaj Vazifedan, DHSc; Theresa Guins, MD; Jeffrey Bobrowitz, MD; …
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Urgent Message: Incorporating questions regarding the use of intravenous drugs may help ensure the diagnosis of puffy hand syndrome is included in the differential for patients presenting with bilateral hand swelling. Citation: Majeed I, VanDyke K. Puffy Hand Syndrome: A Case Report. J Urgent Care Med. 2024; 19 (2): 25-27 Abstract Introduction: Bilateral hand swelling is a common presentation in a variety of conditions, particularly rheumatological disorders. Urgent care (UC) providers can avoid unnecessary testing …
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