Journal of Urgent Care Medicine

Urgent Care Transfers: Why, When, and How

Urgent message: Urgent care is well established as an appropriate destination for many patients whose symptoms are not being limb- or life-threatening. When a truly emergent case presents, however, we need to provide immediate care and assess whether the patient can receive optimal care on site or needs transfer to higher-acuity setting. Deb Rogers, DO and Douglas A. Rund, MD, FACEP, FAEMS Cowboys of medicine? We are able to diagnose and manage almost all complaints …

Injuries to the Upper Extremity Due to Falls on Outstretched Hands (FOOSH)

Urgent message: It is common for patients with injuries to the upper extremity due to falls on outstretched hands to present to urgent care. As such, evaluation, appropriate imaging, and initial treatment should all be within a clinic’s capabilities. Michael Bartuseck, MSN, ARNP, FNP-C, EP-C Introduction Urgent cares centers play an integral role in providing care for patients who have sustained injuries due to falls on outstretched hands (FOOSH). While complex anatomy of the wrist, …

Urgent Care Evaluation of Arrhythmias

Urgent message: Initial evaluation of a patient with an arrhythmia in the urgent care setting can be as difficult as it is critical to the patient’s survival—one key concern being sudden cardiac death, which occurs in roughly 328,000 cases annually. Riaz Fabian, DO Introduction Cardiac arrhythmias are a group of conditions in which a patient has an abnormal heart rate or rhythm. They are caused by any disruption of the electrical conduction system of the …

Approach to the Child with Chest Pain

Urgent message: Chest pain is both more common and, typically, less concerning in children than in adults. If anything, however, this underscores the importance of guarding against a false sense of safety in low-risk causes, and maintaining vigilance for life-threatening etiologies. SABAH F. IQBAL, MD, FAAP and HANSEL OTERO, MD The case: A 12-year-old healthy African-American boy presents to urgent care with 2 days of midsternal chest pain, which is worse when he’s taking big …

Quality Improvement Report: Improving Telephone Follow-Up in an Urgent Care Setting

Urgent message: Follow-up after a patient visit is essential to the continuum of care and to the perception of customer service. Especially in the urgent care setting, where providers may have no ongoing relationship with a patient, the most basic office practices (eg, collecting accurate and accessible contact information) can seem deceptively simple but are of critical importance. Jimmie Toler, MSN, NP-C, Emily E. Johnson, PhD, and Barbara J. Edlund, PhD, ANP, BC Introduction Continuum …

The Red-Hot Joint

Urgent message: Septic arthritis can lead to significant morbidity if not treated in a timely manner. Bacteria within the synovial space can lead to rapid joint destruction and irreversible loss of function. When patients present to the urgent care center with a red, hot, swollen, painful joint, every attempt must be made to rule out this disease entity to prevent significant morbidity and mortality. Introduction Patients frequently present to urgent care with a red, swollen, …

Acute Compartment Syndrome—An Urgent Care Review

Urgent message: Acute compartment syndrome (ACS) is an important high-risk diagnosis to exclude when evaluating peripheral extremity injury. Providers must maintain a high clinical index of suspicion with careful attention to the history and mechanics of injury in an urgent care setting to preclude the devastating, rapidly developing sequela of ACS. Missing a case of ACS may result in significant morbidity—and even mortality. Awareness of both subtle and overt signs will ensure the best care …

Pain in the Hand After Punching a Wall

Case An 18-year-old man presents to an urgent care center with pain at the distal aspect of the metacarpal bone of the little finger. The pain began 2 hours earlier, after he punched a wall. He has pain with range of motion and a minimal amount of numbness in the finger. He reports that he has no other injuries. View the image taken (Figure 1) and consider what your diagnosis would be.

Abdominopelvic Pain, Part 2: Approach to Women in the Urgent Care Setting

Urgent message: Diagnosis of abdominal pain is more complex in women than in men because of the more complex anatomy involved. Using a stepwise approach and involving patients in their care can make a difference. Introduction Part 1 of this article [see “Abdominopelvic Pain, Part 1: Approach to Men in the Urgent Care Setting,” at https://www.jucm.com/abdominopelvic-pain-part-1- approach-men-urgent-care-setting/] explained that finding the cause of abdominopelvic pain can be a difficult task for any health-care provider because the diagnostic process is riddled with important decisions. …