Journal of Urgent Care Medicine

An Evaluation of Unnecessary Prophylactic Antibiotics For Clean Lacerations

Urgent Message: Prophylactic antibiotic prescribing for patients with clean lacerations is a common but unnecessary practice. Rates of prescribing did not differ based on type of provider or physician specialty in this study of 20 urgent care centers. Michael Smart, PhD; Jennifer Bush, MSN, APRN, FNP-C/ENP-C Keywords: antimicrobial stewardship; prophylactic antibiotics; laceration repair; urgent care Abstract Background: Oral prophylactic antibiotics for clean lacerations that require suture repair are commonly prescribed when they are unneeded. We …

An Uncommon Cause of Rectal Pain: A Case Report of Fishbone Foreign Body

Urgent Message: Careful history and examination are required when assessing patients presenting with rectal pain. Clinicians should maintain a high index of suspicion for accidental foreign-body ingestion when assessing unexplained rectal discomfort. Ivan Koay, MBChB, MRCS, FCUCM, FRNZCUC, MD; Cameron Olphert, BSc (Hons), MSc Key Words: rectal pain; foreign body; proctoscopy; fishbone ingestion; hemorrhoids; gastrointestinal issues Abstract Clinical Presentation: A 50-year-old male with a history of type 2 diabetes mellitus and hemorrhoids presented to urgent …

Wheezing as a Pneumothorax Presentation: A Case Report

Urgent Message: For patients with presumed asthma exacerbation, clinicians must maintain a high index of suspicion for other etiologies, including pneumothorax. This may help avoid delays in potentially life-saving interventions when symptoms persist despite treatment or when physical exam findings are atypical. Badi Eghterafi, DO; Nazanin Hazhir Karzar, MD Keywords: asthma, wheezing, chest pain, pneumothorax, spontaneous pneumothorax Abstract Introduction: Large spontaneous pneumothorax is an uncommon but critical complication in patients with asthma. Clinicians evaluating presumed …

When Bell Palsy Is Actually a Stroke: A Case Report

Urgent Message: While Bell palsy is the most common diagnosis for patients with unilateral facial weakness/paralysis, it is important for urgent care clinicians to be able to quickly differentiate it from other more serious diagnoses. Keywords: facial palsy; stroke mimic; Bell palsy; central facial weakness; peripheral facial palsy; urgent care evaluation Luke Wisniewski, OMS3; Finley Kocher, OMS3; Muhammad Akhtar, MD Abstract Introduction: Bell palsy is the most common diagnosis for patients with unilateral facial weakness/paralysis …

Management of Acute Opioid Withdrawal in a Patient With an Unknown Prescribing History: A Case Report

Urgent Message: Opioid prescribing in urgent care can present difficulties, particularly in patients with an unclear prescription history where added caution is needed. There are a number of ways to reduce the risks associated with opioid prescribing and to initiate the treatment of opioid withdrawal in the urgent care setting. Jacob Mather, BSc MBChB Key Words: Addiction, Opioid Withdrawal, Prescribing, Urgent Care Abstract Introduction: We report a complex case of a 37-year-old woman presenting to …

Leveraging Physician-Patient Relationships to Increase Patient Portal Access During an Urgent Care Visit

Urgent Message: Urgent care physicians can leverage the physician-patient relationship established during a visit to improve patient portal enrollment and use in a healthcare system. Sandy Wang, MD, MPH; Carolyn Stern, MD; Kevin Fiscella, MD, MPH; Amaya Sanders, BS; Erik Herbert, BS; Rosie Booker, BS; Tyra Barton, LPN; Mechelle Sanders, PhD Key Words: Electronic Health Records, Patient Portals, Urgent Care, Quality Improvement Abstract Background: Patient portals for accessing electronic health records are useful for easy …

Chronic Calf Pain and Limp: A Case Report of Pediatric Slipped Capital Femoral Epiphysis

Urgent Message: Pediatric patients frequently present to urgent care with musculoskeletal complaints, but clinicians must remain aware of the less common surgical and medical emergencies that can present with these symptoms. Key Words: Slipped Capital Femoral Epiphysis; Pediatric Limp; Antalgic Gait; Obesity; Urgent Care Diagnosis Abstract Clinical Presentation: A 13-year-old male presented to a pediatric urgent care with the chief complaint of left calf pain for a month that had acutely worsened over the past …

Shortness of Breath in Pregnancy: Differentiating Physiology from Pathology in Urgent Care

Urgent Message: As shortness of breath and edema are common in pregnancy, urgent care clinicians must distinguish patients with normal physiologic changes from those with emergent conditions like venous thromboembolism, hypertension, eclampsia, and cardiomyopathy. John Ramos, MMS, PA-C, CAQ-EM Key Words: Ambulatory Care; Differential Diagnosis; Dyspnea; Pregnancy Complications; Pregnancy Complications, Cardiovascular Abstract Background: Physiologic changes in pregnancy contribute to shortness of breath and edema. However, these symptoms can also be caused by serious etiologies including …

United States Sexually Transmitted Infections: A Comprehensive Overview and Relevance To Urgent Care Centers

Urgent Message: Patients frequently utilize urgent care centers for testing and treatment of sexually transmitted infections. All clinicians can be a first line defense to control the spread and combat the current epidemic. Alexandra Faraj, PA-S; Nadesha Muniz, MS Ed, PA-C Key Words: Sexually Transmitted Infections; Chlamydia; Gonorrhea; Syphilis; Expedited Partner Therapy; Urgent Care Abstract The rise in sexually transmitted infections (STIs) in the United States is a major public health concern. Patients frequently utilize …

High-Pressure Paint Gun Finger Injury: A Case Report

Urgent Message: While the initial clinical presentation of a high-pressure paint gun injury may not elicit concern, it is truly high-risk and requires emergent recognition and surgical intervention. Key words: High-Pressure Injection Injury, Paint Gun Injury, Finger Trauma, Pyogenic Tenosynovitis, Occupational Injury, Subcutaneous Paint Infiltration, Finger Compartment Syndrome, Finger Emergency Abstract Introduction: High-pressure injection injuries of the hand are rare but represent true surgical emergencies. Despite often appearing deceptively mild on initial presentation, these injuries …

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