Journal of Urgent Care Medicine

A 32-Year-Old with Fever, Cough, Arthralgia, and Photophobia

A 32-year-old immunocompetent male presents with fever, cough, arthralgia, and photophobia for a few days. On examination, he had a temperature of 100°F (37.8°C) and conjunctival injection. There was a widespread erythematous macular rash on his wrist. When asked about travel, the patient mentioned that he recently visited his family in the Dominican Republic. During his travels, he drank local water and sustained a few mosquito bites. His symptoms began approximately 4 days after his …

A 42-Year-Old with Swelling After a Kick to the Face

The patient is a 42-year-old male who presents with nose and facial swelling after being kicked in the face while wrestling with his teenage son. View the images taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.

STIs Are Epidemic in the U.S.—but How Many of Those Patients Are Going to Urgent Care?

If you read this issue’s cover article on how important urgent care is in fighting the current surge of sexually transmitted infections in the United States, you know that we are in the midst of an STI epidemic. (And if you didn’t read it, you should turn to page X to do so after you’re done here.) Sure, there have been demographic shifts in healthcare preferences; more Americans than ever (especially in the younger …

Managing Cough Without Codeine in the Urgent Care Setting

Urgent message: Opioid prescribing and opioid-related deaths have risen during the COVID-19 pandemic. Although supported by the CHEST Diagnosis and Management of Cough and NICE COVID-19 guidelines, it is time to reevaluate the appropriateness of using codeine in suppressing cough. Megan Penner, PharmD and Hojung Jang, PharmD Candidate CLINICAL SCENARIO A 54-year-old female with a past medical history of diabetes, hypertension, and depression presents to the urgent care center with congestion, nasal discharge, fatigue, and …

Which ED Referrals Are Appropriate? The Problem of Perspective

Joshua Russell, MD, MSc, FCUCM, FACEP I didn’t want to send her to the ER, but what else could I do? Mrs. C was a gaunt 72-year-old Chinese-American woman who had never been to our clinic before. Her son carried her in at 7:56 pm like a bride across the threshold. “She cannot walk,” he said, startling the MA sitting at the front desk. “Has she been seen here before?” our MA asked …

Mysterious Skin Lesions in a Horse Trainer

Urgent message: Medical histories can help inform diagnosis, but clinicians must ensure their decisions are not swayed by erroneous historical elements or cognitive biases. Candace Walkley, MD and Kyle Swanson, OMS-3 INTRODUCTION Staphylococcus aureus and Streptococcus pyogenes may cause acute and inflammatory infections of the soft tissue in immunocompetent patients. However, patients with indolent and progressive lymphocutaneous infections should be evaluated for atypical bacterial and fungal pathogens. CASE PRESENTATION In March 2021, a 57-year-old healthy …

Code Case Files: An Established Adult Male Patient with 2 Days of COVID-Like Symptoms

Bradley L. Laymon, PA-C, CPC, CEMC PRESENTATION A 47-year-old established male patient presented after 2 days of COVID-like symptoms (fever >100.5°F, cough, headache). Symptoms were mild and constant. He denied chest pain, shortness of breath, abdominal pain, rash, dizziness, and nausea/vomiting/diarrhea. He reported trying to alleviate the symptoms with acetaminophen and guaifenesin, with minimal relief. He has no known allergies The patient, who had never tested positive for COVID-19, acknowledged recent exposure to a colleague …

A 16-Year-Old Female with Neck Pain After Swallowing

The patient is a 16-year-old female with right-side neck pain after inadvertently swallowing a chicken wing. She has not eaten and has imbibed minimal fluids for more than 24 hours. 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.

An Unusual Case of Third and Fourth Metacarpophalangeal Joint Dislocations Following a Fall

Urgent message: Metacarpophalangeal dislocations involving digits other than the thumb or index finger may be somewhat atypical, but are known to occur as a result of a fall on an outstretched hand—a common precedent to an urgent care visit. Familiarity with management of such injuries precludes the need to refer the patient. Leonard A. Powell, DO, MS, FACOFP, CMD and Chad E. Richmond, DO ABSTRACT Metacarpophalangeal (MCP) joint dislocations typically occur in a dorsal fashion …

The Value of Repeat Vital Signs

Joshua Russell, MD, MSc, FCUCM, FACEP I’m just going say it: we should repeat vital signs more often in urgent care. But from the odd looks I get whenever I work with a new medical assistant, I realize that asking for vitals to be rechecked isn’t common practice among my colleagues; it may even be frankly contrarian. So, before I lose you, I’ll concede that one set of vital signs is more than enough for …