What are the common conditions, workup, and treatments for patients presenting to urgent care, particularly those with acute respiratory infections, urinary tract infections, minor injuries, or a history of cardiovascular disease?

Common Urgent Care Conditions: Workup and Treatment

Acute Respiratory Infections

For acute upper respiratory infections, antibiotics are NOT indicated unless bacterial complications develop, as 87.5% of URIs are viral in origin. 1

Initial Assessment

• Vital signs: Temperature, respiratory rate, oxygen saturation, blood pressure 2
• Focused examination: Assess for sinus tenderness, pharyngeal exudate, tympanic membrane abnormalities, lung auscultation 1
• Red flags: Respiratory rate >25/min, SpO2 <90%, signs of respiratory distress require immediate escalation 2

Bacterial Sinusitis (Complicating URI)

• Clinical criteria: Symptoms >10 days, severe symptoms (fever >39°C, purulent discharge), or worsening after initial improvement 1
• First-line treatment: Amoxicillin-clavulanate 875mg/125mg PO every 12 hours for 5-7 days 3, 1
• Alternative: Cephalexin or cefaclor for recurrent/chronic cases 1

Streptococcal Pharyngitis

• Indication for antibiotics: Only when Group A beta-hemolytic streptococcus suspected (15% of pharyngitis cases) 1
• First-line: Penicillin for 10-14 days to prevent rheumatic fever 1
• Alternatives: Amoxicillin, oral cephalosporins (cefaclor, cephalexin), or macrolides 1

Critical Pitfall

Patients with recent respiratory infections (within 7 days) have a 2-fold increased risk of myocardial infarction (OR 2.10) and stroke (OR 1.92), regardless of baseline cardiovascular risk. 4 Monitor for chest pain, dyspnea, or neurological symptoms and maintain low threshold for ECG/cardiac workup.

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Urinary Tract Infections

Workup

• Urinalysis with microscopy: Essential for diagnosis 2
• Urine culture: Obtain before antibiotics in complicated UTI, recurrent infections, or treatment failures 2
• Vital signs: Temperature, blood pressure, heart rate to assess for sepsis 2

Treatment

• Uncomplicated cystitis: Amoxicillin-clavulanate 500mg/125mg PO every 8 hours for 3-5 days 3
• Complicated UTI/pyelonephritis: Amoxicillin-clavulanate 875mg/125mg PO every 12 hours for 10-14 days 3
• Severe presentation: Consider IV antibiotics and hospital admission if fever >38.5°C, hemodynamic instability, or inability to tolerate oral intake 2

High-Risk Populations

UTI increases cardiovascular risk 3.3-fold within 14 days of infection in patients with cardiovascular disease history. 5 These patients require:

• Blood pressure monitoring 2
• Assessment for volume status and signs of heart failure 2
• Lower threshold for admission if systolic BP <110 mmHg or signs of decompensation 6

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Minor Injuries

Lacerations

• Assessment: Depth, involvement of underlying structures (tendons, nerves, vessels), contamination level 6
• Wound preparation: Irrigation with normal saline, debridement of devitalized tissue 6
• Closure: Primary closure if <12 hours old (face <24 hours), otherwise delayed closure 6
• Tetanus prophylaxis: Update if >5 years since last dose for contaminated wounds, >10 years for clean wounds 6

Musculoskeletal Injuries

• Ottawa rules: Apply to determine need for radiography in ankle and knee injuries 6
• RICE protocol: Rest, ice, compression, elevation for sprains/strains 6
• Immobilization: Splint suspected fractures before radiography 6

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Patients with Cardiovascular Disease History

Acute Presentations Requiring Immediate Escalation

Any patient with acute heart failure symptoms (dyspnea, orthopnea, peripheral edema) AND respiratory rate >25/min, SpO2 <90%, or systolic BP <90 mmHg requires immediate transfer to emergency department/ICU. 2, 6

Initial Monitoring (All Cardiovascular Patients)

• Continuous: Pulse oximetry, blood pressure, respiratory rate, ECG monitoring 2
• Oxygen therapy: Administer if SpO2 <90% 2
• Assess perfusion: Mental status, urine output, peripheral perfusion 2

Acute Heart Failure Management (If Stable for Transfer)

• Systolic BP >110 mmHg: Furosemide 40mg IV for new-onset HF or 20-40mg IV for known HF 6
• Respiratory distress: Non-invasive ventilation while arranging transfer 2
• Maintain goals: SBP >90 mmHg, SpO2 >90%, adequate peripheral perfusion 2

Hypertensive Emergency

Systolic BP >180 mmHg with end-organ damage (chest pain, dyspnea, altered mental status, visual changes) requires immediate IV antihypertensive therapy and hospital admission. 2

Critical Pitfall

Pneumonia increases cardiovascular event risk 25.5-fold within 14 days, and bloodstream infections increase risk 5.9-fold. 5 Any infection in cardiovascular patients warrants aggressive treatment and close monitoring for decompensation.

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Chronic Disease Patients in Urgent Care

Dialysis-Dependent Patients

These patients must access dialysis within 48-72 hours maximum or face life-threatening hyperkalemia and fluid overload. 7

• Fluid restriction: 500-1000 mL/day if dialysis delayed 7
• Potassium management: Avoid high-potassium foods, consider sodium polystyrene sulfonate 7
• Urgent transfer: Coordinate with functioning dialysis facility immediately 7

Advanced Heart Failure (NYHA Class III-IV)

These patients have marked activity limitation and require uninterrupted access to diuretics, ACE inhibitors, and beta-blockers. 7

• Medication verification: Ensure 7-14 day supply available 7
• Volume status: Daily weights, assess for peripheral edema, pulmonary congestion 2

Immunocompromised Patients

Transplant recipients and cancer patients require uninterrupted immunosuppressant therapy and have extremely high infection risk. 7

• Medication continuity: Priority for securing immunosuppressants within 24-48 hours 7
• Infection threshold: Lower threshold for antibiotics and admission 7