Urgent Care Management: General Approach
For patients presenting to urgent care, management should focus on rapid assessment of vital signs, identification of life-threatening conditions requiring immediate transfer, and treatment of conditions appropriate for the urgent care setting.
Initial Assessment and Triage
The first priority is determining whether the patient requires emergency department transfer versus urgent care management. Key vital sign thresholds that mandate immediate transfer include:
- Respiratory rate >25 breaths/min 1
- Oxygen saturation <90% 1
- Systolic blood pressure <90 mmHg (signs of shock) 1
- Signs of hypoperfusion (altered mental status, cool extremities, delayed capillary refill) 1
Hypertensive Emergency Recognition
If the patient presents with severe hypertension (BP ≥180/120 mmHg) AND evidence of acute target organ damage (hypertensive encephalopathy, chest pain, shortness of breath, neurological deficits), this constitutes a hypertensive emergency requiring immediate ED transfer for ICU admission 2.
Do not attempt to treat hypertensive emergencies in urgent care—these patients need continuous arterial monitoring and IV antihypertensive therapy 2.
For severe hypertension WITHOUT target organ damage (hypertensive urgency), gradual BP reduction over 24-48 hours with oral agents is appropriate, but avoid short-acting nifedipine due to risk of precipitous drops causing stroke or MI 3, 2.
Common Urgent Care Conditions
For patients appropriate for urgent care management, the most common presentations include 1:
- Upper respiratory infections - symptomatic treatment, assess for bacterial complications
- Urinary tract infections - urinalysis, appropriate antibiotics
- Minor trauma and lacerations - wound care, suturing if within scope
- Musculoskeletal injuries - imaging if indicated, immobilization, pain control
- Acute bronchitis - symptomatic care, avoid unnecessary antibiotics
- Gastroenteritis - hydration assessment, antiemetics if needed
- Allergic reactions - antihistamines, steroids; transfer if anaphylaxis
Critical Pitfalls to Avoid
Never delay transfer for unstable patients. If the patient has any of the following, arrange immediate ED transfer 3:
- Altered mental status or declining neurological exam
- Respiratory distress despite supplemental oxygen
- Hemodynamic instability
- Suspected acute coronary syndrome
- Suspected stroke symptoms
- Severe trauma
Document time of symptom onset for all patients, as this is critical for time-sensitive interventions like thrombolytics 3.
When to Consult or Transfer
Transfer to ED with specialty consultation capability if 3:
- Cardiac conditions: Suspected STEMI, unstable angina, acute heart failure, suspected endocarditis
- Neurological emergencies: Stroke symptoms, severe headache with neurological signs, suspected meningitis
- Surgical emergencies: Suspected appendicitis, bowel obstruction, acute abdomen
Telemedicine consultation can be valuable for borderline cases where specialist input would help determine disposition 3.
Documentation Requirements
For every urgent care encounter, document 3:
- Time last known normal (not just time of arrival)
- Vital signs including oxygen saturation
- Focused physical exam findings relevant to chief complaint
- Medications including anticoagulants and antiplatelets
- Decision-making process for disposition (treat vs. transfer)
This algorithmic approach ensures appropriate triage, treatment of conditions within urgent care scope, and timely recognition of patients requiring higher-level care.