ABPS Urgent Care cheat sheet

Headache red flags requiring emergent imaging or transfer: thunderclap onset, fever with neck stiffness, focal neurologic deficit, new headache after age 50, or papilledema.

Ottawa ankle rules: obtain radiograph only if there is malleolar-zone pain plus bone tenderness at the posterior edge of the lateral or medial malleolus, or inability to bear weight four steps.

Ottawa knee rules: radiograph if age 55 or older, isolated patellar tenderness, fibular head tenderness, inability to flex to 90 degrees, or inability to bear weight.

McIsaac/Centor score: tonsillar exudates, tender anterior cervical nodes, fever, and absence of cough; test with rapid antigen detection when score is 2 or higher; treat only confirmed group A streptococcus.

Asthma exacerbation: peak expiratory flow 40-69% predicted is moderate, below 40% is severe; give short-acting beta agonist plus ipratropium, systemic corticosteroids, and oxygen to keep SpO2 at 93-95%.

Community-acquired pneumonia: CURB-65 score 0-1 supports outpatient care, 2 suggests short admission or close observation, 3 or more warrants admission; healthy outpatients may receive amoxicillin or doxycycline.

Anaphylaxis: intramuscular epinephrine 0.01 mg/kg of 1:1000 concentration, maximum 0.5 mg, into the lateral thigh; repeat every 5-15 minutes; antihistamines and corticosteroids are adjuncts only.

Cellulitis: nonpurulent infection is treated with cephalexin or dicloxacillin; purulent or systemic illness warrants MRSA coverage with trimethoprim-sulfamethoxazole or doxycycline; mark the border of erythema.

Uncomplicated cystitis: nitrofurantoin for 5 days, trimethoprim-sulfamethoxazole for 3 days when local resistance is below 20%, or fosfomycin as a single dose.

Lidocaine maximum dose is 4.5 mg/kg without epinephrine and 7 mg/kg with epinephrine; a 1% solution contains 10 mg/mL.

Primary closure timing: clean wounds generally up to 12-18 hours, facial wounds up to 24 hours, contaminated wounds 6-12 hours; bite wounds are usually left open except on the face.

Suture removal: face 4-5 days, scalp 7-10 days, trunk and extremities 10-14 days, over joints 14 days.

Abscess incision and drainage: incise over maximal fluctuance, break loculations, irrigate, and pack cavities larger than 2 cm; arrange wound check in 48 hours.

Digital block: inject 2-4 mL of 1% lidocaine without epinephrine at both sides of the base of the digit; current evidence supports epinephrine safety in digits.

Wound irrigation: target 8-12 psi using a 30-60 mL syringe with an 18-19 gauge catheter, and use 50-100 mL of normal saline per centimeter of wound length.

Knee arthrocentesis: use a lateral or medial parapatellar approach with the knee flexed; send synovial fluid for cell count, crystals, Gram stain, and culture.

Corneal foreign body: remove under slit-lamp magnification after topical anesthetic; do not attempt removal of an intraocular foreign body; routine eye patching is not recommended.

Urinalysis: nitrite is highly specific but insensitive; leukocyte esterase is sensitive but nonspecific; both positive with symptoms strongly supports urinary tract infection.

Age-adjusted D-dimer: for patients older than 50, use age multiplied by 10 ng/mL as the cutoff rather than 500 ng/mL; apply only when pretest probability is low or intermediate.

High-sensitivity troponin: serial measurements at 0 and 1-3 hours are required; a single normal value does not exclude myocardial infarction.

HbA1c: diabetes is diagnosed at 6.5% or higher, prediabetes at 5.7-6.4%; confirm with a repeat test unless classic symptoms with random glucose of 200 mg/dL or higher are present.

Rapid streptococcal antigen test: sensitivity about 85-90% and specificity above 95%; a negative result in a child may warrant culture, whereas a negative adult result generally ends testing.

Spirometry: persistent airflow obstruction is a post-bronchodilator FEV1/FVC ratio below 0.70; severity is graded by FEV1 percent predicted.

Blood glucose meter accuracy is generally within 15% of laboratory values; meters are not appropriate for diagnosing diabetes, and HbA1c or fasting plasma glucose should be used.

INR targets: 2.0-3.0 for atrial fibrillation and venous thromboembolism, 2.5-3.5 for mechanical mitral valves.

Tetanus-diphtheria-pertussis booster is given every 10 years; for contaminated wounds, give if more than 5 years have elapsed since the last tetanus dose.

Colorectal cancer screening begins at age 45 and continues through 75 for average-risk adults; options include colonoscopy every 10 years or annual fecal immunochemical testing.

HIV post-exposure prophylaxis after a needlestick should start as soon as possible, ideally within 2 hours and no later than 72 hours, with a 28-day three-drug regimen.

Diabetes screening: adults aged 35-70 with overweight or obesity; repeat every 3 years when results are normal; screen earlier with hypertension, family history, or other risk factors.

Heat acclimatization for new workers takes 5-14 days with gradual workload increases; maintain hydration, scheduled rest breaks, and monitor for heat illness.

DOT drug testing uses a five-panel screen: amphetamines, cocaine, marijuana, opioids, and phencyclidine; split specimens allow confirmation and medical review officer interpretation.

Latent tuberculosis screening is indicated for healthcare workers, close contacts, and immigrants from high-burden countries; interferon-gamma release assay is preferred in BCG-vaccinated individuals.

CLIA-waived tests are simple with low risk of erroneous results; sites need a certificate of waiver, while moderate-complexity testing requires a CLIA certificate and proficiency testing.

OSHA bloodborne pathogens standard requires an exposure control plan, hepatitis B vaccination offered, personal protective equipment, sharps containers, and post-exposure evaluation.

HIPAA breach notification: notify affected individuals without unreasonable delay and no later than 60 days after discovery; breaches affecting 500 or more people also require media notice.

DEA controlled substances: schedule II prescriptions cannot be refilled; schedule III-V prescriptions permit up to five refills within six months of the issue date.

EMTALA: any patient presenting to an emergency department must receive a medical screening examination and stabilizing treatment regardless of insurance or ability to pay.

Vaccine storage: refrigerator range is 2-8 degrees Celsius, freezer range is -50 to -15 degrees Celsius; temperatures are logged twice daily and excursions are reported.

Outpatient antibiotic stewardship: viral upper respiratory infections do not benefit from antibiotics; documented rationale and delayed prescribing reduce inappropriate use.

Headache red flags requiring emergent imaging or transfer: thunderclap onset, fever with neck stiffness, focal neurologic deficit, new headache after age 50, or papilledema.

Ottawa ankle rules: obtain radiograph only if there is malleolar-zone pain plus bone tenderness at the posterior edge of the lateral or medial malleolus, or inability to bear weight four steps.

Ottawa knee rules: radiograph if age 55 or older, isolated patellar tenderness, fibular head tenderness, inability to flex to 90 degrees, or inability to bear weight.

McIsaac/Centor score: tonsillar exudates, tender anterior cervical nodes, fever, and absence of cough; test with rapid antigen detection when score is 2 or higher; treat only confirmed group A streptococcus.

Asthma exacerbation: peak expiratory flow 40-69% predicted is moderate, below 40% is severe; give short-acting beta agonist plus ipratropium, systemic corticosteroids, and oxygen to keep SpO2 at 93-95%.

Community-acquired pneumonia: CURB-65 score 0-1 supports outpatient care, 2 suggests short admission or close observation, 3 or more warrants admission; healthy outpatients may receive amoxicillin or doxycycline.

Anaphylaxis: intramuscular epinephrine 0.01 mg/kg of 1:1000 concentration, maximum 0.5 mg, into the lateral thigh; repeat every 5-15 minutes; antihistamines and corticosteroids are adjuncts only.

Cellulitis: nonpurulent infection is treated with cephalexin or dicloxacillin; purulent or systemic illness warrants MRSA coverage with trimethoprim-sulfamethoxazole or doxycycline; mark the border of erythema.

Uncomplicated cystitis: nitrofurantoin for 5 days, trimethoprim-sulfamethoxazole for 3 days when local resistance is below 20%, or fosfomycin as a single dose.

Lidocaine maximum dose is 4.5 mg/kg without epinephrine and 7 mg/kg with epinephrine; a 1% solution contains 10 mg/mL.

Primary closure timing: clean wounds generally up to 12-18 hours, facial wounds up to 24 hours, contaminated wounds 6-12 hours; bite wounds are usually left open except on the face.

Suture removal: face 4-5 days, scalp 7-10 days, trunk and extremities 10-14 days, over joints 14 days.

Abscess incision and drainage: incise over maximal fluctuance, break loculations, irrigate, and pack cavities larger than 2 cm; arrange wound check in 48 hours.

Digital block: inject 2-4 mL of 1% lidocaine without epinephrine at both sides of the base of the digit; current evidence supports epinephrine safety in digits.

Wound irrigation: target 8-12 psi using a 30-60 mL syringe with an 18-19 gauge catheter, and use 50-100 mL of normal saline per centimeter of wound length.

Knee arthrocentesis: use a lateral or medial parapatellar approach with the knee flexed; send synovial fluid for cell count, crystals, Gram stain, and culture.

Corneal foreign body: remove under slit-lamp magnification after topical anesthetic; do not attempt removal of an intraocular foreign body; routine eye patching is not recommended.

Urinalysis: nitrite is highly specific but insensitive; leukocyte esterase is sensitive but nonspecific; both positive with symptoms strongly supports urinary tract infection.

Age-adjusted D-dimer: for patients older than 50, use age multiplied by 10 ng/mL as the cutoff rather than 500 ng/mL; apply only when pretest probability is low or intermediate.

High-sensitivity troponin: serial measurements at 0 and 1-3 hours are required; a single normal value does not exclude myocardial infarction.

HbA1c: diabetes is diagnosed at 6.5% or higher, prediabetes at 5.7-6.4%; confirm with a repeat test unless classic symptoms with random glucose of 200 mg/dL or higher are present.

Rapid streptococcal antigen test: sensitivity about 85-90% and specificity above 95%; a negative result in a child may warrant culture, whereas a negative adult result generally ends testing.

Spirometry: persistent airflow obstruction is a post-bronchodilator FEV1/FVC ratio below 0.70; severity is graded by FEV1 percent predicted.

Blood glucose meter accuracy is generally within 15% of laboratory values; meters are not appropriate for diagnosing diabetes, and HbA1c or fasting plasma glucose should be used.

INR targets: 2.0-3.0 for atrial fibrillation and venous thromboembolism, 2.5-3.5 for mechanical mitral valves.

Tetanus-diphtheria-pertussis booster is given every 10 years; for contaminated wounds, give if more than 5 years have elapsed since the last tetanus dose.

Colorectal cancer screening begins at age 45 and continues through 75 for average-risk adults; options include colonoscopy every 10 years or annual fecal immunochemical testing.

HIV post-exposure prophylaxis after a needlestick should start as soon as possible, ideally within 2 hours and no later than 72 hours, with a 28-day three-drug regimen.

Diabetes screening: adults aged 35-70 with overweight or obesity; repeat every 3 years when results are normal; screen earlier with hypertension, family history, or other risk factors.

Heat acclimatization for new workers takes 5-14 days with gradual workload increases; maintain hydration, scheduled rest breaks, and monitor for heat illness.

DOT drug testing uses a five-panel screen: amphetamines, cocaine, marijuana, opioids, and phencyclidine; split specimens allow confirmation and medical review officer interpretation.

Latent tuberculosis screening is indicated for healthcare workers, close contacts, and immigrants from high-burden countries; interferon-gamma release assay is preferred in BCG-vaccinated individuals.

CLIA-waived tests are simple with low risk of erroneous results; sites need a certificate of waiver, while moderate-complexity testing requires a CLIA certificate and proficiency testing.

OSHA bloodborne pathogens standard requires an exposure control plan, hepatitis B vaccination offered, personal protective equipment, sharps containers, and post-exposure evaluation.

HIPAA breach notification: notify affected individuals without unreasonable delay and no later than 60 days after discovery; breaches affecting 500 or more people also require media notice.

DEA controlled substances: schedule II prescriptions cannot be refilled; schedule III-V prescriptions permit up to five refills within six months of the issue date.

EMTALA: any patient presenting to an emergency department must receive a medical screening examination and stabilizing treatment regardless of insurance or ability to pay.

Vaccine storage: refrigerator range is 2-8 degrees Celsius, freezer range is -50 to -15 degrees Celsius; temperatures are logged twice daily and excursions are reported.

Outpatient antibiotic stewardship: viral upper respiratory infections do not benefit from antibiotics; documented rationale and delayed prescribing reduce inappropriate use.