A patient walks into urgent care with chest pain, a head injury, or a bleeding laceration that looks like it’s straight out of a slasher movie—unsure whether they made the right choice by skipping the emergency room.
Every urgent care clinician has been on the receiving end of those questionable visits: we’re prepared for the wide array of unexpected things that may walk through our clinic door, ready to quickly triage and decide if they can stay or go. We all want to help as many patients as we can with as little inconvenience to them as possible, but knowing when to treat and when to transfer is crucial for patient safety.
Here’s a quick guide to common acute complaints and where they should be seen.
Chest Pain: Send to the ER
Not all chest pain is a heart attack, but we can't afford to miss the ones that are. If the pain is exertional, radiates to the jaw or arm, or comes with shortness of breath, nausea, or diaphoresis, this is a no-brainer automatic ER transfer. Urgent cares aren’t equipped for emergent cardiac workups, and when it comes to myocardial infarction, time is muscle. Unless you are absolutely positive that you can identify a less sinister cause (like GERD, pleurisy, or costochondritis), don’t take any chances. Off to the ER they go.
Lacerations: Urgent Care (Usually)
Most simple lacerations can be cleaned, numbed, and stitched up right in the urgent care. But there are caveats, here’s when to consider a transfer:
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▪️Exposed bone ordeep tissue involvement
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▪️Significant or uncontrollable bleeding
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▪️There’s a need for plastic surgery expertise (think: pediatric facial lacerations with parents voicing cosmetic concerns)
If any of those apply, the ER is the better choice.
Head Injuries: It Depends
Mechanism matters.
If the patient bumped their head on a kitchen cabinet and feels fine, urgent care can handle that. But a fall from height, head trauma with loss of consciousness, repeated vomiting, severe headache, or neurologic deficits? That calls for advanced imaging and observation—send them to the ER.
Also, don’t forget your patients on blood thinners; they need a higher level of care. Brain bleeds can be subtle at first, and we don’t want to miss them.
Abdominal Pain: Know the Red Flags
Some abdominal pain is no big deal—mild indigestion, norovirus cramps? Totally appropriate for urgent care.
But sudden, severe, or localized pain (think RLQ for appendicitis), especially with fever, persistent vomiting, or signs of peritonitis? That’s an ER case. They’ll need an immediate comprehensive workup that you can’t offer in the clinic.
Asthma Exacerbation: Treat in Urgent Care (Unless Severe)
Urgent care is well equipped to handle mild-to-moderate asthma exacerbations with nebulizers, steroids, and monitoring.
But if the patient is struggling to speak, using accessory muscles to breathe, hypoxic, or remains hypoxic despite treatment—get them on supplemental oxygen and call EMS to get them to the ER as soon as possible.
Decisions, decisions!
Many patients aren’t sure where to go when they’re sick or injured, and that’s where we come in.
By recognizing red flags and making quick, informed decisions, we help patients get the right level of care, whether it’s a few steri-strips for a minor laceration or a ride to the ER.
The better we are at triaging common patient complaints, the smoother we can keep both urgent care clinics and emergency departments running—and the better outcomes we get for those who need us most.
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