Case Reports

Urgent Message: Accurately identifying psychogenic nonepileptic seizures in the acute care setting helps avoid dangerous and costly medical interventions, such as aggressive antiepileptic drug treatment. Jacob Welch, OMS-4; Logan Hurm, OMS-4; Akul Mitra, OMS-4; Cameron Shoemaker, PGY-2; Michael B. Weinstock, MD Keywords: psychogenic nonepileptic seizures; functional seizure; functional neurological disorder Abstract Introduction: Psychogenic nonepileptic seizures (PNES) mimic epilepsy but lack epileptiform electrical brain activity. In the urgent care setting, prioritizing rapid stabilization often leads to …
Read More

Urgent Message: If not recognized early, herpes zoster oticus may progress to Ramsay Hunt syndrome with facial nerve paralysis. Early antiviral therapy should be initiated, ideally within 72 hours of rash onset, to optimize outcomes. Vishal Prajapati, MBBS Keywords: herpes zoster oticus; Ramsay Hunt syndrome; facial nerve palsy; varicella-zoster virus; otalgia; vesicular rash; antiviral therapy Abstract Introduction: Herpes zoster oticus results from reactivation of varicella-zoster virus within the geniculate ganglion of the facial nerve. When …
Read More

Urgent Message: Dehydration and its associated electrolyte disturbances can precipitate new-onset atrial fibrillation. Recognition of an irregular cardiac rhythm should prompt electrocardiographic evaluation and/or referral to a higher level of care. Morgan Cianciolo, FNP-C, Christina Gardner, DHSc, MBA, PA-C, CAQ-EM Keywords: new-onset atrial fibrillation; dehydration; volume depletion; diarrhea; electrolyte imbalance; urgent care Abstract Introduction: Atrial fibrillation is the most common sustained arrhythmia in adults and is frequently associated with precipitating factors, including systemic illness, metabolic …
Read More

Urgent Message: Most ingested foreign objects pass spontaneously with little risk of complications in adults. However, in cases where patients experience persistent symptoms, escalation to emergency department evaluation may be appropriate. Naun Gutierrez Jr., MSN, FNP-C; Christina Gardner, DHSc, MBA, PA-C Keywords: foreign body ingestion; gastrointestinal foreign body; tongue ring ingestion; radiography; conservative management; urgent care Abstract Introduction: Foreign body ingestion is a clinically important presentation in urgent care, with management guided by object characteristics, …
Read More

Urgent Message: Recurrent or unexplained periorbital ecchymosis (“raccoon eyes”) in an infant should prompt consideration of metastatic neuroblastoma and escalation for appropriate imaging. Alejandro Lopez, BS; Julia Gamache, BS; Ella Weiss, BS; Aaron J. Maki, MD, PhD Keywords: neuroblastoma; metastatic neuroblastoma; periorbital ecchymosis; orbital metastasis; suprarenal mass; pediatric malignancy Abstract Introduction: The presenting symptoms of pediatric neuroblastoma are highly variable. Patients may first present to urgent care for what they perceive as a minor complaint …
Read More