Journal of Urgent Care Medicine

Ramsay Hunt Syndrome—Early Recognition of Herpes Zoster Oticus in Urgent Care: A Case Report

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 …

New-Onset Atrial Fibrillation Triggered by Diarrhea-Induced Dehydration: A Case Report

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 …

Accidental Tongue Ring Ingestion: Balancing Caution and Conservative Management in Urgent Care

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, …

An Infant with Neuroblastoma Presenting as Intermittent Eye Bruising: A Pediatric Case Report

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. …

Peripheral Neuropathy Induced by Nitrous Oxide Misuse: A Case Report

Urgent Message: Nitrous oxide-associated peripheral neuropathy may present similarly to Guillain-Barré syndrome, and clinicians are encouraged to conduct a careful clinical assessment of patients with neurological symptoms. Ivan Koay, MBChB, MRCS, FCUCM, FRNZCUC, MD; Cameron Olphert, BSc (Hons), MSc Keywords: nitrous oxide toxicity; vitamin B12 deficiency; peripheral neuropathy; myeloneuropathy; Guillain-Barré syndrome; paresthesia Abstract Introduction: Although often regarded as “safe,” repeated exposure to nitrous oxide can result in serious neurological sequelae, most notably functional vitamin B12 …

Occult Presentation of Necrotizing Fasciitis With Subtle Clinical Findings: A Case Report

Urgent Message: Necrotizing fasciitis may present without visible soft tissue abnormalities. Therefore, clinical signs and symptoms—including localized pain and tachycardia—are findings that should warrant further clinical investigation. Abstract Introduction: Necrotizing fasciitis (NF) is a severe, rapidly progressing soft tissue infection. Early NF may present to urgent care without visible soft tissue abnormalities. As such, clinical signs and symptoms, including localized pain with tachycardia, should warrant further clinical investigation. Case Presentation: A 43-year-old male presented to …

Recognizing and Managing Adrenal Crisis in Urgent Care: A Case Report

Urgent Message: Adrenal crisis is uncommon in the urgent care setting, but it can be rapidly fatal if diagnosis is missed. Early administration of hydrocortisone and fluid resuscitation with correction of electrolyte abnormalities are essential to reduce mortality. Clayton R. Halford, PA-C Keywords: adrenal crisis; adrenal insufficiency; Addison disease; hypoglycemia; hyperkalemia; pediatric endocrine emergency Abstract Introduction: Adrenal (Addisonian) crisis is a rare but life-threatening endocrine emergency that can present to urgent care with nonspecific symptoms. …

Behçet Disease: Atypical Presentation in a Non-Endemic Geographical Region

Urgent Message: Behçet disease may present atypically in non-endemic regions, and ocular involvement requires urgent specialty evaluation to prevent irreversible vision loss. James McClellan, BS; Kimberly M. Rathbun, MD, PhD, MPH Keywords: vision loss; retinal vasculitis; panuveitis; Behçet disease; branch retinal artery occlusion; branch retinal vein occlusion Abstract Introduction: Behçet disease is a multisystemic inflammatory disease affecting large, medium, and small blood vessels that has an unpredictable and recurrent pattern. Behçet disease has a wide …

When a Headache is the Worst-Case Scenario: A Case Report of Glioblastoma

Urgent Message: While most headache presentations are not life-threatening, urgent care providers must remain vigilant in identifying patients with potentially serious conditions who require transfer to a higher level of care. Elizabeth Minchau, DNP, APRN-BC; Saira George, MD; Stephanie Rellick, PhD; Carmen N. Burrell, DO Keywords: headache; glioblastoma; aphasia; hypertension; personality changes; brain mass Abstract Introduction: Patients often present to urgent care (UC) clinics for headaches. While most headaches are non-life-threatening, the urgent care provider …

Brugada Syndrome in the Urgent Care Center: A Case Report

Urgent Message: Brugada syndrome may present with subtle electrocardiogram findings, and clinicians must recognize the pattern promptly to help prevent sudden cardiac death. Katherine Quinn, MS IV; Eric Mast, DO; M. Drew Mattin, MS IV; Todd Fredricks, DO, MSS Keywords: sudden cardiac death; Brugada syndrome; Brugada pattern; ventricular fibrillation Abstract Introduction: Syncope in young, otherwise healthy individuals is often attributed to benign causes but can occasionally signal life-threatening cardiac conditions. Brugada syndrome (BrS), a rare …

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