Journal of Urgent Care Medicine

Poisoning of a Child Because of an Older Sibling’s Habit

Urgent message: Be aware of new fads and habits that are growing in popularity. Some of them can result in life-threatening symptoms and serious permanent health consequences. Introduction Vomiting is a common presentation in the urgent care setting, especially in the pediatric population. With children, health-care providers must start with a comprehensive differential diagnosis because of the difficulty in obtaining accurate information directly from the patient. The medical history, often presented by the parent, must be carefully sorted through for clues to a …

Pelvic Pain, Dysuria, and Back Pain in an Adolescent Female

Urgent message: Adolescent patients present to urgent care facilities with unique needs and diagnoses. It is imperative that those who care for them be familiar with some of these diagnoses and keep in mind the importance of obtaining a full and accurate medical history and performing a thorough physical examination. Introduction Adolescent patients can represent unique challenges for health-care providers. In caring for them, providers must work from a broad differential, including diagnoses common to …

Ocular Arteriovenous Malformation Manifesting as Proptosis

Urgent message: Proptosis may be caused by a variety of vascular, infectious, endocrine, and neoplastic diseases that may threaten vision or cause serious systemic complications or death. Providers should be familiar with causes and work-up, including which findings suggest a need for immediate imaging and consultation. ARMIN GOLLOGLY, MD, BRIAN ZIPSER, MD, WENDY HUANG, MD, FAAO, FAAP, CHRISTOPHER M. FECAROTTA, MD, FAAO, FAAP, FCPP, AND MARK RICHMAN, MD, MPH Introduction This report describes a case of unilateral proptosis due to …

Sore Wrists with Soft-Tissue Hypertonicity and Swelling

Urgent message: It is important for urgent care providers to be able to recognize the lesser-known arthritides as causes of acute joint pain and to recognize their specific manifestations on x-rays. Further work-up is warranted because some of these diseases can be associated with various metabolic disorders. MAY MOHTY, MD, FAAP, FAAUCM, and HAMILTON WHITE, MS4 Introduction The deposition of calcium pyrophosphate dihydrate crystals in and around joints is called CPPD (calcium pyrophosphate dihydrate deposition) disease. This condition manifests in a variety …

Shin Pain

Urgent message: Lower extremity injuries are very common in adolescent athletes. Urgent care providers must remember that shin pain is not always simply shin splints. CHRISTOPHER TANGEN, DO, and RYAN SHILIAN, DO Also known as medial tibial stress syndrome, shin splints are described as the painful inflammation of the tibial periosteum, which is generally caused by repetitive physical activity.1 Repetitive injuries can cause incomplete fractures, or microfractures, of the tibia. These tibial stress reactions can predispose the bone to acute fractures. Case Presentation …

Sudden-Onset Severe Headache

Urgent message: Patients with imminently life-threatening conditions can present to an urgent care appearing to be in good health or even with a viable alternative explanation for their symptoms. It is important to be vigilant for red flags of serious illness. ARASH MIRZAIE, MS4, and MICHAEL WEINSTOCK, MD Headache is one of the most common presenting complaints in ambulatory settings. Urgent care providers must rapidly evaluate and diagnose a variety headache types in a time-limited …

Rocky Mountain Spotted Fever: Dermatologic Manifestation of a Life- Threatening, Systemic Disease

Urgent message: Obtaining a detailed medical history is paramount for the early detection and treatment of Rocky Mountain spotted fever. Failure to acquire adequate patient information can lead to misdiagnosis and delayed treatment of this potentially life-threatening disease. WHITNEY CRAMER, PA-C Many dermatologic conditions such as rashes and eczema are encountered by urgent care providers on a daily basis. Often these conditions are diagnosed as contact dermatitis or are misdiagnosed, or the patient is referred …

Palatine Mass: Physiologic or Pathologic?

Urgent message: Urgent care physicians often encounter patients with masses in the mouth. If they are aware of the existence of toripalatinus and know how to treat them, they can reassure patients who may mistake this benign, congenital bony growth for cancer. JOSHUA WILSON, MS3, and SHAILENDRA SAXENA, MD, PhD Introduction Urgent care and primary-care physicians often must evaluate masses within the mouth. These masses commonly originate from the submandibular or sublingual gland, but a …

Mixed Martial Arts Injuries

Urgent message: Because typical participants in mixed martial arts are young and healthy, many present to urgent care settings with a clear musculoskeletal injury and no other medical problems. Do not be distracted by the most obvious injury. Injuries from atypical mechanisms of injury are common in mixed martial arts and should be considered when evaluating a patient who has sustained injuries while participating in the sport. DEENA R. ZIMMERMAN, MD, MPH, IBCLC; NAHUM KOVALSKI, …

Soft-Tissue Infection Due to Vibrio parahaemolyticus and Aeromonas hydrophila

Urgent message: Failure to recognize and treat the early development of skin and soft-tissue infection from a stingray envenomation may result in significant tissue necrosis and systemic inflammatory response syndrome. WILLIAM A. WOOLERY, DO, PhD, MS, MBA, FACOFP Stingray injuries to humans are very common but rarely fatal. Approximately 2000 cases are reported annually in the United States.1–3 At my rural hospital on the west coast of Florida, we see an average of 45 such …