Journal of Urgent Care Medicine

Splenic Laceration

Urgent message: Visceral injury is possible in association with the seemingly minor trauma seen in urgent care, underscoring the importance of remaining alert for “red flag” signs and symptoms and judiciously using advanced diagnostics. Introduction Blunt abdominal trauma occurs in 10% to 15% of injured children.1 History and specifically mechanism of injury, and physical exam are important when a patient presents to the clinic with a suspected blunt abdominal trauma. Usually, injuries to the intra-abdominal …

Acute Rheumatic Fever

Urgent message: Patients with seemingly unusual conditions do present to urgent care, underscoring the need to always take a thorough history for all “red flag” symptoms. LEE A. RESNICK, MD, FAAFP Introduction While the incidence of acute rheumatic fever has declined significantly in developed countries over the last several decades, sporadic cases do still occur. Diagnosis may be difficult due to the non-specific symptoms and the lack of experience with the condition amongst most urgent …

Nasal Polyps

Urgent message: Differential diagnosis and careful attention to signs, symptoms and history are particularly important in management of patients with nasal inflammation. MOHAMMED NOMAN MOHIUDDIN, MD Overview Nasal congestion and sinus symptoms are common urgent care complaints. Recurrent sinusitis, either from allergies or upper respiratory infections is frustrating to patients. Proper evaluation and treatment of underlying predisposing factors will help alleviate symptoms and address the disease process associated with polyps such as those seen in …

Acute Pericarditis

Urgent message: This case underscores the importance of not “anchoring” to a previous provider’s diagnosis and always remembering that medical conditions are dynamic. JOHN J. KOEHLER, MD, and DANIEL MURAUSKI, DO Introduction Acute pericarditis is defined as inflammation of the pericardium that surrounds the heart and the base of the great vessels. The classical presentation consists of chest pain, a pericardial friction rub, and serial changes on electrocardiogram (EKG). Although data on the incidence of …

Sarcoidosis

Urgent message: The key to this case was in the details of the presenting symptoms in the patient history: Alarm symptoms including extreme fatigue and weight loss, which warranted further diagnostic work up. ABRAR KHAN, MD, MBA, REVATHY NAIR, MD, and MARIANN MELICHAREK, MD, FACEP Introduction Sarcoidosis is a multisystem granulomatous disorder of unknown etiology. Most patients with sarcoidosis present to urgent care providers with symptoms such as cough, dyspnea, chest pain, eye pain and/or …

Side Effects of New Weight Loss Medications

Urgent message: With the epidemic of obesity and recent FDA-approval of weight loss drugs, urgent care providers should be on alert for patient presentations related to side effects of these agents. Introduction An estimated 154.7 million Americans over the age of 20 are currently overweight or obese. These Americans are at increased risk of disease, including diabetes mellitus, cardiovascular disease, end-stage renal disease and cancer. If current trends remain unchanged, an estimated $861 to $957 …

Sacral Tumor

Urgent message: Each case—and patient presentation—in urgent care must be evaluated on its own merits. Rare diagnoses are possible and “benign” back pain complaints sometimes are not. HEATHER VARLEY, PA-C, and WILLIAM GLUCKMAN, DO, MBA, FACEP Introduction Each day in the urgent care setting, we are presented with a range of various pain complaints, from headaches, to back pain, to extremity pain. These complaints may be the result of injury, overuse, infection, arthropathy, or have …

Dilute Proparacaine

Urgent message: The use of dilute proparacaine appears to be a safe and cost-effective way to treat the pain associated with many acute corneal injuries. JACQUALINE DANCY, PA-C, MPAS Editor’s Note: This article deviates from our typical case report format to underscore one of the key points for management of eye conditions discussed in this month’s cover story. Introduction Ocular injuries are often painful and can cause significant suffering. Many medical practitioners provide immediate, but …

Erythema Infectiosum

Urgent message: Rashes are common in urgent care and taking a careful patient history is important for proper diagnosis of the underlying cause. ICHHA SETHI, MB,BS, JASKARAN S. SETHI, MB,BS, MIKAYLA SPANGLER, Pharm D, BCPS, and SHAILENDRA SAXENA, MD, PhD Introduction Physicians in both primary care and urgent care clinics encounter facial rash quite frequently. Given the high prevalence and variable number of etiologies, it is important to diagnose these patients appropriately so that they …

Schamberg’s Disease

Urgent message: No definitive treatment is available for this condition but diagnosis is important to reassure patients and avoid unnecessary care. SHAILENDRA K. SAXENA, MD, PHD, MIKAYLA SPANGLER, PHARMD, BCPS, and ARCHANA MIKKILINENI, MD Rashes are a common reason for patients to present to the urgent care clinic. Many require treatment but some do not. Schamberg’s disease is one such rash. Case Presentation A 42-year-old male presented to our clinic with a chief complaint of …