Journal of Urgent Care Medicine

Acute Occlusion of the Abdominal Aorta in a Patient with Severe Peripheral Vascular Disease and Untreated Atrial Fibrillation

Urgent message: Acute aortic obstruction should be suspected in all patients with back pain and a history of peripheral vascular disease and atrial fibrillation, as over 50% of these cases are misdiagnosed, resulting in high mortality rates in affected patients. Kristopher Palmer, DO and JM Alderson, DO Introduction Aortic occlusion is a rare but potentially fatal vascular phenomenon that must be considered in all patients with peripheral vascular disease (PVD) complaining of severe pain. Here, …

Intermittent Abdominal Pain and Vomiting in a Teenager: One More Urgent Cause to Consider

Urgent message: Superior mesenteric artery syndrome should be included in the differential diagnosis in children with abdominal pain and weight loss with rapid increase in linear growth. Ralph Mohty, MS3, and Michael Esmay, MD Introduction Abdominal pain is one of the most common complaints in childhood. A minor self-limited condition such as constipation or viral gastroenteritis is usually the cause, but more serious conditions need further evaluation and management.1 Chronic abdominal pain is a term …

An Unexpected Cause of Amenorrhea

Urgent message: The simplest explanation for a mundane symptom may not always reflect the correct diagnosis. Urgent care providers should consider all the possibilities in order to reach the correct conclusion as early as possible, or risk missing a more serious underlying diagnosis. Introduction Sometimes a simple complaint results in a common diagnosis, but other times a rare diagnosis will be discovered. The following case illustrates the importance of considering a wide differential and obtaining …

Altered Mental Status in an Elderly Patient Due to Chronic Salicylate Toxicity

Urgent message: Urgent care providers must maintain a high index of suspicion for life-threatening conditions when assessing patients whose self-reporting of symptoms can be vague and nonspecific. Introduction Elderly patients often present for medical evaluation with vague complaints, oftentimes requiring the provider to obtain additional history from family and caregivers. Urgent care providers must maintain a high index of suspicion for life-threatening conditions based on non-specific symptoms. This case demonstrates the importance of recognizing a …

An Uncommon Mechanism for Work-Related Total Achilles Tendon Rupture

Urgent message: This is a really big deal to urgent care clinicians and operators. Introduction Achilles tendon (AT) ruptures account for approximately 40% of all operative tendon repairs.1,2 With 18 ruptures per 100,000 people, it is the most frequently ruptured tendon—and the incidence of AT ruptures has been steadily increasing over the past few decades.1–4 Typical patients include athletic males between the ages of 30 and 50.3 Because the AT is the strongest, yet most …

An Uncommon Mechanism of Work-Related Partial-Thickness Triceps Tear

Urgent message: Triceps tears are an uncommon acute injury that can occur from multiple mechanisms, including direct trauma. Assessment of these injuries requires obtaining a medical history and exam and a knowledge of characteristic diagnostic imaging findings. Early diagnosis and identification in patients presenting to an urgent care center is critical to ensure that appropriate treatment is initiated in a timely fashion. Introduction Triceps tendon (TT) tear is the least common of all tendon injuries …

A Rare but Insidious Cause of Abdominal Pain

Urgent message: Recognizing the need for workup and referral in patients, even if their symptoms are relatively common, is crucial for optimal outcomes Introduction Abdominal symptoms can be attributed to a wide array of causes. When etiology is not immediately apparent, searching for signs and symptoms the patient may not have reported—or even be aware of—may be the first steps toward timely diagnosis and treatment. In this case, the abdominal symptoms were ultimately due to …

Initially Missed Diagnosis of Quadriceps Partial Tendon Tear

Urgent message: Quadriceps tendon tears are misdiagnosed frequently, leaving patients at excessive risk for long-term disability. Early identification and immediate referral for further care—often, surgery—is necessary for optimal outcomes. Low-riding patella (patella baja) commonly seen in complete tendon tears. (Photo courtesy of Wikimedia Commons.) Introduction Musculoskeletal injuries are among of the most common problems seen in the urgent care setting. Quadriceps tendon tears are uncommon injuries, with an incidence of approximately 1.4/100,000 per year. Consequently, …

Painful Nose Crusting in a Child

Urgent message: Common nasal infections can have serious health consequences if not quickly diagnosed and treated. Introduction Both children and adults present to urgent care centers with nasal pain. Infectious causes of such pain include impetigo, furuncles, and nasal vestibulitis (NV). Noninfectious causes include squamous cell cancer and lupus vulgaris. A careful physical examination and a thorough medical history can allow the health-care provider to rule out more serious conditions or to transfer the patient …

Midline Neck Mass

Urgent message: Swelling of the neck is a common problem seen in the urgent care setting. Etiologies range from infectious to lymphatic to malignant. If serious conditions are not diagnosed and treated in a timely manner, complications may lead to airway compromise, sepsis, or even death. How this article helps you: alerts you to uncommon presentations of neck masses. Introdution Swelling in various areas of the neck is frequently seen in urgent care centers. Most …