Journal of Urgent Care Medicine

A Case of Late-Onset Diabetes

Urgent message: Previously undiagnosed diabetes in elderly patients is too frequently a precursor to the diagnosis of pancreatic cancer. Incidental and unexpected diagnosis of diabetes in older patients in urgent care, especially in normal or underweight individuals, should prompt a discussion about vigilant monitoring for other symptoms of malignancy and close follow-up with a primary care provider. Joshua Russell, MD, MSc, FCUCM, FACEP CASE PRESENTATION A 72-year-old woman with a history of hypertension presented to …

A 10-Year-Old with Fever, Headache, Muscle Aches, Nausea—and a Suspicious Rash

The patient is a 10-year-old girl who presents to urgent care with 3 days of fever, headache, muscle aches, nausea, and a skin rash. She has a temperature of 102°F. On examination you find numerous erythematous macules and purpura on her palms and the soles of her feet. The patient is immunocompetent with an unremarkable medical history. Her mother recounts no recent travel from their home in North Carolina, but notes that the patient spent …

A 35-Year-Old with a Persistent, Frequent Cough

The patient is a 35-year-old woman who presents with a frequent, light cough of several months’ duration. Her medical history is unremarkable, including no history of COVID-19. She is a former “social smoker” who worked out on a treadmill sporadically before the cough began. View the image taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.

A 58-Year-Old Male with Chest Pain

The patients is a 58-year-old male who presents with chest pain. He describes it as sharp, lasting seconds, and worsened by lifting objects at work. Review the initial ECG taken and consider what your diagnosis and next steps could be. Resolution of the case is described on the next page. (Case presented by Tom Fadial, MD, Assistant Professor, McGovern Medical School, The University of Texas Health Sciences Center of Houston.)

Implementation of a Rapid Chest Pain Protocol in a Walk-In Clinic

Urgent message: There are no standardized guidelines for treating patients with chest pain in an urgent care clinic. Using a chest pain protocol with the Marburg Heart Score in a walk-in clinic can assist providers in assuring an appropriate level of care and support standardization in clinician decision-making for treating low-risk chest pain patients. Lorilea Johnson and Diane L. Smith Citation: Johnson L, Smith DL. Implementation of a rapid chest pain protocol in a walk-in …

A 57-Year-Old Female with Shortness of Breath and Weeks of Chest Pain

The patient is a 57-year-old female who presents to urgent care with progressive shortness of breath and chest pain of “several weeks” duration. On exam, she is nonobese, normotensive, slightly tachycardic, and tachypneic with clear lungs and distant heart sounds. View the initial ECG taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.

A 6-Year-Old Girl with Papules on Her Abdomen

A 6-year-old girl presents to urgent care for vaccinations at the start of the school year. Her father asks the pediatric provider to look at bumps that developed on her abdomen about 4 weeks ago. They consist of tiny papules, some scattered and some in linear configurations. The patient is asymptomatic without pain or itching. Her father is concerned because they have not resolved. View the image in this context and consider what your diagnosis …

A 36-Year-Old Male with Chronic, Worsening Hip Pain

The patient is a 36-year-old male who presents with left hip pain for “years.” The pain is motion- or position-related and over time there has been occasional pain in his buttock, back, and thigh. Additionally, he has stiffness, clicking, locking, and catching. View the image taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.

A 20-year-Old Female with Chest Pain and SOB

Urgent message: Urgent care providers need to be vigilant for more than acute coronary syndrome, pulmonary embolism, and thoracic aortic dissection when patients present with chest pain—such as this 20-year-old who developed pneumomediastinum while smoking marijuana. Xiangyang Jiao, MD Case Presentation A 20-year-old female presented to urgent care for pleuritic chest pain and shortness of breath for about 2 hours. The chest pain was located in the upper and mid chest, was dull, pressure like, …

When X-Rays Lie: Important Orthopedic Diagnoses to Consider with Normal Imaging

Urgent message: Musculoskeletal pain is a common urgent care complaint, with x-rays very commonly ordered. However, a “normal” image does not necessarily support eliminating what could be a serious injury from the differential diagnosis. Arun Sayal, MD, CCFP(EM) Citation: Sayal A. When X-Rays Lie: Important Orthopedic Diagnoses to Consider with Normal Imaging. J Urgent Care Med. 2022;16(7):13-16. Medical tests lie. Not intentionally, of course, but their result may not align with reality. A test may …

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