Journal of Urgent Care Medicine

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 …

Wrist Pain Related To Rheumatoid Arthritis: A Case Study

Urgent Message: Wrist pain and swelling are common presentations in urgent care. Several factors can help clinicians identify cases of rheumatoid arthritis in order to promptly refer patients to rheumatology. Christina Williams, BS; Veronica Heitsch, MD Keywords: rheumatoid arthritis; wrist pain; inflammatory arthritis; metacarpophalangeal joint; rheumatoid arthritis diagnosis; disease-modifying antirheumatic drugs Questions for the Clinician at the Bedside Editor’s Note: While the images presented here are authentic, the patient case scenario is hypothetical. Abstract Rheumatoid …

Pediatric Plantar Puncture Wound Through Rubber-Soled Footwear: A Case Report Highlighting Antibiotic Stewardship in Urgent Care

Urgent Message: Low-risk plantar puncture wounds in healthy children can be safely managed without antibiotics. Parents should receive instructions for return precautions. Adam Brandon Bondoc, MD Keywords: plantar puncture wound; pediatric puncture wound; rubber-soled footwear; pseudomonas aeruginosa; antibiotic stewardship; foreign body risk Abstract Introduction: Puncture wounds that occur through rubber-soled footwear increase the risk of infection from Pseudomonas aeruginosa. Prophylactic oral fluoroquinolones are frequently provided to adults for high-risk injuries. However, pediatric care is complicated …

An Uncommon Cause of Rectal Pain: A Case Report of Fishbone Foreign Body

Urgent Message: Careful history and examination are required when assessing patients presenting with rectal pain. Clinicians should maintain a high index of suspicion for accidental foreign-body ingestion when assessing unexplained rectal discomfort. Ivan Koay, MBChB, MRCS, FCUCM, FRNZCUC, MD; Cameron Olphert, BSc (Hons), MSc Key Words: rectal pain; foreign body; proctoscopy; fishbone ingestion; hemorrhoids; gastrointestinal issues Abstract Clinical Presentation: A 50-year-old male with a history of type 2 diabetes mellitus and hemorrhoids presented to urgent …

Wheezing as a Pneumothorax Presentation: A Case Report

Urgent Message: For patients with presumed asthma exacerbation, clinicians must maintain a high index of suspicion for other etiologies, including pneumothorax. This may help avoid delays in potentially life-saving interventions when symptoms persist despite treatment or when physical exam findings are atypical. Badi Eghterafi, DO; Nazanin Hazhir Karzar, MD Keywords: asthma, wheezing, chest pain, pneumothorax, spontaneous pneumothorax Abstract Introduction: Large spontaneous pneumothorax is an uncommon but critical complication in patients with asthma. Clinicians evaluating presumed …

When Bell Palsy Is Actually a Stroke: A Case Report

Urgent Message: While Bell palsy is the most common diagnosis for patients with unilateral facial weakness/paralysis, it is important for urgent care clinicians to be able to quickly differentiate it from other more serious diagnoses. Keywords: facial palsy; stroke mimic; Bell palsy; central facial weakness; peripheral facial palsy; urgent care evaluation Luke Wisniewski, OMS3; Finley Kocher, OMS3; Muhammad Akhtar, MD Abstract Introduction: Bell palsy is the most common diagnosis for patients with unilateral facial weakness/paralysis …

Progressive Ankle Pain in a 12-Year-Old Male: A Case Report of Osteomyelitis

Urgent Message: While most pediatric musculoskeletal complaints are usually benign and self-limited, the urgent care clinician must consider more serious underlying causes of pain in the differential diagnosis. Keywords: pediatric osteomyelitis; atraumatic ankle pain; limping child; bone infection; ESR; CRP; MRI diagnosis Erin Loo, PA-C, MHA, FCUCM Abstract Introduction: Pediatric patients commonly present to urgent care (UC) with musculoskeletal complaints. However, a wide differential should be considered, including musculoskeletal injury, synovitis, autoimmune conditions, cellulitis, avascular …

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