Journal of Urgent Care Medicine

Psychogenic Nonepileptic Seizures in the Urgent Care Setting: A Case Report

Urgent Message: Accurately identifying psychogenic nonepileptic seizures in the acute care setting helps avoid dangerous and costly medical interventions, such as aggressive antiepileptic drug treatment. Jacob Welch, OMS-4; Logan Hurm, OMS-4; Akul Mitra, OMS-4; Cameron Shoemaker, PGY-2; Michael B. Weinstock, MD Keywords: psychogenic nonepileptic seizures; functional seizure; functional neurological disorder Abstract Introduction: Psychogenic nonepileptic seizures (PNES) mimic epilepsy but lack epileptiform electrical brain activity. In the urgent care setting, prioritizing rapid stabilization often leads to …

New-Onset Atrial Fibrillation Triggered by Diarrhea-Induced Dehydration: A Case Report

Urgent Message: Dehydration and its associated electrolyte disturbances can precipitate new-onset atrial fibrillation. Recognition of an irregular cardiac rhythm should prompt electrocardiographic evaluation and/or referral to a higher level of care. Morgan Cianciolo, FNP-C, Christina Gardner, DHSc, MBA, PA-C, CAQ-EM Keywords: new-onset atrial fibrillation; dehydration; volume depletion; diarrhea; electrolyte imbalance; urgent care Abstract Introduction: Atrial fibrillation is the most common sustained arrhythmia in adults and is frequently associated with precipitating factors, including systemic illness, metabolic …

Accidental Tongue Ring Ingestion: Balancing Caution and Conservative Management in Urgent Care

Urgent Message: Most ingested foreign objects pass spontaneously with little risk of complications in adults. However, in cases where patients experience persistent symptoms, escalation to emergency department evaluation may be appropriate. Naun Gutierrez Jr., MSN, FNP-C; Christina Gardner, DHSc, MBA, PA-C Keywords: foreign body ingestion; gastrointestinal foreign body; tongue ring ingestion; radiography; conservative management; urgent care Abstract Introduction: Foreign body ingestion is a clinically important presentation in urgent care, with management guided by object characteristics, …

An Infant with Neuroblastoma Presenting as Intermittent Eye Bruising: A Pediatric Case Report

Urgent Message: Recurrent or unexplained periorbital ecchymosis (“raccoon eyes”) in an infant should prompt consideration of metastatic neuroblastoma and escalation for appropriate imaging. Alejandro Lopez, BS; Julia Gamache, BS; Ella Weiss, BS; Aaron J. Maki, MD, PhD Keywords: neuroblastoma; metastatic neuroblastoma; periorbital ecchymosis; orbital metastasis; suprarenal mass; pediatric malignancy Abstract Introduction: The presenting symptoms of pediatric neuroblastoma are highly variable. Patients may first present to urgent care for what they perceive as a minor complaint. …

Peripheral Neuropathy Induced by Nitrous Oxide Misuse: A Case Report

Urgent Message: Nitrous oxide-associated peripheral neuropathy may present similarly to Guillain-Barré syndrome, and clinicians are encouraged to conduct a careful clinical assessment of patients with neurological symptoms. Ivan Koay, MBChB, MRCS, FCUCM, FRNZCUC, MD; Cameron Olphert, BSc (Hons), MSc Keywords: nitrous oxide toxicity; vitamin B12 deficiency; peripheral neuropathy; myeloneuropathy; Guillain-Barré syndrome; paresthesia Abstract Introduction: Although often regarded as “safe,” repeated exposure to nitrous oxide can result in serious neurological sequelae, most notably functional vitamin B12 …

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 …

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