Journal of Urgent Care Medicine

Management of Lisfranc Dislocation in the Urgent Care Center

Urgent message: Lisfranc dislocations are relatively rare, but should be on the urgent care provider’s radar in patients who refuse to bear weight and who have significant midfoot pain and swelling after an acute trauma causing hyperplantarflexion of the foot. Introduction The tarsometatarsal (TMT), or Lisfranc, joint complex is the attachment between the forefoot and midfoot. This joint is the keystone to normal foot function and is thus critical for normal gait.1 Jacques L. Lisfranc …

Syphilis in the Urgent Care Center

Urgent message: Seeking information beyond the stated history can prompt important information that informs the true diagnosis. This is especially true in patients with a complicated or potentially embarrassing history. Case Presentation A 59-year-old female with a past medical history of type 2 diabetes and hypertension presents to an urgent care facility with complaints of abdominal pain. She is well known to the urgent care staff. She is consistently noncompliant with medical care. Her hypertension …

Rhabdomyolysis in a Previously Healthy 33-Year-Old Man

Urgent message: Life-threatening degrees of rhabdomyolysis can be seen in young, healthy patients with stable presentation and nearly normal examination findings. John Shufeldt, MD, JD, MBA, FACEP and Zana Alattar, MS3 Introduction This case demonstrates the importance of considering and ruling out rhabdomyolysis in patients with myalgia. We describe a case illustrating the management and work-up of myalgia in a young, healthy individual to identify the underlying cause. As with many illnesses, the …

Head Injuries and Cirrhosis: Does everyone need a CT Scan?

Urgent message: The decision of whether or not to image a patient with a head injury has significant implications—for the patient and the urgent care provider. Understanding which patients are at greatest risk for serious head injury, indications for testing, and options for management/disposition is essential. Brandon Godfrey, MD; Haylie Wiesner, BS; and John Shufeldt, MD, JD, MBA, FACEP Case A 47-year-old male with a history of alcohol abuse and cirrhosis presents to an urgent …

Boerhaave Syndrome in a 41-Year-Old Female

Urgent message: While Boerhaave syndrome is a rare finding, a relatively high number of cases may present in the urgent care setting. As such, awareness of and vigilance for related symptoms are essential to taking a proper history and, ultimately, early diagnosis of acute, subacute, or chronic Boerhaave syndrome. John Shufeldt, MD, MBA, JD, FACEP, Amber Hawkins, and Carli Nichta, MS4 Introduction Boerhaave syndrome is a spontaneous esophageal rupture indicated in some cases by …

Acute Compartment Syndrome—An Urgent Care Review

Urgent message: Acute compartment syndrome (ACS) is an important high-risk diagnosis to exclude when evaluating peripheral extremity injury. Providers must maintain a high clinical index of suspicion with careful attention to the history and mechanics of injury in an urgent care setting to preclude the devastating, rapidly developing sequela of ACS. Missing a case of ACS may result in significant morbidity—and even mortality. Awareness of both subtle and overt signs will ensure the best care …

Poisoning of a Child Because of an Older Sibling’s Habit

Urgent message: Be aware of new fads and habits that are growing in popularity. Some of them can result in life-threatening symptoms and serious permanent health consequences. Introduction Vomiting is a common presentation in the urgent care setting, especially in the pediatric population. With children, health-care providers must start with a comprehensive differential diagnosis because of the difficulty in obtaining accurate information directly from the patient. The medical history, often presented by the parent, must be carefully sorted through for clues to a …

Two-Thirds

JOHN SHUFELDT, MD, JD, MBA, FACEP Editor’s note: For almost 10 years, Dr. John Shufeldt has generously shared his talents as a writer, legal expert, and thought leader with JUCM readers as the contributing editor of our Health Law department. Although John is retiring as its regular contributor, he will always remain its award-winning founder. In future issues, the Health Law column will be expanded to include new contributors and cover a broader scope of …

Medical Malpractice Trial, Part 3: The Trial

JOHN SHUFELDT, MD, JD, MBA, FACEP Recap of the Facts Johnny Dalton presented to the emergency department (ED) at St. Jacob’s Hospital after ingesting liquid methadone, a long-acting opioid. Responsive Emergency Medicine and Dr. Beth Ange evaluated and monitored Johnny for nearly 12 hours and discharged him home. Johnny was found dead by his family approximately 20 hours after discharge. Case name: John and Cathy Dalton v. Dr. Beth Ange and Responsive Emergency Medicine Decedent: …

Aortic Dissection

Urgent message: Although chest pain in young adults is often benign, it is important to realize that emergency cases can sometimes be disguised as normal examination findings in adults. ZANA ALATTAR and JOHN SHUFELDT, MD, JD, MBA, FACEP This case demonstrates the importance of considering and ruling out rare cases of aortic dissection in patients with chest pain. We describe a case illustrating the approach to the management and work-up of chest pain in young …

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