Practice Management
Urgent message: Failure to recognize and treat the early development of skin and soft-tissue infection from a stingray envenomation may result in significant tissue necrosis and systemic inflammatory response syndrome. WILLIAM A. WOOLERY, DO, PhD, MS, MBA, FACOFP Stingray injuries to humans are very common but rarely fatal. Approximately 2000 cases are reported annually in the United States.1–3 At my rural hospital on the west coast of Florida, we see an average of 45 such …
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Urgent message: Summer brings increased participation in outdoor activities and sports in which patients are likely to sustain injury. Patients with thigh injuries, such as injury to the quadriceps and patellar tendon, may present to the urgent care center. Timely diagnosis is essential in preserving strength and function of the quadriceps complex. TRACEY QUAIL DAVIDOFF, MD Patients who run and jump are at risk for injuring their quadriceps complex. These activities are common in the …
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Urgent message: When a child presents with periorbital cellulitis with no obvious cause, checking for intranasal foreign body, such as a button battery, is of paramount importance. Serious complications can be avoided if the foreign body is removed in a timely manner. MAY MOHTY, MD, FAAP, FAAUCM, and JACOB ANDERSON, DO Preseptal cellulitis, also known as periorbital cellulitis, is a relatively common diagnosis in the pediatric population. It is defined as infection of the space …
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Urgent message: Because pain in the lower abdomen is a symptom that can indicate many diseases, including acute appendicitis and acute diverticulitis, it is easy to misdiagnose epiploic appendagitis (EA). Thus, it is important that urgent care practitioners be able to distinguish EA from many other entities, especially because surgery presents the risk of complications. MAY MOHTY, MD, FAAP, FAAUCM, and ANDREW WANG, MS-3 An epiploic appendage is a fat-filled sac (1–2 cm thick and …
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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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Urgent message: Failure to diagnose and, if necessary, repair penile fracture can result in devastating consequences such as stricture, fistula, and long-term voiding difficulty. TAYT ELLISON, MS-3, SHAILENDRA SAXENA, MD, PhD, LAURA KLUG, PharmD, and SANJEEV SHARMA, MD Although penile trauma is not a common presentation in the urgent care setting, it is under-reported because of embarrassment, as are other injuries related to sexual activity. The urgent care clinician should be prepared to evaluate these …
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Urgent message: Do not be fooled by the diagnosis made by clinicians before you. Many seemingly benign symptoms can be harbingers of more serious pathology. JESSICA HOFFMANN, MS-4, and JOHN SHUFELDT, MD, JD, MBA, FACEP Chronic back pain is a common presentation in both the urgent care and emergency department (ED) settings. Care-on-demand providers often find themselves deciding how extensive a workup to do for a patient with acute-on-chronic back pain. After a patient has …
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Urgent message: Be on the lookout for periostitis in patients with syphilis who present with extremity pain. MAY MOHTY, MD, FAAP, FAAUCM, and CASEY PHILIPSBORN, MSIV Syphilis (from the Greek word Syphlos, meaning crippled) is an infectious disease caused by the spirochete species Treponema pallidum. Patients can present with manifestations of any of the three stages of syphilis, ranging from a painless ulcer to an asymptomatic rash, to general paresis and dementia, among a myriad …
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Urgent message: Urgent care clinicians should consider the possibility of cholecystitis when evaluating patients with cardiac symptoms. A delay in diagnosis may lead to serious complications, including sepsis. ALONA D. ANGOSTA, PhD, APRN, NP-C, and BRYAN HOLMES, NREMTP Introduction Patients with acute cholecystitis typically complain of right-upper-quadrant pain that radiates to the right shoulder and back, fever, and leukocytosis.1 The pain may also be associated with nausea or vomiting. However, acute cholecystitis can mimic cardiac …
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Urgent message: As the number of patients with autism spectrum disorders continues to increase, it is important that urgent care providers proactively educate themselves about how best to provide acute care for these individuals. ELIZABETH MANGONE and JOHN SHUFELDT, MD, JD, MBA, FACEP A 14-year-old autistic male presents with both parents. The patient is non-verbal and hypersensitive to touch. The parents state that he was stung by a bee and seems to be having respiratory …
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