Practice Management
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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Urgent message: Chest pain in young adults is often benign but it’s important to always consider conditions that increase risk of cardiovascular disease when evaluating these patients. RAFAEL ILYAYEV, MD, FACP, MOHAMED A. MOHAMED, MD, AND HASSAN FARHAT, MD Overview This case illustrates the importance of considering and ruling out rare causes of coronary artery disease (CAD) in young patients who present with chest pain. One of these rare causes is a hypercoagulable state secondary …
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Urgent message: Visceral injury is possible in association with the seemingly minor trauma seen in urgent care, underscoring the importance of remaining alert for “red flag” signs and symptoms and judiciously using advanced diagnostics. Introduction Blunt abdominal trauma occurs in 10% to 15% of injured children.1 History and specifically mechanism of injury, and physical exam are important when a patient presents to the clinic with a suspected blunt abdominal trauma. Usually, injuries to the intra-abdominal …
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Urgent message: Patients with seemingly unusual conditions do present to urgent care, underscoring the need to always take a thorough history for all “red flag” symptoms. LEE A. RESNICK, MD, FAAFP Introduction While the incidence of acute rheumatic fever has declined significantly in developed countries over the last several decades, sporadic cases do still occur. Diagnosis may be difficult due to the non-specific symptoms and the lack of experience with the condition amongst most urgent …
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Urgent message: Differential diagnosis and careful attention to signs, symptoms and history are particularly important in management of patients with nasal inflammation. MOHAMMED NOMAN MOHIUDDIN, MD Overview Nasal congestion and sinus symptoms are common urgent care complaints. Recurrent sinusitis, either from allergies or upper respiratory infections is frustrating to patients. Proper evaluation and treatment of underlying predisposing factors will help alleviate symptoms and address the disease process associated with polyps such as those seen in …
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Urgent message: This case underscores the importance of not “anchoring” to a previous provider’s diagnosis and always remembering that medical conditions are dynamic. JOHN J. KOEHLER, MD, and DANIEL MURAUSKI, DO Introduction Acute pericarditis is defined as inflammation of the pericardium that surrounds the heart and the base of the great vessels. The classical presentation consists of chest pain, a pericardial friction rub, and serial changes on electrocardiogram (EKG). Although data on the incidence of …
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Urgent message: The key to this case was in the details of the presenting symptoms in the patient history: Alarm symptoms including extreme fatigue and weight loss, which warranted further diagnostic work up. ABRAR KHAN, MD, MBA, REVATHY NAIR, MD, and MARIANN MELICHAREK, MD, FACEP Introduction Sarcoidosis is a multisystem granulomatous disorder of unknown etiology. Most patients with sarcoidosis present to urgent care providers with symptoms such as cough, dyspnea, chest pain, eye pain and/or …
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