Journal of Urgent Care Medicine

An Old Condition Presents New Challenges: A Case Report of Acute Rheumatic Fever

Urgent message: Acute rheumatic fever is not common but it does still occur, underscoring the need for head-to-toe examination in patients with vague symptoms that seem unconnected. HEATHER VARLEY, PA-C, and WILLIAM GLUCKMAN, DO, MBA, FACEP Introduction Patients with fever, sore throat, and malaise often present in the urgent care setting and they typically are worked up quickly with a rapid strep test or given a diagnosis of a viral syndrome. The case described here …

Ludwig’s Angina

Urgent message: Thoroughly evaluate patients who complain of dental or oral pain. CHRISTOPHER MCKENNA and JOHN SHUFELDT, MD, JD, MBA, FACEP Ludwig’s angina is a serious and potentially life-threatening connective tissue infection found on the floor of the mouth and in the deep neck spaces. More specifically, it is a bilateral infection of the submandibular space. The two compartments affected are the sublingual space and the submylohyoid space.1 This condition usually presents in individuals who …

Infectious versus Inflammatory Flexor Tenosynovitis: A Little, Big Problem

Urgent message: Infectious flexor tenosynovitis is an orthopedic emergency that can cause long-lasting disability through tendon necrosis and permanent digital contracture if unrecognized or mismanaged. MARY A. LANE, MD Flexor tenosynovitis is an inflammation of the tendon sheath that can be caused by either introduction of infection or various inflammatory conditions ranging from autoimmune arthropathies to crystal joint depositions. Flexor tenosynovitis caused by infection is an orthopedic emergency. It can cause long-lasting disability through tendon …

Abdominal Pain of Unusual Origin in a Teen

Urgent message: Always be mindful of the ‘zebra’ in a stampede of ‘horses’ in the differential diagnosis. ELISABETH L. SCHEUFELE, MD, MS, FAAP Case Presentation J.H. is a 19-year-old Hispanic male presenting with abdominal pain and shortness of breath for the last 4 days. He had visited the urgent care clinic about 2 days before with similar symptoms and was discharged with a diagnosis of muscle strain. J.H. returned with persistent symptoms and he indicates …

High-Risk Conditions Presenting as Back Pain (Part 4)

Urgent message: Back pain with incontinence and focal neurological changes are red flags for serious conditions. ERICA MARSHBURN, BS, BA, and JOHN SHUFELDT, MD, JD, MBA, FACEP Low back pain is a common presentation in the urgent care setting and it is important for providers to be aware of signs and symptoms that could indicate a more serious condition than nonspecific muscular pain. Be sure to make a thorough evaluation of your patients and pay …

Drug Toxicity Following Trip to the Local Head Shop

Urgent message: Thorough work-up is mandatory for patients with mild symptoms from recent use of “bath salts” because of the potential for multi-systems failure. JOHN K. GRANDY BS, MS, RPA-C Case Presentation A 19-year-old male is brought to an urgent care clinic by his mother, who states that her son and his friends took “Molly Mosquito Caps” 2 days ago that were purchased from a local head shop. The patient and his friends all experienced …

High-Risk Conditions Presenting as Back Pain (Part 3)

Urgent Message: Fever plus back pain should alert a provider to a potentially serious condition that warrants further workup. ERICA MARSHBURN, BS, BA, and JOHN SHUFELDT, MD, JD, MBA, FACEP Many high-risk conditions can present as back pain and back pain is a very frequent presenting complaint in urgent care medicine. When the back pain is associated with fever of unknown etiology or if it occurs in someone with a history of receiving intravenous (IV) …

High-Risk Conditions Presenting as Back Pain (Part 2)

Urgent message: Significant cervical spine injuries are rare in urgent care but missing one can have serious implications for patient and provider. ERICA MARSHBURN, BS, BA, and JOHN SHUFELDT, MD, JD, MBA, FACEP In this continuing series on back pain diagnostics in urgent care medicine, we urge providers to carefully consider any high-risk spinal conditions that could be presenting as simple back pain. Although many cases of back pain can be attributed to musculoligamentous injury …

When Serious Pathology Masquerades as a Minor Injury

Urgent message: The patient punctured his hand with a power screwdriver. It turned out to be the least of his problems. Frank Fannin, MD, EMT-P Introduction Hand Injuries are common and a major concern in urgent care settings as a source of potential significant disability and liability. A detailed history and focused exam are paramount to appropriate treatment and disposition. In the following case, a potentially devastating finding turns out not to be all that …

Spontaneous Pneumothorax

Urgent message: In patients with chest pain, check chest films carefully to avoid missing an uncommon diagnosis. Joseph Toscano, MD Introduction The traditional differential diagnosis for chest pain includes spontaneous pneumothorax. Chest x-ray is necessary for confirming the diagnosis, and sometimes the findings can be subtle. As in dealing with any infrequently encountered condition, clinicians should consider the diagnosis and closely examine every chest film they order to avoid missing this uncommon diagnosis. Case Presentation …