Journal of Urgent Care Medicine

High-Risk Conditions Presenting as Back Pain

Urgent message: That back pain is common and typically without serious sequelae may result in misdiagnosis and mistreatment. ERICA MARSHBURN, BS, BA, AND JOHN SHUFELDT, MD, JD, MBA, FACEP Many high-risk conditions can present as back pain, is a very frequent presenting complaint in urgent care medicine. Most back pain is muscular in origin and responds well to conservative intervention. However, because of the frequency of the complaint and infrequency of serious sequelae, providers may …

A Painful Swollen Joint in an Elderly Male

Urgent message: The patient had two recent bee stings. Did they cause his problem or were they red herrings? PAUL BURES, DO, and LEE A. RESNICK, MD Introduction Hot, swollen, tender joints are a common initial complaint in the urgent care setting. Depending on the patient’s HPI and PMH, a definitive diagnosis can often be concluded. A systematic evaluation of infectious, inflammatory, and traumatic causes can help narrow the differential. Judicious use of the laboratory …

A Surprising Cause for “Pregnancy”

Urgent message: When a test does not confirm a patient’s theory about the cause of her symptoms, both patient and provider must look elsewhere. SEAN MCNEELEY, MD Introduction When a mother of three complains of symptoms of pregnancy, the test usually confirms that she is right. Occasionally, however, the results are surprising, as this case illustrates. Case Presentation WM, a 28-year-old female, presented to an urgent care with concerns that she might be pregnant and …

A Surprising Cause for Constipation?

Urgent message: Prescribing Miralax and an enema would likely have killed this patient. He nearly died in the hospital. Can you figure out why? WILLIAM A. GLUCKMAN, DO, MBA, FACEP, CPE, CPC Constipation, a common urgent care complaint, can be a symptom of many things, not all of them obvious, and some life-threatening. In this tricky case, the underlying problem is one that many urgent care physicians would not consider in a differential diagnosis, yet …

A Case of Acute Pancreatitis

Urgent message: Although pancreatitis is a common cause of abdominal pain, many of its signs and symptoms are shared by other intraabdominal conditions. Most patients can be handled on an outpatient basis if diagnosis is accurate, as this case illustrates. MICHAEL TALKAR, MD Abdominal pain is a common and varied presentation in urgent care. A history and physical exam can be used to triage the majority of emergent cases. Strong communication is vital to ensuring …

Acute MI After a Normal Stress Test

Urgent message: Evaluation of chest pain in the low-risk patient can be daunting. This case, in which the patient had no known history of cardiovascular disease, exemplifies the challenge. MARREN J. WEBER, DO The standard treadmill exercise tolerance test (ETT) and echocardiography are widely used as the initial tests of choice for prediction of cardiovascular disease. Historically stress echocardiography has been recognized to perform well in predicting mortality in conjunction with clinical data and other …

Hearing the Hoof Beats of Zebras! Facial Nerve Palsy: A Case Report

Urgent message: There is no diagnosis so “common” that it cannot be missed or mistaken for something else. A systematic approach to the history and examination are crucial to reaching the right conclusion and positive outcomes. Lee A. Resnick, MD Every now and then, medical school pearls are wrong. You remember: “When hearing hoof beats in Central Park, don’t go looking for zebras.” It may be true that zebras are infrequent visitors to New York …

A 23-year-old Woman with a Scapular Fracture

Urgent message: Mechanism of injury – in case being thrown from a slow-moving vehicle – provides essential clues to the extent of injuries, even if the patient initially thought them to be relatively minor. Proper evaluation requires a thorough history. Shannon Dowler, MD The Case The patient is a 23-year-old female who presented to urgent care with an approximately 36-hour history of “shoulder pain.” She is otherwise well-appearing. Discussion with the patient reveals that she …

Pediatric Abdominal Pain: Consider Pneumonia in the Differential Diagnosis

Urgent message: Abdominal pain can be a challenging complaint, especially in younger patients. Consider the full range of differential diagnosis in order to initiate prompt, effective management. Curtis Kommer MD, Latha Shankar, MD, MBA and Robert Stuart, MD Introduction Since the time of Hippocrates, the ability of physicians to unravel the mystery of a patient’s abdominal pain has become synonymous with the art and practice of medicine. Pediatric abdominal pain, in particular, with its extensive …

Promethazine-induced Tissue Necrosis: A Case Presentation

Urgent message: Due to versatility, the urgent care clinician will find promethazine an appropriate choice in many situations. Awareness of potentially serious side effects maximizes the chance of good outcomes while minimizing risk. Shailendra Saxena, MD, PhD, Naureen Rafiq, MD, Liji George, MD, Cara Olsen, PharmD, and Mikayla Spangler, PharmD Introduction Promethazine (Phenergan) is a drug commonly prescribed in emergency departments and urgent care clinics for treatment of a variety of conditions (Table 1). Because …