Journal of Urgent Care Medicine

Cost-Effective Management of Deep-Vein Thrombosis

Urgent message: Utilization of validated scoring systems and clinical decision-making tools can enable the urgent care provider to manage many patients presenting with symptoms of deep-vein thrombosis in the urgent care center, reducing the need for costly referral to the emergency room. Daniel Eisner, DMSc, PA-C ABSTRACT Management of venous thromboembolism accounts for $10 billion in medical spending annually, with much of the cost attributable to emergency room visits. Conversely, managing VTE patients in the …

Mysterious Skin Lesions in a Horse Trainer

Urgent message: Medical histories can help inform diagnosis, but clinicians must ensure their decisions are not swayed by erroneous historical elements or cognitive biases. Candace Walkley, MD and Kyle Swanson, OMS-3 INTRODUCTION Staphylococcus aureus and Streptococcus pyogenes may cause acute and inflammatory infections of the soft tissue in immunocompetent patients. However, patients with indolent and progressive lymphocutaneous infections should be evaluated for atypical bacterial and fungal pathogens. CASE PRESENTATION In March 2021, a 57-year-old healthy …

An Unusual Case of Third and Fourth Metacarpophalangeal Joint Dislocations Following a Fall

Urgent message: Metacarpophalangeal dislocations involving digits other than the thumb or index finger may be somewhat atypical, but are known to occur as a result of a fall on an outstretched hand—a common precedent to an urgent care visit. Familiarity with management of such injuries precludes the need to refer the patient. Leonard A. Powell, DO, MS, FACOFP, CMD and Chad E. Richmond, DO ABSTRACT Metacarpophalangeal (MCP) joint dislocations typically occur in a dorsal fashion …

Bullous Pemphigoid Reaction After Second Dose of COVID-19 Vaccine

Urgent message: Throughout the COVID-19 pandemic, unvaccinated people have shown higher rates of morbidity and mortality in comparison with those who are fully immunized. While most vaccination adverse reactions are mild and self-resolving, it is important to consider the timeline of vaccinations to correlate possible adverse reactions. Amanda dos Santos, MD and Michael Pallaci, DO, FACEP, FACOEP INTRODUCTION The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic continues to affect all aspects of our society and …

A Rare Case of Sequential Simultaneous Bilateral Mandibular Fractures

Urgent message: The angle of the mandible is one of the most common locations among bilateral mandibular fractures. Bilateral mandibular angle fractures are a rare traumatic event and often occur in the setting of panfacial fractures due to an impacting force. Chad E. Richmond, DO, DAOBFP; Leonard Powell, DO, MS, FACOFP, CMD; Keith S. Richmond, DMD, MDS. INTRODUCTION The mandibular angle is a weak zone that is more exposed to fractures than other areas of …

Brain Abscess in an Immunocompetent Patient: Complex Pathology and Communication

Urgent message: Remain diligent in the evaluation of headache; though often a benign condition, the possibility for severe morbidity and mortality warrants careful evaluation of subtle aspects within the history and/or physical exam. INTRODUCTION Headache is one of the most common complaints in the urgent care setting, yet also one that can be daunting for a provider. While there are many benign causes, such as a migraine or tension headache, the potential for an emergent …

How Useful Is Ultrasound in Diagnosing Ovarian Torsion?

Urgent message: Ultrasound can provide essential data in the urgent care evaluation of abdominal pain, aiding in the diagnosis of intestinal abnormalities, urinary tract infection, and obstetrical and gynecological problems such as suspected ovarian torsion. Andrew Alaya, MD, MSc Introduction Abdominal pain is one of the most common complaints among women of childbearing age who visit urgent centers. Urinary tract infection, diarrhea, constipation, acute viral gastroenteritis (AGE), pelvic inflammatory disease (PID), and dysmenorrhea are the …

A Case of Late-Onset Diabetes

Urgent message: Previously undiagnosed diabetes in elderly patients is too frequently a precursor to the diagnosis of pancreatic cancer. Incidental and unexpected diagnosis of diabetes in older patients in urgent care, especially in normal or underweight individuals, should prompt a discussion about vigilant monitoring for other symptoms of malignancy and close follow-up with a primary care provider. Joshua Russell, MD, MSc, FCUCM, FACEP CASE PRESENTATION A 72-year-old woman with a history of hypertension presented to …

A 20-year-Old Female with Chest Pain and SOB

Urgent message: Urgent care providers need to be vigilant for more than acute coronary syndrome, pulmonary embolism, and thoracic aortic dissection when patients present with chest pain—such as this 20-year-old who developed pneumomediastinum while smoking marijuana. Xiangyang Jiao, MD Case Presentation A 20-year-old female presented to urgent care for pleuritic chest pain and shortness of breath for about 2 hours. The chest pain was located in the upper and mid chest, was dull, pressure like, …

Testicular Torsion: The Case of the Dancing Testicle

Urgent message: The differential diagnosis for unilateral testicular pain includes testicular torsion; this is a ”must not miss” diagnosis, as delayed diagnosis can cause significant morbidity both physically and psychologically. Jeannette Vaughn-Dotterer, PA-C CASE PRESENTATION ML is a 47-year-old male who developed left-sided testicular pain after getting out of bed 2 hours prior. He states that his left testicle appears to be “dancing” and seems to be riding higher than his right testicle. ML states …