Journal of Urgent Care Medicine

Case Report: Reoccurring Metatarsophalangeal Joint Pain

Urgent message: Acute or chronic hallux pain is a common complaint in urgent care. Due to the structure, several diagnoses can have similar presentation on history and exam. With this discussion, we examine a sesamoid stress injury. Sergio P. Ramoa, MD, MS INTRODUCTION The tibial (medial) and fibular (lateral) sesamoids are contained within the flexor hallucis brevis tendons along the metatarsal head.1 They have several roles such as absorbing weight, helping glide and reducing friction …

Actinomyces neuii as a Cause of Vulvar Abscess

Urgent message: While abscesses are seen commonly in the urgent care setting, location and presenting complaints can offer essential clues as to the causative organism—and inform timely diagnosis and treatment decisions. Tracey Q. Davidoff, MD, FCUCM Introduction Abscesses are common in urgent care and emergency medicine and are easily treated with drainage, and in some cases antibiotics. The majority of cases are caused by Staphylococcus aureus and Streptococcal sp. Rarely, gram-negative bacilli can be found …

Breakthrough COVID Infection in a Vaccinated person from a Possible Vaccinated Exposure

Sergio Ramoa MD, MS Urgent Message: With variant COVID-19 mutations, incomplete herd immunity, and less restrictive government regulatory statues, it is important to remain vigilant with continued testing and prevention even with a full vaccinated history. Introduction In the United States, cases of COVID-19 have passed 32,000,000 and 570,000 for deaths. 141,000,000 cases and 3,000,000 deaths have afflicted the world. Approximately 9.6% of infected individuals are hospitalized and a majority have mild to moderate symptoms.1 …

A ‘Red Herring’ Chief Complaint

Urgent message: Chief complaints may lead the provider “off the trail” of a more urgent diagnosis. Anchoring bias occurs when relying too heavily on this first piece of information. Providers must remain vigilant for the subtle and nonspecific warning signs of pulmonary embolism. Ryan Hagan, PA-C and Christina Gardner, DHSc, MBA, PA-C INTRODUCTION Chief complaints are used to guide decision-making and may suggest an organ system, but a life-threatening condition may be found in a …

A 60-year old Male with Dyspnea and Hypoxemia at the Start of a Global Pandemic

Urgent message: The identification and global impact of the novel coronavirus has significantly challenged medical decision-making. Urgent care providers now consider the inclusion of the SARS-CoV-2-causing illness in their differential diagnosis when evaluating patients with signs and symptoms of an acute respiratory infection. Louis Costanzo, MD, MBA Introduction As of March 2021, there have been more than 28.6 million documented cases of COVID-19 in the United States, with the majority of cases those ages 18 …

An Atypical Presentation of Thyroid Storm: A Stark Yet Potentially Lethal Diagnosis

Urgent message: Unmanaged hyperthyroidism can cause any number of acute conditions that would drive a patient to visit an urgent care center. Further, thyroid storm can mimic several life-threatening events. Early recognition of the correct diagnosis is essential to raising the likelihood of a positive outcome—and protecting the patient from self-harm. Amrita Mahajan, BA and Lindsey Fish, MD INTRODUCTION Thyroid storm is a rare, life-threatening complication of thyrotoxicosis, a condition caused by excess thyroid hormone. …

A Hand Wound Caused by a Pressure Washer

Urgent message: Injuries caused by pressure washers often require debridement or, in severe cases, amputation. Immediate assessment and appropriate management, where feasible, can preclude the need for surgical intervention while effecting a positive outcome. Ellen Hancock, MD; Julie Park; MD, FACS; and Kendall Wermine INTRODUCTION Pressure washer injuries tend to involve the lower extremities and abdomen and usually require a form of surgical intervention such as debridement of tissue and, in severe cases, amputation.1-4 The …

A Diagnosis Suspected by Mechanism of Injury: Soft tissue Infection Due to Aeromonas hydrophila and Enterobacter asburiae Following Human Wastewater Exposure

Urgent message: Knowing the mechanism of injury and presence of wound contamination is important in hand lacerations in order to avoid and anticipate skin and soft tissue infections and tissue necrosis, particularly in the setting of contaminated water sources. Cayla Baker, PA-C and Christina Gardner, DHSc, MBA, PA-C Introduction In 2018, the U.S. Bureau of Labor Statistics reported 77,340 work-related accidents resulting in lacerations, with 51,130 of those being to the hand.1 It is important …

Worsening, General Weakness and Immobility in an IV Drug User

Urgent message: Spinal epidural abscesses are a rare condition that can be fatal if untreated. Populations most at risk include the elderly, diabetics, and IV drug users. The most common cause of an epidural abscess is the bacteria Staphylococcus aureus. Savannah Chavez, MD; Jordan Miller, DO; J. Chika Morah, MD INTRODUCTION Incidence of spinal epidural abscesses ranges from 0.2 to 2.8 cases per 10,000 per year, with a peak incidence occurring in patients between 60 …

Left Eye Pain in an Overall Healthy 19-Year-old Female

Urgent message: Eye pain is a common presentation to the urgent care clinic. A provider needs to be able to recognize concerning components of history and physical which require further emergent evaluation. Lindsey E. Fish, MD CASE PRESENTATION History A 19-year-old female with past medical history significant only for scoliosis presents to an urgent care clinic complaining of left eye pain for the last 3 days. She reports that the pain feels like it is …