Journal of Urgent Care Medicine

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 …

A 69-Year-Old Female with Hypertension, Dyslipidemia, and a Constellation of Otolaryngologic Symptoms

Urgent message: Epiglottitis is classically viewed as a pediatric disease, but has become increasingly common in the adult population. While symptoms may present as an isolated sore throat, they can quickly progress to complete airway compromise with need for emergency cricothyroidotomy. Due to the high risk for morbidity and mortality, urgent care providers must maintain a high index of suspicion to avoid misdiagnosing a potentially catastrophic disease. Zachary DePriest, MS, PA-C INTRODUCTION Adult epiglottitis (AE) …

A New-Onset, Suspicious Skin Lesion

Urgent message: Patients and providers alike may be inclined to eliminate possible diagnoses based on first impressions. It is essential that the urgent care clinician maintain a wide differential when evaluating patients for new-onset complaints that do not have an obvious cause. Failure to do so may cause delayed diagnoses (and, consequently, delayed treatment). Haley Harrington, Ross L. Pearlman, MD and Robert T. Brodell, MD INTRODUCTION Ticks are small—so small that patients often do not …

Cannabis-Associated Myocardial Infarction in a Young Woman Without Other Cardiac Risk Factors

Urgent message: A growing body of evidence suggests increased cardiovascular risk with frequent cannabis use. With cannabis availability and legalization increasing, the urgent care provider must understand how it affects the risk for acute medical issues among frequent users. Bella Nagappan, MD and Susanne Demeester, MD INTRODUCTION Cannabis, or marijuana, is legal for recreational use in 11 states and medical use in 33 states.1 With this increasing availability and legalization, the urgent care clinician must …

Foraged Mushroom Toxicity Presenting to Urgent Care with Acute Kidney Injury

Urgent message: Though it occurs relatively rarely, mushroom toxicity can result in irreversible organ damage and, in certain cases, death if not recognized quickly. Diagnosis can be difficult due to the facts that toxicity may present at different intervals from time of ingestion, depending on the species of mushroom, and initial symptoms are nonspecific and similar to those of benign gastrointestinal illnesses. Timely consultation with a poison control center may be life-saving. Michele L. Stowe, …