Journal of Urgent Care Medicine

A Pregnant Woman with Upper Right Quadrant Pain

Urgent message: The presentation of a pregnant woman to urgent care is often associated with consternation for both the patient and the provider. When a pregnant patient presents to urgent care with right upper quadrant pain, initial bedside ultrasound screening for gall bladder disease can facilitate initial interventions as well as expedite follow up care. CASE PRESENTATION History A 25-year-old nulliparous female 24 weeks pregnant presented to urgent care 4 hours after onset of nausea, …

Management of Lisfranc Dislocation in the Urgent Care Center

Urgent message: Lisfranc dislocations are relatively rare, but should be on the urgent care provider’s radar in patients who refuse to bear weight and who have significant midfoot pain and swelling after an acute trauma causing hyperplantarflexion of the foot. Introduction The tarsometatarsal (TMT), or Lisfranc, joint complex is the attachment between the forefoot and midfoot. This joint is the keystone to normal foot function and is thus critical for normal gait.1 Jacques L. Lisfranc …

Guttate Psoriasis: An Uncommon Cause of a Rash

Urgent message: While skin-related complaints are not uncommon in the urgent care setting, with psoriasis being a relatively common source, evaluation and diagnosis of a rash can be challenging. This is especially true in the case of a rare variant like guttate psoriasis. Chasity L. Falls, MS, PA-C INTRODUCTION Psoriasis is a common condition. However, the guttate variant is rarer, commonly affecting children and young adults less than 40 years of age and accounting for …

When Is Tachycardia in a Patient with URI Symptoms a Sign of Something More Serious?

Urgent message: Brugada syndrome is a genetic disorder associated with increased incidence of ventricular tachyarrhythmias and sudden cardiac death. There have been cases associated with fever, viral infections, and pneumonias—all conditions urgent care clinicians treat in abundance. This case report demonstrates how urgent care providers can diagnose a potentially lethal disorder when patients are being seen for febrile illnesses. Kathleen B. Raschka, MD Case Presentation A 55-year-old male with a history of hypertension, hyperlipidemia, and …

A Blistering Rash in an Otherwise Healthy 9-Year-Old Boy

Urgent message: Impetigo is one of the most common skin infections in children, and can have a variable presentation. As such, it is essential that the urgent care provider be able to recognize this common skin infection, and to know the treatment options. Aimy T. Patel, MD, FAAP, Allison Burris, MD FAAP, and Nirav Shastri, MD, FAAP, FAMIA, ABMS-CI CASE PRESENTATION History A 9-year-old otherwise healthy boy presents with a 1-week history of an itchy …

Kaposi Sarcoma Presenting in the Urgent Care Setting as a Single Mass Lesion of the Foot

Urgent message: Kaposi sarcoma is considered an AIDS-defining illness with variable locations of presentation. Proper diagnosis of lesions can allow patients to seek out necessary care for potentially serious pathologies. Brad White, DO, Susannah Boulet, OMV-IV, William Billari, OMS-IV, and Jennifer Lee, OMS-IV Introduction Skin lesions and abscesses are common and often relatively benign findings that a physician may not deem serious enough for further investigation. However, as first-line providers, it is critical for urgent …

Atypical Chest Pain in a Fibromyalgia Patient Presenting to Urgent Care

Tracey Q. Davidoff, MD, FACP, FCUCM Urgent message: Underlying medical and psychiatric conditions can cloud judgment and lead to cognitive errors, which may result in potentially serious medical errors.1 Case Presentation A 31-year-old woman with a medical history significant for fibromyalgia, migraines, bipolar disorder, and anxiety presents with 2 hours of severe bilateral neck spasms, left shoulder and arm pain, and chest pain which began soon after taking a new prescription for olanzapine. She also …

An 11-Year-Old Girl with Red, Itchy Rash

Urgent message: Urticaria from cold exposure should be considered to prevent future anaphylaxis and angioedema with re-exposure. KELSEY REED, MSN, APRN, FNP-C CASE PRESENTATION An 11-year-old girl presents to urgent care with complaints of repetitive episodes of sudden onset of itchy red rash with ill-defined borders which has occurred three times in the past 1.5 weeks following exposure to cold water. Twice, the hives occurred after swimming in a pool and once in a local …

An Unusual Etiology of Chronic Subdural Hematoma: Case Report and Review of the Literature

Urgent message: Absence of an obvious cause of symptoms should not mislead the clinician away from the likely diagnosis based on those symptoms. In this case, for example, the patient was ultimately diagnosed with a symptomatic chronic subdural hematoma associated with repetitive straining secondary to cough and constipation. Joel Kaye, BS, MS4 and Dana Tarina, MD Introduction Chronic subdural hematoma (CSDH) is an encapsulated collection of old blood in the space between the arachnoid membrane …

A 30-Year-Old Female with Headaches of Increasing Frequency

Urgent message: Cerebral venous sinus thrombosis (CVST) occurs when a blood clot forms in the venous sinuses within the brain, preventing drainage of blood. It can cause blood cells to break down and leak into the brain tissues, forming a hemorrhage. This can result in stroke. CVST affects about 5 people in 1 million per year. Aasia Ferdous, DO and Jordan Miller, DO CASE PRESENTATION A 30-year-old female presented to urgent clinic with a headache …