Journal of Urgent Care Medicine

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 46-Year-Old Obese Man with a Painful Skin Lesion

The patients is an obese 46-year-old man who complains of a painful skin lesion located between folds of skin that were touching each other. He reports looking in the mirror at home and seeing the area was very red and erythematous. He also says sometimes it feels like a burning sensation on his skin. This was most evident after being outside in the hot, humid weather. View the image taken and consider what your diagnosis …

A 6-Year-Old Boy with Leg Pain After a Hard Impact

The patient is a 6-year-old boy who was brought to your urgent care center by his parents with pain in his right leg. They explain that he while playing with friends he tried to jump from one side of a concrete retaining wall to the other—and coming up short. View the images taken and consider what the diagnosis and next steps would be. Resolution of the case is described on the next page.

The MIPS Mess

It should not be terribly surprising to anyone that the massive government effort to incentivize quality has run into some serious challenges. Adjudicating quality has always been a briar patch of exceptions, confounders, red tape, and bias. To make matters worse, as with large government efforts, you end up with a whole bunch of unintended consequences that typically add cost and effort to the very practices that can handle it the least. As we all …

Multiple Findings Including STEMI, Low Voltage, and Type 2 AV Block in a 72-Year-Old Woman

The patient is a 72-year-old woman who presents with 2 hours of chest pain with associated diaphoresis. She has a remote history of breast cancer. No leg pain or swelling or history of pulmonary embolism. On exam, you find her stated weight of 313 pounds is correct. In addition: General: Alert and oriented X 3, ambulatory Lungs: Clear to auscultation Cardiovascular: RRR without m/r/g, distant heart sounds Abdomen: Soft and NT without r/r/g Ext: Normal …

An 88-Year-Old Woman with Several Weeks of Dizziness

The patients is an 88-year-old woman with 3 weeks of dizziness but no complaints of chest pain/discomfort, shortness of breath, focal neurological signs, or diaphoresis. An ECG is performed by staff prior to clinician evaluation. Upon exam, you find: General: Alert and oriented X 3, ambulatory Lungs: Clear to auscultation Cardiovascular: RRR without m/r/g Abdomen: Soft and NT without r/r/g Extremities: Normal Review the ECG and consider what your diagnosis and next steps would be. …

A 59-Year-Old Man with a Painful Elbow After a Fall

The patient is a 59-year-old man who presents with pain in his elbow. He says he was experimenting with his son’s hoverboard, hanging on to a pole to steady himself. He lost his balance and fell, with his right arm taking the brunt of the impact. His range of motion is limited by both pain and swelling. View the images taken and consider what the diagnosis and next steps would be. Resolution of the case …

Abstract In Urgent Care-September 2019

Practice of Urgent Care: Rude Patients May Do More than Ruin Your Mood Key point: Individual and team performance of clinicians suffer in both quality of diagnostic approach and procedural skills when dealing with rude patients. Citation: Riskin A, Erez A, Foulk TA, et al. The impact of rudeness on medical performance: a randomized trial. Pediatrics.2015;136(3):487-495. Patients in urgent care commonly have unrealistic demands and expectations. When they make disparaging remarks, it’s easy to feel …

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 …

A 47-Year-Old Female Cancer Patient with Red, Flaccid Bullae on Her Leg

The patients is a 47-year-old woman undergoing chemotherapy for breast cancer with 1 day of several red, flaccid bullae on her leg as well as fever, cough, and shortness of breath. View the image and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.