Promethazine-induced Tissue Necrosis: A Case Presentation
Urgent message: Due to versatility, the urgent care clinician will find promethazine an appropriate choice in many situations. Awareness of potentially serious side effects maximizes the chance of good outcomes while minimizing risk. Shailendra Saxena, MD, PhD, Naureen Rafiq, MD, Liji George, MD, Cara Olsen, PharmD, and Mikayla Spangler, PharmD Introduction Promethazine (Phenergan) is a drug commonly prescribed in emergency departments and urgent care clinics for treatment of a variety of conditions (Table 1). Because …
Read MoreCase Report: Upper Extremity Deep Venous Thrombosis – Paget-Schroetter Syndrome
Urgent message: Vigilance for risk factors and diagnostic methods related to Paget-Schroetter syndrome in patients presenting to urgent care with relevant risk factors is essential to initiating therapy on site and timely referral to a hospital and/or vascular surgeon. Darshan Shah, MD, Shikhar Saxena, MD and Shailendra Saxena, MD, PhD Introduction Upper extremity deep venous thrombosis (UEDVT) is estimated to constitute 1% to 4% of all cases of deep venous thrombosis (DVT).1 The incidence may …
Read MoreCase Report: Gout vs. Cellulitis
Urgent message: Sometimes, cellulitis can be confused with gout – especially when it involves the area around a joint. A detailed history and physical exam, along with diagnostic testing, will help you reach definite diagnosis. Introduction Gout is a metabolic disease characterized by recurrent episodes of acute arthritis. It is a type of monoarticular arthritis caused by deposition of monosodium urate crystals in and around the joint. Hyperuricemia (serum uric acid level >6.5 mg/dL) seems …
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A 12-year-old Girl with Back Pain
Urgent message: Back pain in a pediatric patient requires a high index of suspicion. Ominous causes (e.g. cancer, infection), are far more common in the pediatric population. Conversely, mechanical low back pain is far less common, and is a diagnosis of exclusion. Forrest Nguyen, DO Introduction As urgent care physicians, we are responsible for anything that comes through the door. Often, the diagnosis proves to be routine – a viral infection, a sore throat, or …
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December 2009
A Child with Constipation and Swollen Abdomen
Urgent message: Malignancies in children are often discovered only inadvertently, in conjunction with seemingly less dire presentations. Awareness of relevant signs and symptoms by the urgent care clinician can be invaluable in identifying tumors that might otherwise escape notice until they are at an advanced stage. Muhammad Waseem, MD Introduction The identification of a palpable abdominal mass in an urgent care center or emergency department is quite concerning, as it represents a serious underlying disorder. …
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November 2009
Appendicitis Due to Squirrel Dinner
Introduction Appendicitis due to foreign bodies is a rare occurrence; most cases reported in the literature have occurred due to sharp objects such as pins, needles, toothpicks, and small nails. Solid foreign bodies – such as a bullet – rarely cause appendicitis. Appendicitis due to traumatic gunshot wounds has been described before, as have appendicitis cases due to ingested birdshot. Here, we describe an interesting case that demonstrates the importance of eliciting a history of …
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