Journal of Urgent Care Medicine

A 21-Year-Old Male Presents with Altered Mental Status After a Vehicle Accident

KEY QUESTIONS What phenomenon explains the ST elevations in this ECG? What are the features of this condition? What is the clinical significance of this phenomenon?

A 77-Year-Old Man Presents with Dyspnea

KEY QUESTIONS What diagnosis explains the widened QRS? What are the electrocardiographic criteria for making this diagnosis? What rule(s) can help diagnose acute myocardial infarction with an ECG like this?

An 81-Year-Old Female with a History of A-Fib and a Recent Syncope Event

The patient is an 81-year-old female with past medical history of atrial fibrillation on apixaban who presents to urgent care after a syncopal episode 30 minutes prior to arrival. The patient felt lightheaded while being pushed in her wheelchair and then lost consciousness. There was no trauma. She returned to baseline approximately 2 minutes after the event. There was no seizure activity. The patient denied associated chest pain, shortness of breath, headache, urinary or fecal …

A 27-Year-Old Male with Chest Pain and No Reported Medical History

Chamber Abnormalities: Pathologic or Not? A 27-year-old male with no reported medical history presents with chest pain. He relays several weeks of intermittent symptoms which started after lifting heavy boxes. The pain is sharp, located in the mid-chest and is otherwise non-tearing, non-pleuritic, non-positional and not associated with exertion. On examination, the patient is in no acute distress, and appears lean without cachexia or wasting. The pain is reproduced with shoulder extension. It resolves with …

A 36-Year-Old Male with Sudden-Onset Substernal Chest Pain

The patient is a 36-year-old male with a history of tobacco and alcohol use who presents to urgent care with sudden-onset substernal chest pain and shortness of breath that began 1 hour prior to arrival. View the ECG taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.

A 65-Year-Old Man with Shortness of Breath and a History of Heart Failure

A 65-year-old male with a history of heart failure presents to an urgent care center with shortness of breath of 2 days duration. He denies chest pain, nausea, or vomiting. He reports that he ran out of his medications about a week ago. View the ECG and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page. (Case presented by Catherine Reynolds, MD, McGovern Medical School, …

A 57-Year-Old Female with Cardiological History and Shortness of Breath

The patient is a 57-year-old female with a history of coronary artery disease, congestive heart failure, and left ventricular thrombus on warfarin who presents with shortness of breath. She denies any bleeding, bruising, dark-colored stools, chest pain, fever, cough, or leg pain. On evaluation, the patient’s vital signs are normal. She is breathing comfortably and speaking in complete sentences. View the ECG and consider what your next steps and diagnosis would be. Resolution of the …

A 70-Year-Old Female with Nonradiating Chest Pain

A 70-year-old female with history of coronary artery disease presents to urgent care with nonradiating chest pain of 2 days’ duration. She has a known history of left bundle branch block. Baseline ECG: View the ECG taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page. (Case presented by Benjamin Cooper, MD, McGovern Medical School, Department of Emergency Medicine, The University of Texas …

A 38-Year-Old Female with Abdominal Pain and Chest Tightness

A 38-year-old female with no past medical history presents to an urgent care with right upper quadrant abdominal pain and chest tightness, worsening for 1 week. She reports that her chest tightness is associated with shortness of breath, and is worse when walking and lying on her side. She denies fever, cough, dysuria, headache, or weakness. View the ECG and consider what your diagnosis and next steps would be. (Case presented by Catherine Reynolds, MD, …

Taking Care of the First Responders Who Take Care of You, Your Staff, and Your Patients

We’ve all seen painful reminders (or experienced them ourselves) of just how helpless natural disasters can leave us. We’ve also been touched and inspired by the bravery and selflessness of first responders—firefighters, police, EMS, and search & rescue personnel—who come to the aid of people in need regardless of their own circumstances. West Virginia University Occupational Medicine is saying thank you by offering a free physical exam for a day at select locations to all …