Journal of Urgent Care Medicine

An Age-Based Approach to Fever of Uncertain Origin in the Pediatric Patient

Urgent message: Fever in pediatric patients, while frequent, is rarely the result of a serious illness. Urgent care practitioners must be able to consistently distinguish between serious and benign causes with a minimum of invasive testing. BRENDAN KILBANE, MD, FAAP Introduction Ever is one of the most common chief complaints in pediatric patients who present for urgent evaluation. A surprising number of families continue to suffer from “fever phobia,” with one study noting that 91% …

April 2013

9-year-old female suffering after a blow to her right hand

The patient, a 9-year-old female, presented after a blow to her right hand. View the image taken and consider what your diagnosis would be.

3-year-old boy suffering a blow to his leg

The patient, a 3-year-old, had a blow to his lower leg. View the image taken and consider what your diagnosis would be.

5-year-old male exhibits irritability and persistent febrility

The patient was a 5-year-old male. His parents reported that he had been febrile for the past several days (fever between 101°F and 103°F [38.3°C to 49.4°C]) and had become increasingly irritable and ill appearing. Exam revealed bilateral conjunctival injection without exudate, dry red lips and red tongue, and perineal erythema with overlying scale. The patient’s lymph nodes were swollen. View the images taken (Figures 1, 2 and 3) and consider what your diagnosis would …

9-year-old patient trips and receives a blow to right knee

The patient, an otherwise healthy 9-year-old, tripped, suffered a blow to the right knee and presented with the knee cap in an abnormal position. View the image taken and consider what your diagnosis and next steps would be

2-1/2 year-old with recurrent abdominal pain

The patient, an otherwise healthy 2-1/2 year-old, experienced recurrent episodes of abdominal pain without vomiting or diarrhea. On exam, fullness of the abdomen was present. View the image taken and consider what your diagnosis and next steps would be. Click on the button below to see the resolution of the case.

Ear, Nose, and Throat Urgencies in Children

Urgent message: Many infections and injuries of the ear, nose, or throat are unique to the pediatric population. parents view many of these processes as urgent, leading them to seek immediate medical attention. Ann Mary Bacevice, MD Introduction Children tend to be especially susceptible to a wide range of infectious illnesses, as well as vulnerable to a host of minor traumas to or affecting the ear, nose, or throat. This, added to the fact that …

A 9-year-old Boy with Respiratory Symptoms

Urgent message: ‘Fresh eyes’ may be needed to reconsider an initial diagnosis or re-evaluate treatment in patients who present with unresolved symptoms. Joseph Toscano, MD The Case A 9-year-old boy presented to an urgent care clinic with a several-day history of dry cough and intermittently noisy and difficult breathing, especially at night. He had no fever or chest pain, no nasal discharge or headache, and no rash or pruritis. His past medical history included no …

Treatment of Pediatric Community-acquired Pneumonia in an Urgent Care Center

Urgent message: Although diagnosis of pediatric community-acquired pneumonia is not always straightforward, most cases can be diagnosed adequately by non-pediatricians and treated in the urgent care center, thereby reducing hospitalization for this condition. By Deena R. Zimmerman, MD, MPH, IBCLC, Scott Fields, MD, Nahum Kovalski, BSc, MDCM Introduction Pediatric community-acquired pneumonia (CAP) is a common illness. Estimates are that the annual incidence of pneumonia per 1,000 children in North America ranges from 30 to 45 cases …