Urgent Care Troublemakers!

No fancy links or articles today, just a quick listing to serve as a reminder of some diagnoses that can easily "sneak up" on the urgent care provider. It is one issue to have diagnoses that are dangerous because their presentation is subtle or vague. Many of these items, such as PE, despite their stealthiness, are at the forefront of or diagnostic radar because they are common. 

Consider though, the ultimate challenge though are entities that are rare and that have perplexing presentations. I am not talking about "diseases you only see on the boards" such as pheochromocytomas. I am talking about the diagnoses that you see every 5-10 years once, and even then your mind is struggling to piece the clinical clues together. Review the list, feel free to add others in the comment section below, and as you read each entry, think to yourself, "Can I recall what one of those patients "looks like" and would I think of it/catch it in a busy clinic?"

• Kawasaki Disease- Fairly rare. The prolonged fever often leads to several physician visits, and you may be seen in the urgent care after one or several pediatrician visits have been fruitless. More vexing, is can you mentally link the eye issues, or the hand/feet issues, and the lymph nodes? Recall Rex has UpToDate, so feel free to quickly review these disease criteria. 
• International Travel. Everyone travels. No one takes their malaria meds. No one gets their shots. No one listens, but they will blame you for what you miss when they return from their business/missionary trip with a fever. I do not encourage malaria smears in the express care; rather, I encourage ample consideration for the ER for anyone with a fever and international travel in the last month. Too many diagnoses, not enough time or labs or continuity to address the labs.
• Acute Angle glaucoma- Don't be ashamed, if you don't recall what this is take the opportunity to look it up. Again, its rarity will allow you to miss this diagnosis.
• Compartment Syndrome- I advise go with your gut here. Recall many of the classic "p's" are late signs. 
• Temporal Arteritis- Don't be fooled into ignoring jaw pain. Edge on the side of caution, and consider steroids with appropriate, timely referrals. We see so many benign headaches and are always on the lookout for subarachnoid hemorrhage so much that this major diagnosis possesses great stealth. 

What items would you add to this list? All are uncommon. All are dangerous. Are all on your radar?