Emergency Room Doctors Fail to Order Appropriate Testing For Wounded Patient with Diabetes

Case Overview

Questions to the Emergency Medicine expert and their responses

If a patient's cast is removed, should his orthopedic surgeon be informed of this?

It is the standard of care to be very cautious in treating hand wounds, especially in a diabetic, and the patient's orthopedic surgeon should probably have been called when the patient returned to the ED the next day.

If a diabetic patient presents with recurrent pain in her hand due to previous trauma, would that warrant further workup?

However, if there was no fracture and the patient was returning with pain, it was fine to remove the cast and, in fact, it is often the cast that is causing the problem - casts can cause compartment syndrome which can be dangerous. If the hand did not appear to be infected, no blood tests would be indicated. However, a few important questions remain. Were there breaks in the skin to cause infection? Did the hand at the second ER visit have any signs or symptoms consistent with infection? Was the cast too tight and possibly causing early compartment syndrome that was fixed by cast removal? If there were no signs of infection on the initial hand evaluation at all, there would not be any reason to do any further evaluation, especially if the cast was tight and thought to be causing the pain.

About the expert

This highly qualified, board certified and well published expert earned her Bachelor's from Brown University and her medical degree from Yale University School of Medicine. This was followed by and internship and residency in Emergency Medicine at Yale New Haven Hospital. This expert then completed her formal medical education by doing a fellowship in women's health at the same institution. This expert is a member of numerous medical societies in her field and was even elected president to one of them. This expert has also earned awards for her contributions as a physician to her patients and trainees. This expert is well published, having authored 9 peer-reviewed papers and 4 book chapters/reviews. This expert's proficiency in research has even allowed her to serve as a reviewer and editor of three medical journals. This expert currently serves as Assistant Professor and Attending Physician in Emergency Medicine at an Ivy League University Hospital Center.

E-045177

Specialties:

Emergency Medicine