This case takes place in Vermont and involves a patient who presented to hospital shortly after a fall that resulted in an injury to her ankle. Following evaluation, it was determined that she had suffered a small fracture, and it was noted that the patient had redness on her leg at that time. Nevertheless, the patient was placed in a cast and was given crutches. The patient fainted shortly thereafter and was kept in the hospital for observation. During her stay at the hospital, the patient’s vital signs began to deteriorate, and it was also noted that she had a red line running up her leg that was consistent with a serious infection. The following day the patient went into cardiac arrest and died. It was later revealed that she had a severe bacterial infection.
Question(s) For Expert Witness
- 1.) How often do you treat patients with this presentation?
- 2.) What is the standard work up for these patients?
- 3.) Could you review the medical records and opine on your findings?
Expert Witness Response E-002758
In ID, we routinely consult on Grp A cellulitis — necrotizing fasciitis is an infrequent but severe and predictable complication of these infections, including in the post-trauma setting. These infections require a high index of suspicion with prompt surgical consultation / intervention, as well as appropriate antibiotic therapy promptly provided. The cast can sometimes mask close clinical observation, but one must maintain vigilance particularly if vitals are unstable or there are other signs of multi-organ involvement.
Expert Witness Response E-008307
This is not an uncommon scenario (skin/soft tissue infection after trauma). Once cellulitis was evident, the patient should have been given appropriate antibiotics; we would also evaluate for deeper infection (bone/muscle/joint/heart involvement). I am actually seeing a similar in-patient right now.