This case involves a college athlete who developed complications following an injury to his leg during a football game. He was experiencing pain following the game and went to a clinic for evaluation. The pain persisted, and he developed edema, after which he presented to the emergency room. At the ER, he was seen by a PA – however, he was not evaluated by a physician. He visited his primary care physician the next day, who suggested he visit an orthopedic surgeon, and the earliest appointment he could was over a week later. Upon assessment by the orthopedic surgeon, the patient was diagnosed with compartment syndrome with an accompanying infection. The patient has since undergone multiple operations, and has suffered significant nerve damage.
Question(s) For Expert Witness
- 1. What steps would you take in order to manage a patient with this infection?
- 2. Have you ever lectured or published on this subject?
Expert Witness Response E-007867
An initial evaluation of a patient with this infection is to conduct a thorough history and a physical exam. Based on the patient’s history and the severity of the infection a decision should be made to treat with intravenous antibiotics as an admitted patient or oral antibiotics as an outpatient. If the patient is treated with oral antibiotics there must be a follow up within 24 to 48 hours to evaluate the efficacy of the treatment and any development of complications. One of my responsibilities as an attending emergency physician at an academic hospital is to teach residents and medical students. Therefore I give formal as well as informal lectures on topics such as infections and compartment syndrome. Given the incidence rate of compartment syndrome I have seen a fair number of patients with this complication in my 14 years of practicing Emergency Medicine.
Expert Witness Response E-025783
I am a practicing academic emergency physician. I see patients with this chief complaint on a regular basis. I also have a Masters Degree in Medical Research and am fellowship-trained. This added training has given me specific skills that lend themselves well to a meticulous review and careful analysis of cases such as these. When managing this infection, first, you must make sure the diagnosis is correct. Then you should assess for likely causes such as strep vs MSSA vs MRSA. Then you should outline area of infection with a surgical pen. Antibiotics should be administered. If the patient is well-appearing, oral antibiotics are appropriate. If the patient is acutely ill, IV antibiotics and observation is indicted. I have seen some cases with compartment syndrome as well.