Deadly Diagnosis with a Difficult Dispo
59 MDW San Antonio United States
Pagination or Media Count:
The diagnosis and necessary intervention is obvious based on the plain films obtained. The patient had palpable crepitus to his right medial knee which was confirmed by the hypodensities seen on his x-rays. What made this an interesting case was the difficulty securing the patients disposition. Within five minutes of this patient arriving the emergency departmentED, a surgical consult was placed and the patient was started on broad spectrum antibiotics. Within fifteen minutes a general surgeon was at the bedside. After reviewing the information, reported that the consult should go to the orthopedics team because the infection was isolated to the patients extremity. Within 20 minutes, Orthopedics arrived bedside and agreed that the case was concerning for a gas producing infection of the patients leg. The orthopedics team attempted to calculate a LRINEC score with the initial set of resulted labs excluding a CRP. The LRINEC score at that time suggested the patient was low risk for necrotizing fasciitis. This score though in complete and stable vitals reassured the orthopedics team that the patient did not need to be taken immediately to the OR and could wait for a CT scan of the patients leg. As the emergency medicine team, we advocated to take the patient emergently to the operating room, feeling the patient would likely decompensate if source control was not quickly obtained.
- Medicine and Medical Research