A 50-year-old white male went to the emergency department with complaints of right leg pain.

Case Study 2

A 50-year-old white male went to the emergency department with complaints of right leg pain. The patient is an avid runner, and knowing this, the provider diagnosed the patient with a right leg muscle strain. The patient was sent home with Flexeril as needed and Motrin 800 mg q8h as needed. One week later, the patient followed up with his primary care doctor with continued right leg pain. His doctor instructed him to continue to take the muscle relaxant and Motrin, and advised that the pain should subside in 5–10 days. The following day the right leg pain increased, prompting the patient to return to the emergency department. Multiple providers failed to diagnose a blood clot in the patient’s right leg.

To prepare:

• Review Part 11 of the Buttaro et al. text in this week’s Learning Resources.
• Select one of the cased studies provided. Reflect on what went wrong in this case study, as well as why patient blood clots continue to be misdiagnosed.
• Think about how you might have prevented the misdiagnosis of the patient the case study. Consider strategies for obtaining patient history, ordering diagnostics, and recommending potential treatment options.

required Readings

Buttaro, T. M., Trybulski, J., Polgar Bailey, P., & Sandberg-Cook, J. (2017). Primary care: A collaborative practice (5th ed.). St. Louis, MO: Elsevier.

ANSWER

Errors and Misdiagnosis

In the provided case study, various omissions and errors led to the misdiagnoses. First of all, the caregivers failed to conduct a thorough evaluation of the patient’s symptoms. The care provider should have taken sufficient time to obtain reliable patient history. Questions regarding the medication history of the patient could have given reliable leads to the appropriate diagnoses. For example, the caregiver could have asked about family history of clotting conditions, recent long-distance runs, recent trauma, hydration status, smoking history and any history of malignancy (Buttaro, Trybulski, Polgar Bailey & Sandberg-Cook, 2013). The application of OLDCARTS in the HPI process is also critical in ensuring the correct diagnoses. Secondly, the caregiver failed to conduct diagnostic tests. Also, there is no documented account of the physical appearance of the affected area which implies that the diagnosis was purely based on assumptions.

Misdiagnosis’ Prevention In the above case study, further patient’s assessment would have been paramount to prevent misdiagnoses. Upon the return of the patient with no symptom relief, the caregiver would have ordered more testing, regardless of the muscle strain diagnoses made previously. Taking comprehensive history of the patient would help to single out DTV. Blood works, such as D-Dimer, CMP, PTT, PT/INR, and CBC should have been considered. Ultrasound or Bilateral Lower Extremity Doppler is a necessary diagnostic tool in the case at hand (Ball, Dains, Flynn, Solomon & Stewart, 2015). Once a confirmation….