Further Questions for patient
Sprain of joints:
- Have you observed muscle spasms?
- Have you experienced joint weakness recently (after the accident)?
- Can you shit a leg?
- Have you observed cases of bruising?
- Have you felt some discomfort or pain before your last dance class?
- Have you heard some audible sounds when you tried to walk?
Muscle injury:
- Do you have any health problems or feel discomfort right before the accident?
- Do you feel pain or irritation of the nerve endings?
- Does pain bother you when you take a rest?
- Can you use the ankle muscle in different positions?
- Have you felt relief during the last 12 hours?
- How can you classify your pain in the leg: as moderate, middle, severe?
Leg fracture:
- Have you observed some changes in your leg as soon as the accident occurred?
- Could you move your leg after the accident?
- Was there any blood after the accident?
- Is the leg pain localized or general?
- Do you have some abrasions before the accident? What were their reasons?
Differential Diagnoses:
Dislocation and sprain of joints and ligaments at ankle, foot, and toe level (S93): is the condition when an ankle is injured as a result of turning it in an awkward way and disturbing the joints. An ankle sprain is one of the most common consequences of physical activities, and the results of damage have to be carefully managed to avoid further problems (Wikstrom, Hubbard-Turner, & McKeon, 2013, p. 385). Ankle sprains could occur at all ages (Buttaro, Trybuski, Bailey, & Sandberg-Cook, 2013, p. 887). Dancers are the people, who could suffer from sprained ankles a lot and experience such symptoms as the inability to move or bear weight on the affected ankle, pain, and swelling that could be accompanied by bruising that may/may not be visible (Kadel, 2014, p. 839). Elizabeth admits that she landed on the side of her ankle and heard a pop. The result of such unsuccessful landing was a left ankle injury and the inability to bear weight and walk unassisted.
Injury of muscle, fascia, and tendon at lower leg level (S86): this type of trauma could include the health problems caused by the injuries of an ankle that influence muscles, fascia, or tendon in the chosen area. The main symptoms of ankle injury include pain and the inability to move it properly. Ankle stiffness is another important symptom of this kind of injury. As a rule, the causes of injuries in dancers are bad luck, fatigue, stress, or the inability to choose the right technique during the procedure (Rietveld, 2013, p. 426). Elizabeth reports her health as good. Therefore, it is possible to believe that her injury is caused by bad luck and the inability to gain control of a particular situation. Elizabeth just landed on the wrong side of the ankle that causing a popping sound and further inability to walk independently.
Unspecified fracture of the left lower leg (S82.92): is the condition when one of the bones in the leg is broken or cracked. The causes of this health problem could include falls, accidents, sports injuries, and overuse (Russell, 2013, p. 205). Patients with broken legs could have such symptoms as severe pain that does not make a move possible, tenderness, and swelling. Elizabeth says that she cannot walk without assistance and step on the damaged leg. Though she does not observe any obvious deformation of the leg (that is also a possible symptom of a fracture), it is hard to avoid this kind of possibility.
Body Systems to Examine:
HEENT: visual activity, PERRLA, and otoscope examination are required to look for any changes or possible problems with eyes, nose, and ears and to understand if the head has some injuries after the fall.
Pertinent positives: possible eyes problems and the inability to observe the territory, possible hearing problems, and the inability to listen to the direct instructions during the dance class.
Pertinent negatives: no vision changes or hearing problems are observed, and the patient does not suffer from other problems that could be identified during HEENT.
Respiratory system:
- Positives: the possibility of breath shortness because of stress or another psychological or emotional challenge that could occur because of the necessity to follow the orders and meet the expectations set by other people with the help of which it is possible to complete the task at a high level.
- Negatives: unlabored respirations are expected to prove the presence of an accident.
Gastrointestinal system:
- Positives – nausea or vomiting that could be the outcome of a fall.
- Negatives – the absence of nausea, vomiting, or abdominal pain that decreases the chances of other body systems’ involvement in the accident.
Muscular system:
- Positives: possible bruising and swelling that could be used as important symptoms, leg or ankle deformation that could be visible or invisible for an ordinary person but detected by a doctor, and the nature of pain that could be general or localized.
- Negatives: no evident changes in the area of the injury could prove the problems with joints or muscles that are not visible.
Neurological system:
- Positives: tiredness, weakness, and intolerance could be the reasons why the patient is not attentive enough to complete the tasks set during the dance classes.
- Negatives: no headache, confusion, and weakness that could make the patient distracted or unconfident in the decisions made and the steps taken.
Specific Lab/Testing To Offer:
An X-ray should help to understand the nature of pain in the patient’s ankle after the physical examination is made, and the final diagnosis is not given (Hastie, Divecha, Javed, & Zubairy, 2014, p. 583). It is wrong to avoid the necessity of physical examination and tests. At the same time, it is possible to make use of the results offered by MRI or CT scans (Buttaro et al., 2013, p. 887).
Did her mom do the right thing by waiting until this morning or should she have taken her to ED last night?
I think that her mom did make the mistake when she did not visit ED right after the accident took place. As soon as the injury occurred, it was necessary to visit the doctor and clarify the reason for such pain and her inability to step on her injured foot.
Elizabeth is a teenager, is it a HIPAA violation to share healthcare information with her parents if she is not present?
HIPAA does not actually violate the idea of sharing healthcare information about the conditions of a teenage patient being later absent. Much depends on the states where the situation takes place. Still, in the majority of cases, doctors are free to share the healthcare information about the conditions of their children with parents to avoid misunderstandings and wrong treatments.
References
Buttaro, T.M., Trybulski, J., Bailey, P., & Sandburg-Cook, J. (2013). Primary Care: A Collaborative Practice. (4th ed.). St. Louis, MO: Elsevier Mosby.
Hastie, G.R., Divecha, H., Javed, S., & Zubairy, A. (2014). Ankle injury manipulation before or after X-ray – Does it influence success? Injury, 45(3), 583-585.
Kadel, N. (2014). Foot and ankle problems in dancers. Physical Medicine and Rehabilitation Clinics of North America, 25(4), 829-844.
Rietveld, A.B.M. (2013). Dancers’ and musicians’ injuries. Clinical Rheumatology, 32(4), 425-434.
Russell, J.A. (2013). Preventing dance injuries: Current perspectives. Open Access Journal of Sports Medicine, 4, 190-210.
Wikstrom, E.A., Hubbard-Turner, T., & McKeon, P.O. (2013). Understanding and treating lateral ankle sprains and their consequences: A constraints-based approach. Sports Medicine, 43(6), 385-395.