Given Rowley's put this out for consideration, I'm guessing the answer
isn't, "Neither A nor E, triage to car park!"
He's alcoholic. Has he had a fit and sustained a tear to one of his
adductors? That'd give him a hard tender area. By extension, is his clotting
off, resulting in a muscle haematoma?
DVT seems unlikely at that level without the whole leg being swollen; I
wouldn't anticlog him anyway with the possibility of making a muscle
haematoma worse.
Suggest:
1) Analgesia as needed
2) FBC, UE, LFT, clotting. D-dimer NOT indicated due to presence of
?traumatic cause
3) Bring back to ED clinic for USS of thigh +/- deep veins, assuming you
don't have your own scanner and someone competent to do this there and then.
4) Stern words about what ambulances cost, what EDs are for and what GPs are
for!
Deep-seated sepsis or an abscess seem unlikely - afebrile and with normal
haemodynamics. I suppose this, or even femoral osteomyelitis, should be
considered, but I'd suggest, based on the information given, this is
unlikely.
All the best
Matt Heywood
[log in to unmask]
EM Spr, Norwich, UK
|