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Case
#52 "Not Too Sick…Yet"
by Charlene Babcock Irvin, MD
 At
sign out rounds, I took over the care of a
51 y/o female who presented with leg pain.
She did not do anything unusual yesterday,
and felt fine this morning, but has been
having increasing pain in her left leg. She
notes the pain is worst in the lateral thigh
area. Movement increases the pain. The
leaving doc notes the exam was unimpressive
except for pain in the lateral muscles of
the thigh. Because the pain seemed more
severe than a muscle pull, a vascular study
to r/o DVT was ordered. She really didn’t
have any boney tenderness, and no history of
trauma, so no x-ray was ordered.
I then became busy with two new patients and
another sign out that was septic, so it was
about one hour before I got back to do my
own exam on this patient.
She was asking for more pain medication, and
noted that the pain medication given earlier
worked, but now had worn off. When asked to
point where it hurts the most, she pointed
to mid thigh, lateral portion on the left.
PMH: NIDDM, HTN
SH: No smoking history. Social alcohol
consumption
FH: Negative for DVT
ROS: No fevers, chills, nausea, vomiting.
She has never had pain or symptoms like this
before. No chest pain, shortness of breath,
abdominal pain, dysuria, bowel problems or
rashes.
PE: Obese black female (wt = 120 KG) in no
acute distress talking with her friend at
the bedside.
VS: (on arrival—now 3 hours old) BP 145/82,
RR=24, Pulse = 98, Temp = 98.9 Sat = 96% RA
HEENT: Normal
Heart: Tachy at 100 now
Lungs: Clear bilaterally
Abd: Obese, non-tender
Ext: Pulses present bilaterally (Dorsalis
Pedis), No erythema is appreciated anywhere
along the leg. There are no rashes. ROM is
limited by pain in the thigh. Movement of
ankle and foot is unremarkable. There is no
boney tenderness to the knee or tibia/fibula
or foot. When palpating the area of the
lower thigh, I noted a small amount of
crepitus in the subcutaneous area.1.
There are multiple actions (>10) that need
to be done immediately, what are they?
2. Does this patient have SIRS?
3. What is the cause of this and how is it
treated?
Click here for answers and to respond
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