Misdiagnosed in the ER :(

[JUSTYSMOM]

Hi,

About three weeks ago, I banged my right big toe HARD. I mean REAL HARD! I don't even remember what I banged it on. Probably a box of canned goods we had around the house (from all of the HURRICANES we had down here in S. Florida!!)

It didn't hurt at first. But after a day or two, it was thorobbing, swollen, hard to walk on- etc etc. I figured it was just badly bruised. So I waited a few more days (kept walking on it). Uh oh- now I can't fit my shoe over my foot- even more pain & swelling. My leg is perpetually being elevated for the swelling.

So I take off a few days from work. The foot keeps getting worse. Now I can't even touch my toe to the ground. I notice that my foot (especially my right toe/joint area) is RED, HOT and EXTERMELY painful to the touch. I can't even touch it without wincing in pain!

Ok- time to go to the ER. I can't take the pain anymore. I am convinced it is broken! I get there and they give me a wheelchair to sit in. They finally take x-rays. The x-rays are normal. The doctor tells me that I have Cellulitis. The nurse comes in and gives me a HUGE shot of antibiotic. That hurt like hell! Then they prescribe Keflex for 10 days 3x day.

Ok- long story short- I am on this antibiotic for a good 7 days- I still go to sleep with pain & wake up with pain . I have no real improvement. As a follow up to the ER, I go to my Podiatrist. He takes one look at my foot and says it's not Cellulitis.

I have GOUT! He puts me on Indomethacin 3x daily. Low & behold within 3 days- my foot shows MIRACULOUS improvement! WOW! I just wish I had the indomethacin to begin with. It would have saved me so much pain and anguish.

Is this typical to be misdiagnosed for things like this case?

Thanks,

Julie :)

[ERNurse752, RN]

As you described your s/s, the first thing I thought was gout. But I already knew you were misdiagnosed b/c you said so.

I think it would be very easy to misdiagnose you - you are a 36 y/o female, which is not typical for gout, plus you have a history of recent trauma to the area.

The index for suspicion was raised when you had no improvement with time or treatment with abx.

Hope you keep on feeling better!

[ERNurse752, RN]

Just wanted to add, situations like yours are a good example of the reason ERs always tell people to follow up with PCP/specialist/etc, b/c things may not be as they seem in the long run what they seem to be in the ER.

:)

[CHATSDALE]

you have my sympathy...i have chronic gout and sometimes if flares up acute..real bummer..glad you are doing better

[Jolie, BSN]

Please understand that I'm not trying to be a flame-thrower here, but I suspect that your choice of the ER for care may have contributed to your mis-diagnosis. ER personnel practice with the mindset of caring for patients with acute injuries and illnesses, not patients with internal medicine-type problems. (Although they certainly see their fair share of that too.) They examined you, reviewed your labs and X-rays, and came up with what they believed to be the proper diagnosis, based on their mindset. I wonder if you had been seen in a family practice office or internal medicine office if the proper diagnosis would have been reached sooner, because of a different mindset on the part of the practitioner.

I know how frustrating this is, but please don't be too hard on the doc who treated you in the ER. S/he did not know you and was relying on the data at hand. Remember, docs are trained to "think horses" when they hear hoofbeats. Your case was a "zebra", and a clear indication as ERNurse752 states, of why follow-up is so important.

Hope you're feeling better.

[JUSTYSMOM]

Please understand that I'm not trying to be a flame-thrower here, but I suspect that your choice of the ER for care may have contributed to your mis-diagnosis. ER personnel practice with the mindset of caring for patients with acute injuries and illnesses, not patients with internal medicine-type problems. (Although they certainly see their fair share of that too.) They examined you, reviewed your labs and X-rays, and came up with what they believed to be the proper diagnosis, based on their mindset. I wonder if you had been seen in a family practice office or internal medicine office if the proper diagnosis would have been reached sooner, because of a different mindset on the part of the practitioner.

I know how frustrating this is, but please don't be too hard on the doc who treated you in the ER. S/he did not know you and was relying on the data at hand. Remember, docs are trained to "think horses" when they hear hoofbeats. Your case was a "zebra", and a clear indication as ERNurse752 states, of why follow-up is so important.

Hope you're feeling better.

Naw- I appreciate the care I received at the ER. I honestly thought my foot/toe was broken. That's why I went to the ER. I was in AGONY!!!

In any case- they DID say to follow up with my primary care- which I did (actually a podatrist). That's when I got the proper diagnosis. It sucks that so may patients use the ER as their primary care "physcians".

[Victoriakem]

OMG, it's so wonderful to actually have someone follow up with a Doc, & not just return to the ED. Gout is often hard to dx, esp. when you had a recent injury to that area. Hope you feel better soon.

[Silicone]

Was the gout diagnosis confirmed with a blood test?

[|nexus|]

I once took care of a pt on a medicine unit who was there for three days because nobody could figure out whether she had cellulitis or gout and they weren't letting her go until they knew. I suspect that the two dxes are frequently mixed up.

[veteranRN]

I imagine they are mixed up. Especially since the primary sxs are "red, hot, and swollen". Sounds like both to me.

[KRVRN, BSN, RN]

It would be interesting to know whether the podiatrist's first impression would have been cellulitis or gout if you had gone there first? He had a bit of an edge since he had the knowledge that several days of abx hadn't helped.

[ChrisA]

Additionally, isn't cellulitis a "riskier" situation, thus inducing the ER to treat for the more serious dx?