Welcome to this month’s What’s Your Diagnosis Challenge!
But before we begin, check to see if you got the previous case on Emergency Department Management of Patients With Sickle Cell Disease correct.
Case Presentation: Elder Abuse and Neglect: Making the Diagnosis and Devising a Treatment Plan in the Emergency Department
An 80-year-old man is brought in by EMS for high blood sugar, and you note that this is his third time presenting to the ED with this chief complaint…
- As you examine the patient, you ask him why he isn’t taking his medications, and he states that he hasn’t been able to get to the pharmacy.
- On examination, the patient is ill-kempt, with poor skin turgor, long toenails, and a small wound on his left foot.
- At first, you think he’s being difficult, but then you begin to wonder whether something else could be going on…
Case Conclusion
You discussed the case with the EMS team that brought the patient in. His initial blood sugar level was 478 mg/dL. The paramedic was concerned about the patient’s living situation and the reliability of his caregiver, a grandson who works as a long-distance truck driver. The EMS team did not think the patient had access to his medicines or food when his grandson was gone on a trip. You completed a thorough physical examination and documented poor nail care and an ulcer on the patient’s left heel, which was initially concealed by his socks.
You decided to make a report of neglect to Adult Protective Services. The patient was admitted to the hospital for management of his uncontrolled hyperglycemia and for a podiatry evaluation for a possible osteomyelitis in his heel. He was evaluated by case management, physical and occupational therapy, and social work, all of whom agreed the patient would benefit from placement in a nursing facility. The patient admitted that he could not care for himself when his grandson was not home and was agreeable with the plan.
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Last Updated on November 4, 2024
