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(Author: Brent Jones – April 20th, 2005)
ER Knee (6.1.2) Storyboard: ACL Injury (6.1)
David Lambert is on vacation and injured his right knee. He was just assessed at a rural community health centre and has been transferred to the closest hospital where he is admitted to the ER.
David is taken from the waiting room to an examination room by an ER nurse. She reviews the reason for the visit and acquires information from David about any allergies and current medications. David is feeling the effects of the recent narcotic analgesic and is a bit vague in providing history. The nurse obtains his blood pressure, heart rate and temperature and records all of this data in the ER’s EMR. She accesses his records and obtains David’s health profile and notes the allergy to non-steroidal anti-inflammatory drugs (NSAIDs).
The ER physician that evening, Dr. Brown (a local family physician), quickly reviews David’s health profile and the nursing notes in the EMR. He then sees David and takes the history of the present injury and asks about past medical history. Dr. Brown examines the knee and feels that an x-ray is warranted to look for a fracture. He records his findings in the EMR and completes the appropriate requisition form for the x-ray.
David is wheeled to the DI department where the technician reviews the requisition for the x-ray. A DI RIS file is created for David and the x-ray is taken. This hospital has a full PACS system so images are captured in a digital format. David is wheeled back to the ER.
Dr. Brown reviews the x-rays on monitors in the ER and rules out a fracture. His diagnosis is a complete tear of the ACL with possible medial meniscus tear. Crutches, a hinged brace and a narcotic analgesic are provided and David is discharged from the ER. Dr. Brown completes his notes of the encounter in the EMR.
Tables
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History |
Physical exam |
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Provisional diagnosis |
Management plan |
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Allergies |
Medications |
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Past medical history |
Past surgical history |
This health service follows upon the community health centre visit (see 6.1.1) and describes all the health service events taken during the patient visit, for the first time, at a local hospital ER. Previously, the patient was just assessed at a rural community health centre and has been transferred at this local hospital ER; the patient is on vacation in this jurisdiction and lives and other jurisdiction.
Each health service event takes place during a same period of time (e.g. without cut of time), in presence or not of involved client; the health service events can be grouped in a health service encounter.
| General Info | |
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| Name | 6.1.2 ER Knee Encounter Diagram |
| Type | Use Case Diagram |
