A case of leg pain


Mrs J was a 75 year old female who presented to ED with left knee pain.

Past medical history: Nil of note

Admission care

09:28hrs: Patient seen by triage nurse

Explained that she had pain in her left knee the previous day, and had a poor night’s sleep. She was able to mobilise and was fully weight bearing but walked with a limp. The patient gave a pain score of 10/10 and reported no history of trauma.  Bloods ordered: FBC, U&E, CRP, D-dimer.


Analgesia provided with two co-codamol 30/500 tablets.

09:48hrs: Observations checked by HCA

Observations taken- 186/76 and a temperature of 37.6. Patient’s pain score was reported as 10/10.

11:12hrs: Patient seen by emergency nurse practitioner

Noticed gradual discomfort in right knee over past 2 days, got worse last night and kept her awake overnight. Took paracetamol yesterday which made no difference but codeine and paracetamol in Emergency Department has helped a bit. Denies any falls or injury to knee, no previous knee problems.

O/e: Decreased range of movement and swelling of the right knee, with tenderness along the medial collateral ligament and joint line. Calf soft and non tender. No abnormality to the right lower leg.

Impression: Soft tissue inflammation

Advice: Regular codeine and paracetamol, with a topical anti-inflammatory. Rest the leg with moderate activity for a few days, and to see her General Practitioner if there was increasing pain/redness/heat or reduced mobility.

11:49hrs: Discharged by emergency nurse practitioner

Discharge summary completed – soft tissue injury of the left knee as presenting complaint. No follow-up required.

Subsequent events


Next day 09:30hrs:

Patient collapses at home, found by husband on the floor in the kitchen.  Ambulance called, pronounced dead at the scene.

Coroners post-mortem performed.

Cause of death:
1a: Pulmonary embolus
1b: Deep vein thrombosis (left leg)


How would you describe the level of care that the patient received during her admission assessment?

1 = very poor care, 2 = poor care, 3 = adequate care, 4 = good care, 5 = excellent care

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