Lawyer Monthly - January 2022 Edition

and other cases where the diagnosis was considerably more difficult. Unfortunately, in a number of these cases the physicians appeared to lack a firm understanding of the variety of situations in which an ACS can develop, and in other cases the physicians and allied health staff failed to recognise the signs and symptoms of the ACS or had embarked on a treatment plan which made it more difficult to make the correct diagnosis in a timely fashion. In the latter scenario I have seen pain medicine being administered more frequently and in higher doses to relieve the pain when a surgical consult and fasciotomies to release the pressures within the compartment were instead indicated. What methods did you use to handle these cases? Providing expert opinion in ACS cases can be challenging. I meticulously review and re-review every piece of documentation available. These reviews include physician notes (admitting physicians, treating physicians, consulting physicians, residents and medical student notes when available), nursing and allied health notes, all laboratory values, vital signs including pain assessments over time, medication records (keeping an eye out for the patients needing greater and greater amounts of pain medications at shorter time intervals), as well as all images and tests. If available I meticulously read and re-read depositions of everyone involved in the care of the patient, as well as that of the patient and everyone who has first-hand knowledge of the events that took place. Based on these reviews I create a timeline of pertinent events. I also perform a detailed search of the relevant medical literature to assure myself that I am abreast of newly published information regarding ACS. Once I have reviewed all the available medical records, created an accurate timeline, assured myself that I am current regarding the relevant literature on the topic, I write my report. Once written, I review and revise my report as many times as necessary to assure accuracy and consistency with the facts on hand, and that it clearly reflects my opinions based on my understanding of the records, my education and training and clinical experience. What should litigants and counsel be aware of in a case involving ACS? The diagnosis of an acute compartment syndrome can be difficult to make at times. However, because patients often suffer life-altering consequences, including loss of limb function or a loss of the limb itself, not to mention death, a delay in the diagnosis and treatment in this day and age is unacceptable. Unfortunately, ACSs present themselves in a variety of different scenarios, sometimes in a delayed or inconsistent fashion and often in patients who may have other significant injuries or illnesses, all of which may legitimately delay its diagnosis. However, once an ACS has been made or found to be most likely present there are few reasons to delay definitive treatment. The phrase “a chance to cut is a chance to cure” is no better exemplified than in the setting of an Acute Compartment Syndrome. Why have you taken a particular interest in ACS as a medical professional? The results of a missed acute compartment syndrome, including well-leg compartment 64 WWW.LAWYER-MONTHLY.COM | JAN 2022 EXPERT WITNESS The results of a missed acute compartment syndrome, including well-leg compartment syndrome, are often devastating for the affected patient.