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Broken nose, gunshot wound and not an X-ray in sight

January 15, 2007|Marc Siegel | Special to The Times

"In Case of Emergency," ABC, Jan. 3.

The premise: Former high school friends are reacquainted during trips to an emergency room where another alumnus, Dr. Joanna Lupone (Lori Loughlin), treats them. Each lists a friend from high school as an emergency contact on the hospital forms, which speeds their unusual reunion.

One of them, Jason Ventress (David Arquette), accidentally shoots himself in the foot with a large handgun while contemplating suicide. Lupone bandages the foot and he is released. Another alumnus, Harry Kennison is punched in the nose. Lupone touches his tender nose and pronounces it broken. He is then sent home without treatment.

The medical questions: What is the medical purpose of listing a person as someone to contact "in case of emergency"? Shouldn't an accidental gunshot wound lead to questions about a possible suicide attempt? Is cleaning out and bandaging the wound (the treatment Ventress received) sufficient, or would he be given X-rays and antibiotics? Can a broken nose be diagnosed so easily -- without X-rays or at least a careful examination?

The reality: The most important use of the "in case of emergency" section of the hospital chart occurs when the patient is either comatose or lost to follow-up after discharge. In this episode, there is no real need to use the emergency numbers.

Ventress' gunshot wound should have led to extensive questioning about a possible suicide attempt. The police would have been called, as well as a psychiatric evaluation team.

As far as the wound itself, standard protocol would include X-rays, antibiotics, an orthopedic consult and a tetanus shot if the patient hasn't had one in five years. But Ventress never receives X-rays, antibiotics or an orthopedic evaluation.

As for the broken nose, Dr. Mark Morocco, assistant professor of emergency medicine at UCLA, notes that X-rays are "almost never done to confirm a broken nose because X-rays often miss it and don't help you to treat it." The ER doctor would attempt to staunch the flow of blood by pinching it or packing it with gauze after first examining the nasal passages for a septal hematoma (ball of blood) that would require emergency removal. Antibiotics are routinely given because of a high risk of infection.

Though Lupone exhibits a soothing manner, her treatment is lacking.

Dr. Marc Siegel is an associate professor of medicine at New York University's School of Medicine. E-mail

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