Patient Case 1: 27-Year-Old Man With Car Accident Injuries

Matthew A. Torrington, MD: Our first case is a 27-year-old man who presented with extreme pain in his right ankle, ribs, and arm after getting into a car crash. He has a past medical history, significant for substance use disorder, high blood pressure, and diabetes. He works from home, drinks 1 to 2 cups of hard alcohol when he’s stressed, smokes a pack of cigarettes a day, and is married with 4 children. He takes buprenorphine 2 mg per day, lisinopril 20 mg, and metformin 500 mg. He came into the emergency department [ED]. In the first hour upon arrival at the ED, he described pain as 10 of 10. He got 1 g Tylenol IV [intravenous]. In the second hour, he had 6 of 10 pain. There was no comment about his pain and what they gave him then. In the third hour, 7 of 10. In the fourth hour, 10 of 10. The imaging showed a hairline, a broken ankle, a broken rib, and a small hairline fracture on his clavicle. CT and MRI showed no tissue or brain damage. He got a cast for his right ankle and then got started on low-dose opioid therapy, Percocet 5/325 [5 mg oxycodone hydrochloride, 325 mg acetaminophen], 1 every 4 to 6 hours as needed for pain for 5 days until he gets to his primary care provider.

This transcript has been edited for clarity.