The ED is not a substitute for outpatient wound management but rather the gateway for where many patients enter the health care system. Emergency physicians will need to weigh the severity of the wound and infection status to determine if inpatient versus outpatient management is most appropriate. Social determinants, such as a history of poor medication compliance, housing insecurity, lack of a support system and transportation resources, comorbidities, or need for vascular intervention, may necessitate inpatient admission. Photographic documentation of the wound is helpful to enhance continuity of care. Implementing a thoughtful, cost-effective approach to ED wound care centered on optimizing wound healing and referral may improve patient outcomes, reduce admissions, and optimize resources.

Back to the patient. On closer exam, the patient’s blanching erythema of his lower legs was secondary to chronic venous insufficiency with concern for early-stage development of a skin ulcer. A foam dressing was placed over the ulcer on his left ankle, and compression dressings were applied to his lower legs to reduce swelling, transitioning to compression stockings in the coming days. The ED case manager arranged follow up in the wound care clinic in two days.

References                  

1. Nussbaum SR, Carter MJ, Fife CE, et al. An economic evaluation of the impact, cost, and Medicare policy implications of chronic nonhealing wounds. Value in Health. 2018;21(1):27-32.
2. Bluestein D, Javaheri A. Pressure ulcers: prevention, evaluation, and management. Am Fam Physician. 2008;78(10):1186-1194.
3. Glauser J. Wound management: Do we know anything for sure? Emergency Medicine News 2004;26(13):19.
4. Hoversten K, Kiemele L, Stolp A, et.al. Prevention, diagnosis, and management of chronic wounds in older adults. Mayo Clin Proc. 2020;95(9):2021-2034.