Forefoot / Midfoot · Trauma · Infection & Wound · Standard
Work Accident
Podiatric surgery residency interview case. Work through it the way you would at an interview: take the history, ask for the exam and imaging, then commit to a diagnosis and plan.
Chief complaint
"A jackhammer landed on my foot." (via Spanish interpreter)
38-year-old Spanish-speaking male seen in the ED.
History of present illness
One hour ago, while working, a jackhammer landed on his RIGHT foot. He was wearing steel-toed work boots. He has severe pain and bleeding from the toes and could not walk.
- Isolated injury; no fall, head strike or loss of consciousness
- Pain 10/10 in the forefoot, constant
- Toes feel numb
- Last meal about 5 hours ago
- Last tetanus booster unknown
Questions a strong candidate asks at this step
- Use a certified medical interpreter (history and consent)
- Exact time and mechanism — crush, how heavy, how long was the foot pinned?
- Footwear (steel toe cap can itself crush the toes) and contamination of the work site
- Numbness, tingling, coldness — the 6 Ps; pain out of proportion (compartment syndrome)
- Other injuries; head strike / LOC
- Tetanus status and last meal (NPO)
Present the rest of the case
Past history, exam, imaging, assessment, plan and discussion questions, with model answers, are in the interactive trainer. The diagnosis is kept there on purpose so you can practice committing to one.