Case Archive
Otolaryngology, Emergency Medicine
Ref. # 12238

A four year old North Carolina boy fell off a bed with a feather duster in his mouth. He was admitted to the ER, diagnosed with posterior pharyngeal trauma, and released. The next day he returned with increased respiratory distress and fever. His parents were instructed to take him to the nearest major hospital, where he was diagnosed with craniocervical necrotizing and postpharyngeal puncture wound. He underwent an emergency I & D of the retropharyngeal and lateral pharyngeal spaces. A medQuest otolaryngologist reported the care during the initial visit was deficient: the boy should have been admitted for further evaluation as the source of bleeding was not identified. On the second visit the boy was febrile and tachypneic. X-rays showed air in the soft tissue, indicative of a head and neck emergency and more specifically, retropharyngeal abscess. If the hospital was unable to manage such an emergency, the boy should have been stabilized and sent to an ambulance to the nearest major hospital. A medQuest ER specialist reported that a federal COBRA violation was committed because arrangements were not made to transport a patient with an emergency medical condition.

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