I have reviewed 3,247 emergency department records in the past five years. The first 48 hours tell me everything I need to know about whether your client walks away with a settlement or you waste 18 months on a case with no merit.
The Triage Note Captures What Defense Experts Will Spend Years Trying to Erase
The triage nurse documents your client's exact words within minutes of arrival. "My back didn't hurt before the accident" becomes critical when the defense pulls a chiropractic record from eight years ago. The initial pain scale rating of 8/10 in the ED becomes 4/10 by day two after pain management gets involved. I have seen defense attorneys argue pre-existing conditions in cases where the initial assessment clearly states "no prior history of lower back pain per patient." That triage note is your shield. The ED physician's assessment happens before the patient's attorney contacts the hospital, before risk management reviews the chart, before anyone knows this becomes litigation. You get pure clinical judgment untainted by legal considerations.
Vital Signs Document the Severity Defense Teams Will Minimize
Blood pressure of 180/110 in a previously normotensive patient tells me about pain severity and physiologic stress. Heart rate of 120 beats per minute in a resting patient indicates sympathetic nervous system activation from trauma or acute injury. Respiratory rate of 24 breaths per minute shows respiratory compromise or severe pain response. I reviewed a slip and fall case where the patient's initial BP was 200/115 from a traumatic subdural hematoma. By day three, the defense expert claimed the patient had chronic hypertension. The first 48 hours of vital signs proved the hypertension was acute and trauma-related. Temperature elevation within 12 hours of surgery points to infection. Temperature spikes at 36 hours post-op become your sepsis timeline.
The Initial Imaging Captures Acute Injury Before Inflammation Clouds the Picture
Radiology reads change. The preliminary read done at 2 AM by the on-call radiologist often differs from the final read completed three days later by the attending radiologist. I want both reports. The CT scan performed within six hours of injury shows acute hemorrhage, fracture lines, and soft tissue swelling at their truest presentation. MRI performed within 24 hours distinguishes acute edema from chronic degenerative changes. The radiologist notes "no evidence of prior fracture" in the initial imaging report. Three months later, the defense brings in an expert who claims the fracture pattern suggests previous injury. Your initial imaging report shuts that argument down. I worked a medical malpractice case where the first chest X-ray post-surgery showed a retained surgical sponge. The radiologist noted it. Nursing staff missed it. Patient developed sepsis. That initial imaging report established the timeline and causation.
Medication Administration Records Reveal What Providers Actually Believed
Nurses administer morphine 4mg IV every two hours to patients in significant pain. They give Tylenol to patients with minor discomfort. The medication administration record shows what the treatment team genuinely believed about your client's condition. I reviewed a workers compensation case where the nurse administered Dilaudid 2mg IV every three hours for the first 36 hours post-injury. The defense claimed the injury was minor. The MAR proved otherwise. Nursing staff do not waste controlled substances on patients who are faking. Antibiotic administration within the first 24 hours establishes infection presence or surgical prophylaxis. The timing matters. Antibiotics started at hour six post-op indicate surgical site infection concern. Antibiotics started in the pre-op holding area indicate prophylaxis.
Nursing Notes Before the Chart Review Happens Tell the Unfiltered Truth
Nurses chart patient statements, observable behaviors, and clinical status in real time during the first 48 hours. "Patient crying out in pain with minimal movement" becomes "patient resting comfortably" after risk management reviews the chart. "Dressing saturated with serosanguinous drainage, physician notified" becomes your evidence of surgical complication. "Patient oriented to person only, confused about place and time" documents traumatic brain injury symptoms before the neurologist formally diagnoses cognitive impairment. I have seen nursing notes from the first shift post-admission describe symptoms the physician claimed developed days later. Those initial nursing assessments establish your timeline. They corroborate your client's version of events before the medical team builds a defensive narrative.
Lab Values Within 24 Hours Establish Baseline and Reveal Missed Diagnoses
Hemoglobin drops from 14 g/dL on admission to 9 g/dL at 18 hours post-surgery. That is internal bleeding. The surgical team should have caught it. Creatinine rises from 1.0 mg/dL to 2.8 mg/dL within 36 hours. That is acute kidney injury. White blood cell count jumps from 8,000 to 18,000 cells per microliter in the first 24 hours. That is infection or significant inflammatory response. Lactate levels above 4 mmol/L indicate sepsis or tissue hypoperfusion. The first 24 hours of labs show the body's immediate physiologic response to injury or medical intervention. These values do not lie. They establish severity, reveal complications, and prove causation before anyone constructs a defensive timeline.
Frontline Legal Nurse Consulting reviews medical records for attorneys who refuse to leave money on the table. Call (928) 223-4233 or visit frontlinelegalnurse.com.