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Case 27: 40y/o construction worker presents to the ED with pain and swelling of the RLE x 3 days, s/p work-related laceration. No discharge from the lac. Last tetanus 3 years ago. Febrile to 103.1 and tachycardia.

1. Emergency orders
2. Physical Exam
3. Diagnostic tests
4. Therapy
5. Location
6. Final order
7. Dx

1 Answer

1 vote

Final answer:

A 40-year-old construction worker presents with a laceration and symptoms that may indicate tetanus. A thorough assessment, immediate treatment, and diagnostic tests are essential to manage the condition and prevent complications. The emergency strategy includes fever management, wound care, and possibly tetanus immunoglobulin along with a vaccine booster.

Step-by-step explanation:

Case Study: Tetanus in a Construction Worker

A 40-year-old construction worker has presented to the emergency department (ED) with pain and swelling in the right lower extremity (RLE), following a work-related laceration that occurred three days prior. The patient does not exhibit any discharge from the laceration but presents with high fever and tachycardia. Additional patient history includes a last tetanus immunization three years ago. The priority is to manage the patient's symptoms and prevent any potential complications from the lacerated wound, particularly infections like tetanus.

1. Emergency Orders

Immediate intervention may include administering antipyretics for fever, initiating fluid resuscitation if there are signs of dehydration or shock, and possibly starting antibiotics prophylactically. The stabilization of any vital signs is critical.

2. Physical Exam

A comprehensive physical examination will assess the extent of the injury, signs of wound infection, and any additional symptoms that may suggest systemic involvement like tetanus, such as muscle stiffness or spasms.

3. Diagnostic Tests

Diagnostic tests may include a complete blood count (CBC), wound cultures, X-rays if bone involvement is suspected, and potentially a tetanus antibody test to determine the levels of tetanus immunoglobulin in the patient's blood.

4. Therapy

Treatment options include wound debridement, tetanus immunoglobulin administration, a tetanus vaccine booster, antibiotics, and analgesics for pain management.

5. Location

The patient should be treated in a hospital setting, where he can be monitored closely for signs of systemic infection or tetanus.

6. Final Order

If tetanus is diagnosed or strongly suspected, intensive care admission may be required. All health interventions and patient progress should be recorded in their medical chart.

7. Dx

The differential diagnosis should include tetanus, which is a concern given the patient's symptoms, the nature of the injury, and the timing of the last tetanus vaccination.

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