Sometimes simple is best

[SeaCat]

A while back we had a patient on my unit. He came on to the unit through the E.R. complaining about pain in his upper rear thigh. It was slightly swollen and red when he came onto the unit. Slowly over several days the swelling grew worse and the area became a darker red.

By the time I was introduced to the patient he had been seen by several doctors including the I.D. (Infectious Disease Doctor.) The back of the guys leg was inflamed, hard to the touch and more than just painful. No one knew what was going on, the ideas ranged from a tumor to an infection. I was helping the guy to the shower when I finally got a look at it. It took me all of two seconds to know what was going on.

You see I spend a lot of time outside and have done so all of my life. Because of this I have seen more than a few things that Mama Nature can throw our way.

I got the guy back into bed after the shower and then left the room to find the Charge Nurse. I found her with the Unit Supervisor and told them what I suspected about the guys leg. They just looked at me and scoffed but agreed to talk with the guys M.D. Before I knew it I was called back into the patients room and told to tell the M.D. what I thought and why. I did so while pointing out a few things.

The swollen area while growing was fairly limited. It was hard and hot to the touch around the outside but the very center of it was soft and spongy. The entire area was a deep nasty red while the very center was slowly turning a yellowish white. I also mentioned that I had asked the guy about his lifestyle and he had informed me he had been camping less than a week before he had noticed the swelling.

The doctor listened to this then ordered a C.T. of the leg. Later that evening the patient was in surgery. For the next week we spent a lot of time unpacking and repacking a massive wound in his leg, a wound much deeper than it was wide.

The guy had been bitten by an Outhouse Spider, otherwise known as a Brown Recluse.

Sometimes you have to look for the simple causes of a problem rather than the complicated.

Cat

 

[Handley_Page]

Full marks, there, Cat.
I'm told it can take a good while for the wound to heal (necrotic tissue or something).

 

[SeaCat]

Full marks, there, Cat.
I'm told it can take a good while for the wound to heal (necrotic tissue or something).

Yes it can. Between the size of the wound and necrosis it can seemingly take forever.

The best treatment for this kind of wound unfortunately is to cut away all affected tissues while erring on the side of caution. (You don't want to miss any of the damaged tissue.) This can lead to large wounds.

This treatment is much like the treatment for Centipede Bites in Hawaii. (Their toxin is much the same.)

Cat

 

[jomar]

Good call, but why the hell didn't the docs suspect it earlier? And if they couldn't figure it out would a CT help rule something in/out?

 

[sutherngent985]

Good call, but why the hell didn't the docs suspect it earlier? And if they couldn't figure it out would a CT help rule something in/out?

Because, in a Drs world, simple solutions to complex problems arent allowed.

I would imagine its a case of ruling out common problems before thinking of less common. And from what little I know, a bite like that, while not rare, doesnt come up very often.

 

[SeaCat]

Good call, but why the hell didn't the docs suspect it earlier? And if they couldn't figure it out would a CT help rule something in/out?

A CT can only show you what is there, not what is causing it. In this case the first CT showed a mass. The second CT showed the fluid filled cavity.

As for why the Docs didn't suspect th=is at first, there's no telling. Maybe it was because of the way it first showed up. Maybe it was because the right questions weren't asked in the E.R. and maybe it was because it wasn't expected.

Doctors like the rest of us are only human.

Cat

 

[jomar]

Because, in a Drs world, simple solutions to complex problems arent allowed.

I would imagine its a case of ruling out common problems before thinking of less common. And from what little I know, a bite like that, while not rare, doesnt come up very often.

When I was at my doctors he was training a pa, basically telling her to assume the worst and work back from there diagnostically. You rule out a lot of stuff with a range of questions so don't necessarily need to get to expensive tests.

And yes, some docs get stuck and insist a thing can't be the thing because they insist there are no such things in the region.

 

[jomar]

A CT can only show you what is there, not what is causing it. In this case the first CT showed a mass. The second CT showed the fluid filled cavity.

So two CTs that showed some differences.

As for why the Docs didn't suspect th=is at first, there's no telling. Maybe it was because of the way it first showed up. Maybe it was because the right questions weren't asked in the E.R. and maybe it was because it wasn't expected.

Doctors like the rest of us are only human.

Cat

True.

 

[SeaCat]

Because, in a Drs world, simple solutions to complex problems arent allowed.

I would imagine its a case of ruling out common problems before thinking of less common. And from what little I know, a bite like that, while not rare, doesnt come up very often.

I can think of any number of problems that were shown in the E.R. that were misdiagnosed because the right questions weren't asked or because the patient and doctor expected something else.

My all time favorite was a patient that came in through the E.R. complaining of a painful itching rash on their shoulders.

The patient had been in a car accident two weeks before which had resulted in a couple of broken ribs and a broken arm.

The patient had been seen by the hospital I.D. and placed in contact isolation. The floor R.N. had walked into the room and done her assesment then called the I.D. I was called in to assist in the treatment.

When I walked into the room with the R.N. and looked at the patient I started grinning. We took a lancet, a Hairpin and a bottle of Hydrogen Peroxide and started treating the patient. The patient was released later that day feeling much better.

The patient had been unable to wash the backs of his shoulders because of his injuries. Because of this and the fact he had very oily skin, (much like mine) the backs of his shoulders were covered with both Black Heads and White Heads. The R.N. and myself spent some time lancing the Hite Heads, draining them and cleaning them. We also spent time with the Hair Pin removing the Black Heads. (I had to teach the R.N. how to do this.)

Again this was something that wasn't expected because it was something simple.

Cat

 

[Handley_Page]

Forgive my asking, Cat, but what does the Hydrogen Peroxide do ?

 

[Vermilion]

Forgive my asking, Cat, but what does the Hydrogen Peroxide do ?

I think Americans use it to disinfect, much as we would use something like TCP...
I might be wrong, though

 

[Handley_Page]

I think Americans use it to disinfect, much as we would use something like TCP...
I might be wrong, though

It was used at one time as a compound for bleaching hair (Peroxide Blonde). I know it's good at getting small stones from an open wound (had that done - it boils blood).

 

[SeaCat]

Forgive my asking, Cat, but what does the Hydrogen Peroxide do ?

Hydrogen Peroxide is a Disinfecting and a debridement agent.

It debrides some by bubbling which lifts away loose tissue and other Debri. It disinfects by killing some bacteria.

Some people claim it hurts, I never found it to hurt but then again I also clean out cuts on my person with Rubbing Alcohol and this doesn't hurt either. (It does sting slightly on the deeper cuts or rub rashes.)

Cat