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IPFS News Link • Events: America

An ER Night Shift Part 1: Cellulitis

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I work in a regional ER serving a community of 200,000 people and I thought it might be interesting to look at the patients I saw, from an austere/survival medicine perspective, on a recent night shift. On this night, I saw or supervised the care of the following 26 patients with these ultimate diagnoses: (problem, age, sex)

Cellulitis after a catfish bite                38 M

Dislocated jaw                                    20 M

Infected scabies                                  14 F

Stab wound chest                               33 F

CORD                                                  51 M

Hip Dislocation                                   74 M

Aggressive mental health patient       30 F

Tonsillitis                                             22 M

Fractured tibia                                    33 F

Lacerated hand                                   36 M

Appendix                                             17 F

Infection                                              36 M

Constipation                                        64 M

Asthma                                                15 M

Miscarriage                                         27 F

Croup                                                  4 M

Hanging                                              17 M

UTI                                                      48 M

Trauma – pushbike. Chest pain           8 M

D's & V's                                             32 M

FB eye                                                 16 M

Fell from car – abrasions                    20 M

Supracondylar fracture                       7 M

Subdural                                              20 M

Fractured ulna                                    38 M

Snake bite                                           21 M

What I plan to do over the next little while (and it might take a while to get through them!) is look at each patient in turn – how they presented, how easy it was to diagnose the problem and what are the options for diagnosis and treatment in an SHTF type scenario.

So, to begin……

Patient 1: Cellulitis after a catfish spine jab 38 yr. old Man

This patient was a 38-year-old man who had been fishing with friends three days before he came to the hospital. While landing a fish he grabbed hold of it with his hand and got several spines impaled in it. He said that he easily pulled them out and washed his hand with clean fresh water and got on with his fishing. After 36 hours, his hand started to hurt around the area of the wounds. He noticed it was becoming red. Over 12 hours the redness spread from the palm of his hand up onto the inner aspect of his wrist. The pain increased and he was unable to move his wrist much due to pain or make a fist because of swelling in his fingers and palm.

What is cellulitis?

Cellulitis is an infection in the layers of the skin – the dermis and the epidermis. Classically it presents as it did in this man – an injury which damages the skin (although we do see it in apparently intact skin sometimes), after a day or so the area becomes hot, red, swollen and painful – over time (hours to days) it gets worse – more pain and worsening of the other symptoms. Usually, it is obvious what is going on. It can be confused sometimes with a severe skin allergy, but the history of what happened usually gives it away.

Sometimes the patient also has signs and symptoms of the infection moving more widely in the body – they may feel hot, have chills or shakes, be off their food and experience nausea or vomiting. The presence of these suggests the infection is more established and more aggressive treatment is required.

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