L.M., an 18-year-old construction worker, has arrived at the ER with three lacerations to his inner thigh which resulted from a recent fall at a construction site. The lacerations (5, 3, and 2 inches in length) are bleeding profusely, and the largest one is located close to the patient’s groin. The patient has been trying to stop the bleeding with a soiled cloth. His BP is 90/60, pulse rate is 96, and the respiration rate is 28/min. The patient is reporting pain during the examination.
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How would you proceed with this patient when he first presents to the ER?
As soon as the patient arrives at the ER, I would stop the bleeding to examine the wounds. For that, it would elevate the injured extremity and create a compression bandage in the groin area. I would ask the patient if he had received the tetanus-diphtheria vaccine within the last five years (Margevicius, 2008).
Describe the steps in evaluating these wounds. Are additional data needed from the history and physical exam before treatment decisions are made? Would you order any laboratory tests and/or imaging?
I would begin the thorough evaluation of his lacerations starting with his previous health history. In particular, I need to find out whether or not the patient is suffering from connective tissue disorders or diabetes mellitus and takes any immunosuppressing medications that could impact the future healing of the wounds (Margevicius, 2008).
Additionally, x-ray imaging of the wounds will be required to ensure the integrity of the bone and artery and also detect the presence of foreign bodies in the wounds because the patient does not know what caused them.
How would you categorize this wound? How would you proceed with suturing?
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The wound can be categorized as three moderate lacerations and require primary closure performed within 12 hours since the moment the injury was acquired. Once the lacerations are cleaned from dirt and foreign bodies, I would close them by sutures, surgical tape, or adhesive – depending on the shape of the wounds.
What pharmacotherapeutics might this patient need and WHY?
As a pharmacotherapeutic treatment for lacerations, I would recommend that the patient takes analgesics (nonsteroidal anti-inflammatory medications), acetaminophen because the patent is likely to experience pain during the next few weeks (Feucht, Greydanus, Merrick, Patel, & Omar, 2012).
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Also, a course of antibiotics is recommended for this patient because the injury was kept unsanitary conditions while the patient was traveling to the ER and there is a high chance that the wound had been infected.
What complementary therapies, if any, might be included in a plan of care for this patient?
As a complementary therapy, the patient will be recommended to avoid doing physical exercise or going to work for several weeks, to take a lot of rest, and keep his extremity elevated.
What health promotion strategies are especially important with this patient?
The major health-promotion strategy for this patient will include the explanation of the importance of having a first aid kit at a construction site that is a high-risk place of work. Also, it will be explained to the patient that using unsanitary cloth as the bandage is very dangerous and could result in severe infection and that he, as well as his coworkers, should use safer medical materials to stop bleedings and cover wounds.
What follows up and education does this patient need?
The education for the patient will include self-management for lacerations and an explanation of the medication administration. For a follow-up, the patient will be requested to come back for a check-up in a week or visit if the wounds begin to show signs of infection.
What Healthy People 2020 objectives are related to this case?
Healthy People 2020 has an Occupational Safety and Health objective OSH-2.3 that aims at the reduction of “work-related injuries among adolescent workers aged 15 to 19 years” (ODPHP, 2017). This objective is related to the case.
How would you bill for this visit? What level of E&M would be used?
For this visit, I would use a facility code 99284 (level IV, APC 615).
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Would this patient benefit from a Circle of Caring? Describe.
This particular patient could benefit from a Circle of Caring because the assumed consent to disclose personal health history could speed up his care and help the professionals evaluate his injury faster and in an accurate manner. In particular, the Circle of Caring would provide the assessing professional with the patient’s information concerning his tetanus-diphtheria vaccination, as well as his existing medical conditions that could potentially impact the wound healing in the future (diabetes mellitus or the connective tissue disorders, and the immunosuppressing medication history).
Feucht, C., Greydanus, D., Merrick, J., Patel, D., & Omar, H. (2012). Pharmacotherapeutics in medical disorders. Berlin, Germany: Walter de Gruyter.
Margevicius, L. A. (2008). Laceration evaluation and repair. Advance Healthcare Network, 16(11), 63.
ODPHP, (2017). Occupational safety and health. Web.