A trick to treat, part 2

In my last entry, I shared that I have had some strange patient encounters lately! It all started after I met a mysterious stranger at a wound care conference and remarked on how quiet things had been lately. Needless to say, that didn't last long! I am posting here in the hope that my experiences will assist other clinicians. Here is the second of three eerie cases.

Read part 1 here!

Case 2: Bite fright

History: 55-year-old woman with past medical history significant for hirsutism, AUD, and DM2, previously seen by our service for diabetic foot ulcer, presents with bite wound to forearm that patient says is result of an unprovoked bite from a "giant wolf the size of a bear" that occurred while the patient was walking home from a bar close to her home. Immediately after bite, patient was seen in local ED, where the wound was copiously irrigated, cleansed, and closed with interrupted sutures. Cultures were obtained and patient was empirically prescribed broad-spectrum antibiotic. Rabies post-exposure prophylaxis protocol was initiated at that time and patient has just received Day 07 rabies vaccine. Lab report obtained during record review reveals culture returned positive for S. aureus and Privotella and Bifidobacterium spp.  

Assessment: Laceration and puncture marks in ovoid pattern, with peri-wound ecchymoses noted on right forearm. Edges of laceration approximated with sutures. There are two deeper puncture wounds about 7.5 cm apart which are not sutured. Scant dried sanguineous drainage.

Plan: Cleansed area with hypochlorous-acid-based cleanser, patted dry with gauze. Removed twelve sutures from laceration. Due to risk of infection, suggested silver-containing dressing for antimicrobial action, however patient howled with pain upon application of silver dressing, and skin began to redden. Removed dressing immediately and rinsed with normal saline. Switched to medical-grade honey sheets for primary dressing, then wrapped with dry gauze and secured with soft cloth tape. Dressing should be changed every 72 hours and as needed if it becomes soiled/saturated/dislodged. Allergy list updated to include silver. Follow up in 1-2 weeks or sooner if needed.

Disclaimer: These cases are fictional, created in the spirit of the spooky season. Any resemblance to actual persons, living or (un)dead, events or localities is entirely coincidental. However, the plans detailed above are based on actual evidence and informed by my professional experience and training. This content is for informational purposes only and should not be taken as medical advice or construed as the basis of a patient-provider relationship. Always seek the advice of a physician or other qualified clinician with any questions you have regarding a medical condition or treatment plan.

For more information on having a safe and healthful Halloween, check out these tips from the CDC.