A trick to treat, part 3

Welcome to the final case of our three-part series. Read part 1 and part 2. These strange cases started to come in after I met a mysterious stranger at a wound care conference and remarked on how quiet things had been lately. ;) I am posting here in the hope that my experiences will assist other clinicians.

Case 3: Stake Out?!

History: We are asked to urgently evaluate a 43-year-old man for a chest wound. Past medical history significant for microcytic anemia and xeroderma pigmentosum.

Social history: Non-smoker and denies alcohol consumption ("I never drink wine"). Lives in remote location with his caregiver Renfield.

Assessment: Patient at rest in oblong box, awake and conversant despite significant penetrating chest wound from impalement with with protruding wooden object. Noted chest was not rising normally during inhalation, and patient is pale with peri-oral cyanosis. Patient was surprisingly coherent, scoring 14/15 on the Glasgow Coma Scale, with only some mild confusion (when asked his age, stated he had been “forty-three for a long time.”). He stated he had been attacked by unknown assailants while asleep and believes they might have killed him had they not been driven away by his caregiver.

Plan: EMS activated. While medics en route, chest wound exposed and occlusive dressing improvised using empty petrolatum gauze packet applied around object and secured with surgical tape. Patient requested removal of object and I urged to him wait until surgical evaluation. He then stated that he wanted "fresh blood" and I assured him he would likely receive a transfusion at the hospital, if not before.

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 above are based on actual evidence and informed by my professional experience and training. This content is for informational/humorous 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.