Young female who was seen the day before at our urgent care | Figure 1

Young female who was seen the day before at our urgent care. she had been transferred to a “medical center” after speaking with hand surgery, the wound was closed by PA and she never saw hand surgeon. She comes back today with this infected wound which progressed rapidly. I took sutures out and gave her Clindamycin and rocephin IV. I showed hand surgeon photos and he recommended cont P.O. keflex only and he would see pt in office the next day. How would you proceed?

Case Examples

58 year old female with a 4 day onset of abscess. She visited an urgent care and had a "debridement" done. She arrives in this condition. Hand wanted me to I&D the abscess, and of course the bare DIP joint was visible under the abscess. Started patient on broad spectrum antibiotics with a referral to hand surgeon the next day.

Last update to case: ostomy mostly healed although significantly smaller and will end up flat or inverted. Necrotic tissue is gone. Still detached but only shallowly, output is good. Surgeon told patient he did not think a revision would be necessary but that they could discuss that further after she completes chemo. Unknown when chemo will start since rectal incision is not healing well, I&D done 10 days ago has closed 1/2 way and stalled (she didn't want picture of this) Very poor intake.

60-year-old gentleman presented to my office yesterday requesting a "cortisone injection." Not surprisingly, he has right foot pain. He remembered that I gave him an injection for a neuroma in 2009 with good results. He is not diabetic. He is under the care of a vascular surgeon at a local wound care center. Wound VAC on medial ankle for non-healing venous stasis ulcer. Has undergone RF ablation for venous disease. The only pulse I could identify is a weak lateral tarsal artery. I sent him back to his vascular surgeon. He was upset that I would not give him the injection. Comments?

56YOF consulted me regarding an abdominal pain starting at the umbilicus and spreading to the RFI. Eliciting rebound tenderness, I typed a covering letter, sending her to the closest (government) academic hospital with the presumptive diagnosis of appendicitis. She could not afford private care. There, she was given analgesics and sent home. 2 days later and desperate for help she called an ambulance. This led to an emergency laparotomy, appendectomy but now with peritoneal sepsis. The next day she was sent home to heal. The wound opened (first picture) and I noted there was an infected drain scar but found no sutures (nor scars of sutures) in the skin of either the drain or the laparotomy. I wrote another cover letter, adding pictures of the wound and once more sent her back. She was VERY reluctant, preferring to travel about 300 kilometers to her rural home and their local hospital but I convinced her they would not have adequate facilities. At the academic hospital she was given wound care dressings and applications...and sent home. So, she returned to my facility in desperation. We are not a hospital but a health Hydro (Dealing with subclinical conditions).. yet I arranged a (guest) room and we started wound care around the clock. Picture 3: No, that is NOT her breasts.. the upper part of the picture is her umbilicus... Accommodation was "on the house" and the nursing staff gave their time for free. The wound slowly healed, the sepsis subsided. She returned to work about 6 weeks later.

A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis. He had a history of hypertension, long-term smoking, and a sedentary lifestyle. On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.

A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets. Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.

A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.

Patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family, are there any features in this EKG that would warrant further work-up or is this just a pediatric EKG?