AMC Clinical exam preparation

amc clinical exam preparation


Your next patient is a 14 year old boy, Jeremy, who comes with his father, Mr. Pickard.
Jeremy was delivering pamphlets into letterboxes when he was attacked by a bull terrier just a few houses away from his home whilst pushing pamphlets into the peoples letterbox. The dog attacked Jeremy and bit him on his right let. Fortunately he was able to jump back on his bike and ride away in a hurry. He went home immediately and his mother tried to clean the wound with clean water and put a bandage around the leg to stop the bleeding.
Your tasks are to:
1. take a focused history
2. perform an examination
3. discuss your management with the patient and his father answer any questions



HOPC:
As above, no further relevant information

PHx: unremarkable, has had all early childhood immunizations although he thinks he has not had one for quite a number of years.

EXAMINATION: (LOOK, LISTEN, FEEL !!!!):
There is an extensive v-shaped laceration with ragged edges of about 5 and 6 cm length, the skin flap is shriveled and looks dusky. Torn muscle fascia is visible in the depth of the wound. In addition there are two puncture wounds consistent with canine teeth impact.
No vascular or nerve deficit.

TREATMENT:
• irrigate the wound vigorously with aqueous antiseptic
• debride the wound edges
• leave wound open for delayed closure or healing by secondary intention
• cover with non-adherent, absorbent dressing like paraffin gauze or Melolin
• Tetanus prophylaxis with immunoglobulin and toxoid
• Prophylactic penicillin, e.g. 1.5 million units procaine penicillin im stat, followed by amoxicillin + clavulanate for 5 days
• immobilisation
• Daily review for early detection of infection

QUESTIONS:
• Which antibiotic would you give if the patient was allergic to penicillin?:
Metronidazole and doxycycline
• Under what circumstances would you suture the wound?:
Face or scalp (well perfused, cosmetic results)
• We have heard that dogs can have rabies, do we have to worry about that?:
No, there is no rabies in Australia