OK I know it has been a long time since I have posted -
Unfortunately my workplace blocked "blogger" from our internet, limiting the time I have to post little snippets. Additionally it has been really busy, it is "trauma season" after all.
I felt that a patient I had recently deserved a little mention however since it is a pretty unique (at least for me) patient & presentation.
Chief Complaint: 24 yo with vertebral (back) fracture & foot pain.
History of the Present Illness: Patient is a homeless heroin addict who was asleep in a dumpster. The patient was unaware that the following morning was garbage day and was woken by the dumpster being emptied in to the garbage truck. He was "rescued" when the garbage man heard his cries / screams for help. (He did manage to grab his needle / supply before he toppled out).
Past Medical History: Multiple Abcesses, Necrotizing fascitis (spreading skin infection), Hepatitis, early liver failure, Kidney damage, No IV access (currently administering his "medications" into his buttocks.
Past Surgery History: Extensive debridement of skin from his infections. Etc.
Allergies: NoneMeds: Heroin 2-3 grams / daily; Dilaudid 24mg at a time for fun, Oxycontin as much as he can get, Methadone 120mg / day (when he is in rehab), a variety of other "recreational pharmacuticals"
Exam: Back pain, Foot pain, malnourished, unshowered for probably weeks, offensive smell. No obvious lice, (not examined for body lice). Multiple scars. No IV access - Patinet has blown /scarred every vein from the neck to his toes. (including jugulars). Enlarged Liver & Spleen secondary to hepatitis/liver damage.
Overall plan.... Back Brace, Psych Consult, Attempt to avoid withdrawal & provide pain control.
Anyway it was pretty interesting for me and I thought it might interest you too!
