. A 58-year old Native American presents in the Mercy emergency room with headache, irritability, generalized...

. A 58-year old Native American presents in the Mercy emergency room with headache, irritability, generalized muscle pain and uncontrollable back spasms. He has become very restless and worried because he has had the back spasms all through his court case that afternoon and they became extremely painful. In his history, the patient states that he has a very busy life. He is on medication for high blood pressure (beta blocker) and has mild asthma. He injured himself about 10 days earlier, puncturing his left arm with a nail from an old barn he is tearing. The wound has produced moderate quantities of pus, but he has been keeping it clean. When asked, he did not remember having a tetanus shot since he was a kid. The wound was sampled for microscopic examination and culture. The back appears to have very tight contractions and spasms. The patient is in obvious agonizing pain. a) What is your diagnosis here? b). What is the proper treatment of this problem? c). How could this have been prevented?

Expert Solution

ANSWER :

a) Diagnosis - Tetany

b)Treatment :

▪︎Tetanus immunoglobulin(TIG) :

It provides immediate short term protection against tetanus , as it contains antibodies which kill Clostridium tetani.

▪︎Antibiotics like penicillin and metronidazole:

Prevents multiplication of bacteria
Prevents production of neurotoxin.

▪︎Treatment for muscle spasms :

Muscle relaxants - Baclofen
Anticonvulsants - Diazepam
Muscle relaxants by neuromuscular blocking - Vecuronium , Pancuranium

▪︎Wound treatment :

Debridement of the dead and contaminated tissue of the wound.

c) Prevention of tetany :

Tetanus vaccine : It is given to children in combination as DTaP- Diptheria,Tetanus toxoid and acellular pertussis.
Schedule(5 doses) : 2 , 4 , 6 , 15 - 18 mnths and 4-6 yrs of age for children.
Booster dose given at 11- 18 yrs of age , followed by every 10 years.
So, if he would had taken tetanus shot in childhood this could be prevented.

Nightingale answered 2 years ago

Jean is a 45-year-old male who presents to the emergency department complaining of a headache and...

Jean is a 45-year-old male who presents to the emergency department complaining of a headache and mild chest pain. He has no SOB or diaphoresis. The triage nurse takes his blood pressure and gets a value of 140/120. What is his pulse pressure and MAP? Are these values normal? If not, what is considered the normal range? What are some possible consequences if this is not corrected?

An 83-year-old resident of a skilled nursing facility presents to the emergency department with generalized edema...

An 83-year-old resident of a skilled nursing facility presents to the emergency department with generalized edema of extremities and abdomen. History obtained from staff reveals the patient has history of malabsorption syndrome and difficulty eating due to lack of dentures. The patient has been diagnosed with protein malnutrition. •The role genetics plays in the disease. • Why the patient is presenting with the specific symptoms described. • The physiologic response to the stimulus presented in the scenario and why you...

A 45 year old man presents in the Emergency Room with a two day history of...

A 45 year old man presents in the Emergency Room with a two day history of black covered stools and recurrent nosebleeds. His history reveals both a recent as well as past history of ethanol abuse. His coagulations studies reveal: Platelet Count: 60,000/cumm PT: 20 sec APPT: 52 sec Thrombin Time: 11 sec Fibrinogen: 201 mg% FDP greater than 40 ?g.ml 1. What is the probable diagnosis? 2. What additional tests should be performed to confirm the diagnosis?

A 50-year-old man, who is a chronic alcoholic, presents to the emergency room with a sudden...

A 50-year-old man, who is a chronic alcoholic, presents to the emergency room with a sudden onset of abdominal pain that radiates to the back. A blood test reveals elevated serum pancreatic lipase levels and a CT abdomen suggests inflamed pancreas. Both of these findings together confirm the diagnosis of acute pancreatitis. The patient was admitted and appropriately managed. The pain reduces over the next two days. On day 3, the patient reports worsening of pain, nausea, and vomiting. An...

You are caring for a 58-year-old electrician admitted to your emergency room for purulent drainage from...

You are caring for a 58-year-old electrician admitted to your emergency room for purulent drainage from his incision site. He is a one-week post-CABG. His cardiologist reports positive blood cultures. Hospital admission reports no health insurance, and the patient shares he has been having difficulties paying for his medications. His wife is at the bedside. Case Study Analysis Assignment Outline: Introduction Brief overview of the pathophysiology of the disease. Include: What lab abnormalities would you look for? What diagnostics would...

A 67-year-old female patient presents to the emergency room you work at complaining of shortness of...

A 67-year-old female patient presents to the emergency room you work at complaining of shortness of breath and pain on the right side of her chest. Upon auscultation of the lung field during the physical exam, you note flatness and diminished breath sounds over the right lung. Her temperature is 101.3°F. What are the possible causes of her symptoms? (What is your differential diagnosis?) What tests might order to determine the specific cause of this patient’s symptoms? Why? This patient’s...

A 62-year-old retired elementary school teacher presents to the emergency room with complaints of shortness of...

A 62-year-old retired elementary school teacher presents to the emergency room with complaints of shortness of breath, swelling, and generally not feeling well. Related Question #1 What physical assessments are priorities given her symptoms? Related Question #2 What diagnostic tests should be ordered immediately? Explain the purpose(s) of each. Part 2 Vital signs are obtained and recorded as BP 90/48, R24, HR 100 irregular and varying pulse quality, T 97.8°F, pulse oximetry at 92%. Cardiac monitor reveals atrial fibrillation with...

A 36-year-old woman presents to the emergency room with a history of right upper quadrant pain,...

A 36-year-old woman presents to the emergency room with a history of right upper quadrant pain, shaking chills and jaundice. This pain came on suddenly 6 hours earlier and has been progressing. She took her temperature at home and it was 102 F. She vomited once at the onset of pain. She has had intermittent episodes of epigastric and right upper quadrant pain after eating, for the past 6 months. The pain always abated after 30-60 minutes. Her BP is...

MC is a 52-year old African American female who presents to the emergency department with reports...

MC is a 52-year old African American female who presents to the emergency department with reports of shortness of breath, productive cough, and pain to her chest. She reports her cough is worse at night with chronic pain due to coughing. She denies wearing home oxygen and can been seen purse lip breathing. The nurse observed dyspnea on exertion when MC ambulated to the restroom. She states that she must stop halfway up the stairs in her home to catch...

4. A 4-year-old girl presents with her parents to the emergency room you work at. Her...

4. A 4-year-old girl presents with her parents to the emergency room you work at. Her parents explain that the flu is going around her daycare and that their daughter began to feel sick 4 days ago. She has been unable to eat since then, with prolonged vomiting for 3 days. She is admitted to the hospital for rehydration and correction of her acid-base disturbance. a. Her parents are highly concerned about how she could have developed an acid-base disturbance...

Question