“My hand hurts really bad; it feels hot, like it is on fire.”
History of Present Illness
SL is 25-year-old man who presents to the emergency department with worsening pain, redness, and swelling in his right hand. He got a splinter of wood on the palmer surface of his right hand near the base of his thumb 3 days ago while chopping wood. He thought he successfully removed the splinter, but the hand progressively became more painful and swollen where the splinter had been. Today, the burning pain (rated 8/10) has spread through his forearm and he is now feeling the pain up to his armpit. He reports that chills started yesterday. No numbness or tingling of the arm or hand, no weakness noted. Denies any prior issues with the hand.
Recurrent major depressive disorder; ulnar neuropathy of left upper extremity secondary to motor vehicle accident 2 years ago; hepatitis C
Repair of anterior cruciate ligament in left knee in 2015; cholecystectomy in 2013; motor vehicle accident 2 years ago resulted in anterior cervical disc fusion C6/7, and repair of cervical fractures
Father has COPD; mother is healthy
Single; lives with friends; mechanic work occasionally in the past, but is currently unemployed. Smokes 1 ppd × 7 years and drinks 1 case of beer per week. Smokes marijuana, and inhales or injects methamphetamine daily.
Penicillin (rash); sulfa (hives); morphine (itching)
Duloxetine 60 mg PO daily (nonadherent)
Amitriptyline 50 mg PO at bedtime (nonadherent)
Albuterol metered-dose-inhaler 1 to 2 puffs q4h PRN shortness of breath (nonadherent)
Temp 98.8°F, HR 80 beats per minute, RR 16 breaths per minute, BP 127/83 mm Hg, pO2 97% on room air; Ht 6′2″, Wt 67 kg
He appears thin and not well nourished. Not significantly distressed, but somewhat anxious.
Normocephalic and atraumatic; no scleral icterus; normal range of motion; neck supple
Breath sounds normal. He has no wheezes or rales.
Normal rate and regular rhythm; no murmur heard
Alert and oriented to person, place, and time
Skin is warm and dry, with scarring on various areas of extremities