Insect bite with complication
 

S- 33 yr old, WM, cc of " an itchy insect bite was starting to heal, but has gotten very sore since yesterday and now is starting to turn red and swell"

0- vitals WNL, no systemic fever, R forearm exam reveals tender, edematous, red plaque with central punctum present

You area is not one conducive to deadly insects or the initial injury likely to be anything other than a standard insect bite.

What is the likely diagnosis for secondary condition?
Your treatment would be?

Area appears as follows upon exam.

OK.. I admit it isn't as "cool" as a trauma thread, but it is very likely to be seen by the team doc.

BTW- that pic is of a females arm, but I couldn't scrounge up a better example when I was posting this.

Spider bite?

TR

TR, sounds like a winner. It was a non-venomous variety .

Note- I would like everyone to focus on the bite being benign and non-poisonous in this thread. It might have been deadly to a normal man, but this thread is focused on a SF Team Sergeant as a patient again. LOL Therefore, treat this case as a normal spider bite with subsequent complications during the healing phase.

Much more likely scenario to have to treat....

DX-Insect Bite with signs of infection.


Is the site warm to the touch? Tenderness on palpation? Is the redness/edema growing in size since intial bite. Looks and reads as though it is secondary infection setting in.

TX-Broad spectrum ABX?

Fire away lads.


Jason

Cellulitis?

TR

Yes. Yes. Yes.

Yes. Oral or IV? Other supplemental treatment?


Correct, Sir.


(style of the man of few words, rubbing off on me. Making thread short but sweet. :p )

Oral Doxycycline.

TR

Not sure about the Oral or IV route for the ABX. I would think agressive IV ABX would be able to nip it in the bud pretty quickly.

I have not yet been fully trained on ABX administration IV or orally yet and am just going on what I can dig up in my school books and on the web. (Medic in training disclaimer).


Thanks for the education Doc Saca

Oral... Yes. No systemic signs yet ( fever, lymphatic spread,etc) so PO it is. If it continues to worsen or becomes systemic... then IV.

My preference would have been an Augmentin (amoxycillin-clavulanate acid) OR a 1st-generation cephalosporin like Keflex(cephalexin ) due to likely etiology of Staph. infection.

Drugs choices are dependant on what is available to the medic... correction to recommended drug of choice by NDD, Eagle, etc would be appreciated based on what is likely to be available.

Culturing, of course, is the ideal way to determine drug choice, that is not an option in the field though.

Other Tx that may help patient's symptoms?
Warm compresses.

Benedryl for itching.