H and P with Update
Peter Parker, 25 year old Caucasian male, admission day 2 with acute cellulitis secondary to a spider bite. He presents with a swollen right upper extremity, raised lesion on the forearm red, painful and ulcerated in the center. The arm is warm to the touch, red and edematous. The spider bite does not resemble the typical spider bite and the insect was not recovered. Initial cultures show Gram positive streptococcus. The patient presents with diarrhea, nausea and vomiting, chills and fever. There is sloughing of the skin of the right hand. No PMH. AAO x3. Pt is an athletic male, takes no home medications except a multi-vitamin and synthroid.
You do not appreciate any significant issues on your head to toe exam. You are going in to pass your morning meds. You have taken your VS and checked your labs. (Review these results and consider their implications.)