1214L Case Study Wound Care

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Florida SouthWestern State College, Lee *

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1214L

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Medicine

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Apr 3, 2024

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docx

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1 Case Study – The Reenactor G.W. and his wife, S., have been Civil War reenactors for more than 10 years. For the 150 th anniversary of the Battle of Gettysburg, G. got to play Daniel Sickles of the Union Army, and S. played a Gettysburg townswoman. More than 15,000 reenactors descended on the historic battlefield over the weekend before July 4 th , and more than 50,000 spectators viewed the reenactments. The weather was as hot as during the actual battle July 2-6, 1863, with temperatures in the high 90’s and high humidity. Just like Sickles, G. got impatient waiting for action and moved his Third Union Corps from Little Round Tops to the Peach Orchard. G. commanded his corps to move, but then he slipped, fell, and gouged the right side of his calf on a rock. He was bleeding, hot, and tired. He sent S. a text, and she came up to Little Round Tops with an emergency kit. “Rather unlike the care the men actually got 150 years ago!” said G. “Well,” said S., “I’ve got to cut away those nice uniform pants I made you to see what you’ve done this time!” S. used the kit scissors and cut the wool fabric in four places to reveal the wound. “Ew!” said S. “A 2-inch slash in your leg. Looks a bit dirty, too. What exactly did you cut it on?” G. replied, “I slipped, and my leg just went into the rock.” S. took off her apron and covered the wound to stop the bleeding. “This is too close to reality for me, G.!” she said. “But I think I can pull the cut back together if I use some of these butterfly bandages.”

1 With three butterfly bandages, S. was able to pull the edges of the wound together. “I think mostly your pride was hurt on this field, G!” she laughed. G. got up and went back to his corps, rather proud of the state of his now especially realistic looking uniform. S. went back to her spot at the top of Seminary Ridge. The reenactment continued for another six hours. By 6 pm, G found S. enjoying the post battle barbeque. He was too tired to eat, so S. suggested they get in the truck and go back home, which was only an hour away. When G. and S. got home, G. said “I really don’t feel so well. Maybe I have a touch of heat- stroke?” “Your head is cool, F. Let me take your temperature.” G’s temperature was 94.8  F (34.9  C). “You really are a cool cucumber, G. You must have done a good job of keeping hydrated out there. I don’t think it’s heatstroke. Maybe you are just wiped out. Still, I better take you to the emergency room anyway and have your leg checked out.” When G. got to the emergency department, his wound was assessed and described as a 5 cm simple soft-tissue laceration (i.e., it avoided the ligaments, muscle, and tendons in his calf). His vital signs were as follows:  Temperature (oral): 94.8  F (34.9  C)  Blood pressure: 110/68 (client’s wife reports that his BP at home last week was 122/85  Heart rate: 90  Respiratory rate: 24/min.  Pulse oximetry (oxygen saturation): 98% References  Arlington National Cemetery Website. “Daniel Edgar Sickles.” http://www.arlingtoncemetery.net/dsickles.htm  Capellan, O., and J. Hollander. 2003. “Management of Lacerations in the Emergency Department.” Emergency Medicine Clinics of North America 21, no.1 (February). https://secure.muhealth.org/~ed/students/articles/emcna_21_p205.pdf  Gabriel, A. 2011. “Wound Irrigation.” eMedicine (May 19). http://emedicine.medscape.com/article/1895071-overview  Martin, G.S., D. M. Mannino, and S. Eaton, etal. 2003. “The Epidemiology of Sepsis in the United States from 1979 through 2000.” New England Journal of Medicine 348, no. 16: 1546-1554.  Rivers, Emanuel P., and Tom Ahrens. 2008. “Improving Outcomes for Severe Sepsis Shock: Tool for Early Identification of At-Risk Patients and Treatment Protocol.” Critical Care Clinics 24, no. 3, Supplement 1 (July): 1-47. http://www.criticalcare.theclinics.com/issues?issue_key=S0749-0704(08)X0004-1  SEPSIS Know from Day 1. “What is Procalcitonin?” http://www.sepsisknowfromday1.com/what-is-procalcitonin.php  Singhal, H. 2012. “Wound Infection Treatment and Management.” eMedicine (January 6). http://emedicine.medscape.com/article/188988-treatment

1  Wedmore, I.S. 2005. “Wound Care” Modern Evidence in the Treatment of Man’s Age- Old injuries.” EB Medicine . http://www.ebmedicine.net/topics.php? paction=showTopic&topic_id=39  Zehtabchi, S. 2007. “Evidence-based Emergency Medicine/Critically Appraised Topic: The Role of Antibiotic Prophylaxis for Prevention of Infection in Patients with Simple Hand Lacerations.” Annals of Emergency Medicine 49, no. 5: 682-289.e1.  Zinn, S. P. “Medical Student LC: Module 1-Wound Care and Healing.” http://www.medstudentlc.com/page.php?id=67 Questions 1. How should individuals be taught to care for a laceration acquired “in the field,” assuming medical care can be accessed within four to six hours? 2. Describe the wound care G. should receive upon reaching the emergency department.

1 3. What is sepsis, and what are the early signs of sepsis from a laceration acquired in the field? 4. Was closing G’s. laceration in the field with butterfly bandages a good idea? Why or why not? 5. Using the diagrams on the next page as a guide, fill in the blanks to describe the three phases of wound healing and the role of the cellular “actors” involved.

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