CASE LEARNING OBJECTIVES
Identify the goals of therapy for acute osteomyelitis
Identify the clinical signs, symptoms, laboratory, and imaging tests in the diagnosis and therapeutic monitoring of acute osteomyelitis
Develop an appropriate treatment and monitoring plan for acute osteomyelitis
Educate the patient regarding disease state and drug therapy
"I have severe pain in my left arm, which was broken in a car accident last week. I've taken a few pain pills since then, but now it really hurts. Maybe I need a stronger pain pill."
History of Present Illness
SC is a 19-year-old Caucasian male who presented to the emergency department complaining of severe pain in his left upper arm. He was involved in a car accident 7 days ago and had an open fracture of the left proximal humerus. At that time, he was admitted to the hospital for surgery. He received pre- and postoperative cefazolin, and was discharged after overnight observation on an oral antibiotic and PRN pain medications. At the time of discharge, the patient showed no signs of infection and required only occasional hydrocodone/acetaminophen for pain. He was scheduled for a follow-up office visit with the orthopedic surgeon in 1 week.
Asthma, diagnosed in childhood
Allergic rhinitis, diagnosed in childhood
Father is 46 years old with type 2 DM and HTN, whereas mother is 43 years old with asthma. He has a younger sister in high school. Both sets of grandparents are alive.
The patient graduated from high school and currently attends community college. He lives with his parents and maintains a part-time job at a movie theater. His health insurance is covered under his father's insurance plan.
Occasionally drinks beer; denies tobacco and illicit drug use
Allergies/Intolerance/Adverse Drug Events
Benadryl causes him to be "jittery."
Cephalexin 500 mg 1 capsule PO q 6 h for 7 days
Ibuprofen 400 mg 1 tablet PO q 6 h PRN mild-to-moderate arm pain
Hydrocodone/acetaminophen 5/325 mg 1 tablet PO q 4 h PRN severe arm pain
Fluticasone/salmeterol 250/50 mcg 1 puff twice daily
Albuterol 1–2 puffs q 4 h PRN wheezing (needs refill)
Loratadine 10 mg 1 tablet PO once daily
Fluticasone intranasal spray 2 puffs each nostril once daily PRN allergies
Acetaminophen 325 mg 1–2 tablets PO PRN headaches
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