Counting To 9: An Unexpected Outcome

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Counting To 9: An Unexpected Outcome - Page #3

Lab Studies: Sodium 132 (Corrected 136) <br>Potassium 3.9 <br>Chloride 93 <br>Bicarbonate 30 <br>BUN 15 <br>Creatinine 1.0 <br>Glucose 359 <br>Calcium 8.9 <br>Anion gap 9 <br> <br>White blood cells 24.9 (87% neutrophil) <br>Hemoglobin 13.2 <br>Platelet 381 <br> <br>C-Reactive Protein 32.1 <br>Erythrocyte sedimentation rate 45 <br>Lactic acid 1.0 Other Studies: XRAY RIGHT HAND 3 VIEW <a href="CaseStudyImages/CS9CS8CS7CS6CS5CS4CS-1396.jpg" title="Case Photo #9" data-lity><b>Case Photo #9</b></a> : <br>Prominent circumferential right hand soft tissue swelling with subcutaneous emphysema tracking along the first and second web spaces and around the base of the right index finger soft tissues, raise concern for a gas-forming infection and/or an open wound/laceration in the setting of trauma. No acute displaced fracture or dislocation. <br> <br>MRI RIGHT HAND: <br> Abscess of the first web space and index finger extending from the <br>head and neck of the second metacarpal carpal with a dorsal wound <br>extending to the volar aspect circumferentially fluid around the head of <br>the second metacarpal. There is involvement of the dorsal and palmar <br>interosseous muscles with evidence of myonecrosis and involvement of the <br>adductor pollicis with myonecrosis. <br> Osteomyelitis of the head of the second metacarpal. <br> Granulation tissue and necrotic tissue extending to the base of the <br>proximal phalanx of the index finger. <br> Septic arthritis of the second metacarpophalangeal joint. <br> Reactive edema of the adductor pollicis muscle. <br> Reactive tenosynovitis of the flexor pollicis longus. <br> Extensive cellulitic change of the entire hand maximally in the <br>dorsal aspect of mid hand. Consultations: Orthopedic Surgery Click here to continue. Challenge yourself by writing down a revised, working diagnosis before moving to the next slide.		Back
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