An 11-year-old boy presents to the emergency room (ER) with a 4-inch laceration on his right arm. He was with his friends doing bicycle stunts when he fell off his bike and cut his arm on a rusty nail from the ramp. In addition, his wrist is swollen, bruised, tender to touch, and warm, with limited mobility. He will most likely need stitches to close the laceration and a splint for the sprain.

 

In your initial post answer the following questions:

1. After treatment, as he prepares to leave, you give him last-minute care instructions for laceration and sprain. What would be important for this boy to know to prevent further health concerns with his injuries?
2. The boy concernedly asks you, "My uncle lost his foot because he got gangrene in it. Am I going to lose my arm if I get an infection in this cut?" How would you respond?

 

Question #1:

I would first tell the patient to don't do physical activity such as exercise or do activities that involve the use of the affected muscle very much because if he does, the stitches can break and the wound would open again. I would also tell him to wash the would many times during the day using a soap in order to prevent infections. I would also suggest him to eat healthy food, like vegetables, food rich in zinc, vitamin C, proteins in order to help for a better scarring. Also, the patient shouldn't do rude movements with the affected arm and that recovery won't be too long. I would also tell him that COMPLETE scarring is a very long process (months) and in order to get a the smallest scar possible, the should hydrate the skin and protect it from sunrays. Finally, if he feels any sign or symptom such as fever, severe pain in the affected arm, or change in color of the affected skin, to contact the health provider.

Step-by-step explanation

Question #2:

I would tell him that not necessarily. His uncle has diabetes and this predisposed him to get neuropathy and diabetic foot that involves wounds in the foot without pain so, it can go unnoticed and an infection there can lead to severe infection...also, because there are problems with microvasculature in diabetics patients, blood won't be able to be delivered in adequate amounts to the foot and this will lead to hypoxia and gangrene leading to tissue death and hence, it can end in an amputation. So, there are many factors that caused his uncle to lose his foot however, this boy is a healthy patient that is being treated with antibiotics and anti-inflammatory drugs to prevent further complications such as infection. The only way this patient can get a severe gangrene of the limb and result in an amputation is that a severe infection occurs in the affected arm and that it progresses to osteomyelitis (bone infection), however this is very unlikely to occur.