History
- You are FY2 in GP
- A 25 year old man has come for follow up
- He had a dog bite few days back and was treated
- Wound was cleaned, antibacterial ointment given and a sterile bandage was given
- He was prescribed co-amoxiclav, and completed the dose
- He was tetanus vaccinated , was not sure about rabies vaccine
- Generally fit and well, but presented with diarrhoea for 2days for several times
- No sign of dehydration, no other risk factor or complications of dog bite
Task: Talk to him and address his concerns
Concern
- Why am I having diarrhoea?
- Did you treat me wrong?
Examination and investigation
- Take observation, head to toe
- Examine the wound (clean , dry and healthy)
- Routine blood, RBS, electrolytes
Management
- Greet and and confirm identity, paraphrase the scenario
- Take focused history
– what brought him to the hospital
– how he was treated
– how’s he doing now
– any symptoms like fever
– pain swelling around the wound
– muscle ache, tummy pain, vomiting, diarrhoea etc - Ask MAFTOSA,
He was prescribed co-amoxiclav
did he completed the antibiotics dose?
explore diarrhoea (for how long, how many times, any blood mix in it or mucous, color ) - ask after effect (associated symptoms)
any tiredness, dizziness, tummy ache, feeling sick etc
– Ask vaccination status
– Do ICE, verbalise examination and summarise, tell him he is having a side effect from the antibiotics, diarrhoea is a common side effect of co-amoxiclav (Open BNF and show him) - Management will be send home
- As no sign of dehydration: Tell him it is not serious, it will be alright without treatment
- Give Advice
- to drink plenty of fluid to avoid dehydration
- Keep the wound dry and clean, do not scratch or rub
- Use antiseptic topical ointment only
- Safety netting