39 yo male in ER with CC of lacerated bleeding left foot. He retells that he was at the kitchen holding a catsup bottle and the bottle slipped his hands and hit his left foot. the patient is in slight pain. The physician gives tetanus toxoid IM 0.5cc over the left deltoid. Tetanus lmb 250 (IU) IM in the right deltoid local wound care done by nurse washing the wound with saline solution Nurse notices a 1.5 cm gaping wound with active bleeding toes can be moved at will. Nurse referred patient to ER phys.
Physician repaired the wound by suturing. Prior to suturing, physician ordered ketorolac 30mg/heplock
Anesthesiia: Xylocaine 2% infiltration
Discharge: after prescribed:
Co-amoxiclav 625 mg/tab 1 tab q 12 to complete 7 days
Mefenamic acid 500 mg/cap 1 cap q6 if pain is unbearable
Rx
Advice the px to take Mefenamic acid with food 2hrs later returned to the ER with itchiness of upper eyelids with puffyness. Px is also had nasal stuffiness
Review of Px records
-asthmatic
-allergic to seafood
-denied allergy to pain medication
-ER physician further noted, nurse perform skin test to ketorolac and revealed negative for in duration
Questions:
1, Identify the point drugs with cause the current condition of the px
2. Was there any adverse event at the time of 2nd er visit or admission
3.Relate how a skin test is performed
4. What is the Naranjo scale?
5. Is the ER physician liable for negligence?
6. How will clinical pharmacist investigate the adverse event?
Sharon
Naranjo scale is a scale of how NSAIDS, anti-inflammatory drugs effects the body.Ketrolac is an Nsaid as is Menenamic. A skin test is when a small amount of the substance that caused the allergic reaction is injected under the skin and if a reaction appears it shows that the patient is allergic to the medication.
The ER doctor is not liable for for negligence. He tried the safest medication available for this type of injury,
The clinical pharmacist knows as much about medications and the side effects of drugs
I am an RN and a Certified Pharmacy Technician
MishMash
1. Ketorlac and Mefenamic acid are Non-Steroidal Antiinflammatories (NSAIDs) it is well known that NSAIDS should be avoided by asthmatics as they exacerbate asthma.
2. Patient had "itchiness of upper eyelids with puffyness. Px is also had nasal stuffiness". [Direct copy and paste from Question.]
3. As described in above answer.
4. Naranjo scale - The Naranjo Scale is a questionnaire designed by Naranjo (and others) for determining the likelihood of whether an ADR (adverse drug reaction) is actually due to the drug rather than the result of other factors.
5. The ER physician should have asked the patient if they were asthmatic before attempting to prescribe NSAIDs. They should also have read the patients past medical history before attending to the patient. The physician appeared not to do this. The physician in question is liable for negligence.
6. Lets hope the clinical pharmacist follows the correct protocols as set out in the hospitals policy manual; and wishes to teach the doctor the right procedure while bearing in mind the health of the patient. This would include interviewing the patient and the doctor separately.
Orignal From: Hello can someone help me with this case?
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