|
Puncture Wound from
Nail Gun
in a
Construction Worker
|
by Vilayvanh Sysounthone, DPM
2nd Year Resident, St. Mary Hospital
Hoboken, New Jersey
19 y/o male construction worker presents to ER one hour after sustaining
a puncture wound from a nail gun to the dorsum of his right foot. The
patient denies any significant medical history. He denies tobacco, alcohol
and drug use. The patient has no known drug allergies. It is noted that he
last ate approximately 8 hours ago.
Immediate treatment included Demerol for pain while diagnostic tests were
conducted.
Examination reveals that the nail penetrated 4 layers prior to striking
the foot: patient’s sock, shoe tongue, sweat pants, and jeans. Remainder of
the physical exam was normal with note that only a portion of the foot could
be examined due to the foreign body and attached clothing.
X-rays are as pictured below in 3 views.
The patient was given a single dose of ciprofloxacin IV in the ER and
posted to the OR for emergent removal of the foreign body with lavage of the
wound. Tetanus prophylaxis was given in the form of tetanus toxoid and
immunoglobulin. The patient was discharged to home the next morning.
OK, doctors....It's time for you to act. Here is this week's
CLINICAL JUDGMENT CALL:
| Given the nature of this
injury and the treatment described, what is the most appropriate
antibiotic management upon discharge from the hospital?
A. Clindamycin 150mg PO TID x 3 weeks
B.
Ciprofloxacin 500mg PO
BID x 2 weeks
C.
Amoxicillin /
Clavulanate Potassium 875mg PO Q12h x 2 weeks
D.
Cephalexin 500mg PO QID x 2 weeks
E.
Linezolid 600mg PO Q12h x 4 weeks
F.
No antibiotics are indicated
|
Be sure to look for next week’s Residency Insight to see the results
of the Interactive Poll and for discussion on the case outcome.
Please send any suggestions, thoughts, questions or case presentations to me at:
editor@podiatry.com
John S. Steinberg, DPM
Editor, PRESENT
