Monday Pharmaceutical Mystery: September 17

SEPTEMBER 17, 2018
Gunda Siska, PharmD
An man aged 18 years is buying some topical antibiotic ointment for a newly aquired cut on his leg. He was playing baskeball, and he collided with another player and got a little scrape. That was 2 hours ago, and the injured area is very painful and red. There is no burising, and there is no drainage from the wound. You can see a marked outline or redness and the skin is very warm .
 
Mystery: Why is this small wound so painful? Why is it so red if the injury just occurred 2 hours ago. Usually a red area that size takes longer to form.
 
Solution: This patient likely has narcotizing fasicatis, a serious bacterial infection. With a pen, you trace the outline of the redness and put the exact time. You tell the patient that you highly recommend he be seen by a doctor ASAP.  You know that by tracing the red area in ink the emergency department doctor will be able to see how quickly this infection is spreading. In 2 hours, necrotiing fasciaits will be significantly outside the marked area, and the doctor can take appropriate action.

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