DATE OF ADMISSION: MM/DD/YYYY
CHIEF COMPLAINT: Bee sting.
HISTORY OF PRESENT ILLNESS: The patient is a (XX)-year-old female who was stung by a bee yesterday at 5:30 p.m. in the ulnar aspect of the middle third of her right forearm. The patient states that she took some Benadryl this morning, but it did not really help and it is fairly swollen. Much of the swelling occurred yesterday; however, it almost doubled in size today. No fevers or shaking chills. The area is fairly painful.
PAST MEDICAL HISTORY: No history of diabetes mellitus or underlying coronary artery disease.
PAST SURGICAL HISTORY: The patient has had a cholecystectomy in the past. She has also had an oophorectomy.
FAMILY HISTORY: Negative for diabetes.
CURRENT MEDICATIONS: None.
ALLERGIES: None.
REVIEW OF SYSTEMS: Apart from those listed above, the remainder of systems are negative.
PHYSICAL EXAMINATION:
GENERAL APPEARANCE: The patient is alert.
VITAL SIGNS: Temperature 98.2, respirations 22, pulse 90, and blood pressure 158/114.
HEENT: Head is atraumatic. Eyes: PERRL. No scleral icterus. Throat: No drainage.
NECK: Supple. No meningismus. No adenopathy.
CHEST: Clear.
HEART: Sinus rhythm.
BACK: No CVA tenderness.
ABDOMEN: Nontender.
EXTREMITIES: The patient has an area of redness and induration and edema over the ulnar aspect of the right forearm, which is about maybe a 1 cm x 4 cm area. It looks like a fairly significant venom reaction, but we do not see any definite evidence of cellulitis; although, this may possibly be early cellulitis. No lymphangitis or adenopathy.
NEUROLOGIC: Normal for age.
PSYCHIATRIC: Mild anxiety.
LABORATORY DATA: White blood count is within normal limits.
EMERGENCY DEPARTMENT COURSE: The patient initially was given Atarax 100 mg p.o., Percocet 10 mg p.o., and Keflex 500 mg p.o. This was quite helpful. However, about an hour after she got here, the patient became very anxious and had some sharp chest pain associated with numbness in her hands and a sense of panic. An EKG was done. Review of the EKG shows sinus rhythm, rate 74, PR interval 172 msec, axis normal. No ST elevation or ST depression. EKG diagnosis: Sinus rhythm. The patient appears to be having a panic attack and therefore was given Ativan 1 mg IV, and this seemed to pretty much solve the problem. A blood sugar is being run at this time, and if it is within a reasonable limit, she will be allowed to go home because she really does feel much better. It also should be noted that the area of redness has already reduced a fair amount.
IMPRESSION:
1. Acute venom reaction to hymenoptera, of the right forearm.
2. Possible early cellulitis; however, this seems to be less likely.
PLAN:
1. Discharge prescription for Atarax, Keflex, and Percocet for pain.
2. No driving while taking Atarax or Percocet.
3. Recheck Tuesday morning.
4. Return immediately for any high fever or if the area of rash starts to extend dramatically and quickly.
DISPOSITION: The patient has been discharged to home.
