CHIEF COMPLAINT: Itching.
HISTORY OF PRESENT ILLNESS: This is a (XX)-year-old Hispanic female who presented to the emergency department complaining of a three-week history of itching spots all over, mainly her extremities and one on her abdomen, after moving into a women’s shelter. She states that she had been told that they had bed bugs at that location and they have been instructed to clean their sheets and clothes in hot water, which she has done. However, she does not think her roommates have been doing that. She denies any fevers, denies any new product exposure, and denies ever experiencing this before.
PAST MEDICAL HISTORY: Depression.
CURRENT MEDICATIONS: Zoloft and trazodone.
ALLERGIES: None.
FAMILY HISTORY: Noncontributory.
SOCIAL HISTORY: Negative for tobacco, alcohol or drug use.
REVIEW OF SYSTEMS: Positive for chronic knee and back pain. Negative for fevers, chills, nausea, vomiting, diarrhea, constipation, headache, visual disturbances, neck pain, chest pain or shortness of breath. All other systems are negative, except as noted in the HPI.
PHYSICAL EXAMINATION:
VITAL SIGNS: Blood pressure 120/90, pulse 94, respiratory rate 18, temperature 97.4, and pulse ox 100% on room air.
GENERAL: The patient is awake, alert, and oriented, in no apparent distress, resting comfortably on the bed.
HEENT: Atraumatic and normocephalic. Pupils are equal, round, and reactive to light. Extraocular movements are intact. Sclerae are anicteric. Conjunctivae are clear. Oropharynx is clear with pink, moist mucous membranes.
LUNGS: Clear to auscultation bilaterally.
HEART: Regular rate and rhythm.
ABDOMEN: Soft, nontender, and nondistended. No masses, no hepatosplenomegaly.
SKIN: Warm and dry. No evidence of rash. She does have multiple, well-circumscribed circular areas of erythematous macules on mainly her upper and lower extremities and one on her abdomen, the largest of which is 1.5 cm in diameter. There is no significant induration and no tenderness in any of these areas.
LABORATORY RESULTS/RADIOLOGY: None.
EMERGENCY DEPARTMENT COURSE: The patient was seen and evaluated. She remained hemodynamically stable throughout her stay. She received 50 mg of Benadryl and instructions on cleaning her linens, clothes, and having her roommates do the same. She was given a prescription for Atarax and for Claritin and discharged home.
MEDICAL DECISION MAKING: The patient presented with evidence of urticaria, likely from bed bug bites. She has no evidence of scabies, no evidence of cellulitis, no evidence of any abscess. She is hemodynamically stable for discharge.
IMPRESSION:
1. Urticaria.
2. Bed bug bites.
PLAN:
1. The patient is to take Atarax as needed for itching and Claritin as needed for itching.
2. She is to return for worsening redness, purulent discharge, fever or other concerns.
The patient verbalized understanding of the discharge instructions.
DISPOSITION: The patient was discharged to home in good condition.
