15 YEARS DIAGNOSED WITH CELLULITIS

SECONNDARY TO INOCULATION OF VENOM FROM A

SUSPECTED SNAKE BITE:
Presenting Complaint: Patient who is a 15-year-old male walked
into the ward at the Volta Regional Hospital in Hohoe in the Volta
Region of Ghana at 1:15pm accompanied by the mother with the
complaint of a swollen right hand of two days duration.

History of Presenting Complaint: The patient was well until 5

days ago when he placed his right hand in a hole and got bitten by
what they suspect to be a snake. According to the mother, his right
hand started getting swollen 2 days after the incident so he came in
for treatment. The patient was admitted to the ward, and intravenous
access was secured and a blood sample was taken for further
analysis. The patient’s vital signs were monitored and medications
were prescribed. The patient was kept on continuous monitoring and
both the mother and patient were reassured.

On Direct Questioning: the swollen right hand was painful, there

was discharge exuding from the swollen right hand but there was no
dizziness, cough or bleeding from the site.

Past Medical History: there was no past medical history.

Drug and Allergen History- He has taken herbal medication

before.

Adolescent History: He is a student; he does not drink or smoke.

Examination: On general examination, he is an adolescent male,
fully conscious and alert, is afebrile, fairly hydrated, and not in any
obvious respiratory distress nor is jaundiced but looks pale and was
in pain, noticeably from the swollen right hand. The Glasgow Coma
Scale score was 15/15. The vital signs: temperature was 37.6
degrees Celsius; pulse was 69 beats per minute, respiratory rate was
21 cycles per minute, blood pressure was 130/90mmHg and SpO2
was 99% in room air. On examination of his right hand, it appears
swollen to the wrist, is discharging and is painful with the distal
phalanx of finger appearing darkened.

Medications: Intravascular Amoxiclav 1.2 grams three times daily

for 24 hours and intramuscular Tramadol 100 milligrams three times
daily for 24hours.

Plan: the patient and his mother will be educated on his condition,
treatment regimen, prevention and the need to adhere to review.

Evaluation: General condition is fairly ill.

DAY 1:
The next day, the patient reported to have slept well and had no
complaints. The presenting symptoms have subsided. The patient
was reassured, hygiene was maintained and his vital signs were
checked and present as follows: temperature was 36.8 degrees
Celsius; pulse was 81 beats per minute, respiratory rate was 16
cycles per minute, blood pressure was 125/76 mmHg and SpO2 was
95% in room air. The patient’s medications were administered and
documented. The patient rested but woke up at 2 p.m. and was
propped up in bed but had no complaints and vital signs were
checked.

Plan: administer IV Amoxiclav 1.2 grams, oral Tramadol 50

milligrams and tab Paracetamol 1 gram three times daily along with
CT hand elevation and monitoring vitals 4 hourly.

Evaluation: Patient’s general condition is fairly stable

DAY 2:
The patient looks better and had no complaints. On direct
questioning, there was no bleeding from orifices, no fever or chills,
no difficulty breathing. On general examination, the patient looked
stable, was not pale, not jaundiced, was afebrile and hydration was
satisfactory. On examination of the right hand, the swelling reduced
but the distal phalanx of finger remained darkened and with sensory
loss. The patient was reassured, patient’s hygiene was maintained
and his vital signs were checked and present as follows: temperature
was 36.2 degrees Celsius; pulse was 68 beats per minute, respiratory
rate was 20 cycles per minute, blood pressure was 110/51 mmHg
and SpO2 was 99% in room air.

Plan: Discharge patient home on oral Amoxiclav 1 gram two times

daily, oral Tramadol 50mg three times daily and oral Paracetamol
three times daily and carpal tunnel hand elevation at home and to
return for review on 15th January, 2024.