Detailed Treatment Process
Male, 12 years old, persistent fever for two weeks The following is the outpatient record Visit date: June 22 Department: General Surgery Chief complaint: Redness and swelling of the skin on the left lower limb with ulceration for 10 days History of present illness: Past medical history: Examination: Redness and swelling of the skin on the left lower limb with ulceration and bloody exudate Auxiliary examinations: Outpatient preliminary diagnosis: Erysipelas; cellulitis Management: Treatment: 1. Major dressing change (wound surface between 30-50 cm²); excision of superficial mass; minor nerve block anesthesia 2. Prescription: Cefaclor sustained-release tablets 0.375 g / 6 tablets / box, 3 boxes in total, [oral] 1 tablet twice daily 3. Prescription: Lidocaine hydrochloride injection 0.100 g * 1 / ampoule, 1 ampoule in total, [nerve block] 0.1 g per dose as needed 4. Prescription: Acetaminophen sustained-release tablets 0.650 g / 6 tablets / box, 1 box in total, [oral] 1 tablet once daily
The following is the complete blood count report (normal reference ranges on the right) Gender: Male Age: 13 years old Department: Dermatology Specimen type: Whole blood Sampling date: June 12 Testing date: June 12 Report date: June 12 20:38 Clinical diagnosis: Erysipelas? 1. CRP 30 (<8 mg/L) 2. White blood cell count 13.11 (4-10 × 10⁹/L) 3. Neutrophils 78.0% (50-70%) 4. Lymphocytes 13.30% (20-40%) 5. Monocytes 6.80% (3-8%) 6. Eosinophils 1.70% (0.5-5%) 7. Basophils 0.20% (0-1%) 8. Neutrophil count 10.22 (1.4-6.5 × 10⁹/L) 9. Monocyte count 0.89 (0-0.7 × 10⁹/L) 10. Lymphocyte count 1.75 (1.2-3.4 × 10⁹/L) 11. Eosinophil count 0.22 (0-0.7 × 10⁹/L) 12. Basophil count 0.03 (0-0.2 × 10⁹/L) 13. Red blood cell count 5.09 (4-5.5 × 10¹²/L) 14. Hemoglobin 143 (120-160 g/L) 15. Hematocrit 41.3% (35-45%) 16. Mean corpuscular volume 81.1 (82-95 fl) 17. Mean corpuscular hemoglobin 28.1 (27-31 pg) 18. Mean corpuscular hemoglobin concentration 346 (320-360 g/L) 19. Red cell distribution width 12.7% (0-15.4%) 20. Platelet count 173.00 (100-300 × 10⁹/L) 21. Plateletcrit 0.18% (0.1-0.27%) 22. Mean platelet volume 10.50 (7.8-12.5 fl) 23. Platelet distribution width 12.2 (9-17 fL)
Gender: Male Age: 12 years old Outpatient department: Outpatient Dermatology Specimen type: Anticoagulated blood Clinical diagnosis: Lower limb skin infection Sampling time: June 17 11:31 Received time: June 17 12:12 Testing date: June 17 Report time: June 17 13:29 Printing time: June 17 13:37 White blood cell count 6.70 (3.97-9.15 × 10⁹/L) Neutrophils 54.5% (50.0%-70.0%) Lymphocytes 23.2% (20.0%-40.0%) Monocytes 10.5% (3.0%-10.0%) Eosinophils 11.1% (0.5%-5.0%) Basophils 0.7% (<1.0%) Neutrophil count 3.70 (2.00-7.00 × 10⁹/L) Lymphocyte count 1.60 (0.80-4.00 × 10⁹/L) Monocyte count 0.70 (0.12-1.00 × 10⁹/L) Eosinophil count 0.80 (0.02-0.50 × 10⁹/L) Basophil count 0.00 (<1.00 × 10⁹/L) Red blood cell count 4.67 (4.09-5.74 × 10¹²/L) Hemoglobin 141 (131-172 g/L) Hematocrit 0.404 (0.380-0.508) Mean corpuscular volume 86.5 (83.9-99.1 fl) Mean corpuscular hemoglobin 30.2 (27.8-33.8 pg) Mean corpuscular hemoglobin concentration 349 (320-355 g/L) Red cell distribution width 13.0% (11.6%-14.0%) Platelet count 229 (85-303 × 10⁹/L) Mean platelet volume 7.9 (6.5-12.0 fl)
Gender: Male Age: 12 years old Department: Emergency Pediatrics Specimen type: Blood Submission date: June 23 12:46 Receipt date: June 23 12:50 Report date: June 23 Clinical diagnosis: *** White blood cell count 9.31 (4.00-10.00 × 10⁹/L) Red blood cell count 5.08 (3.50-5.50 × 10¹²/L) Hemoglobin 147.00 (110.00-160.00 g/L) Hematocrit 41.90 (36.00-50.00%) Mean corpuscular volume 82.50 (86.00-100.00 fL) Mean corpuscular hemoglobin 28.90 (26.00-31.00 pg) Mean corpuscular hemoglobin concentration 351.00 (310.00-370.00 g/L) Platelet count 116.00 (100.00-300.00 × 10⁹/L) Neutrophils 69.80% (45.00-77.00%) Lymphocytes 17.00% (20.00-40.00%) Monocytes 12.50% (3.00-8.00%) Eosinophils 0.50% (0.50-5.00%) Basophils 0.20% (0-1.00%) Neutrophil count 6.50 (2.00-7.70 × 10⁹/L) Lymphocyte count 1.6 (0.8-4.0 × 10⁹/L) Monocyte count 1.16 (0.12-0.80 × 10⁹/L) Eosinophil count 0.05 (0.05-0.50 × 10⁹/L) Basophil count 0.02 (0-0.10 × 10⁹/L) Red cell distribution width 37.10 (37.00-50.00%) RDW-CV 12.30% (11.60-14.50%) Platelet distribution width 10.30 (9.00-17.00 fL) Mean platelet volume 9.90 (9.00-13.00 fL) Plateletcrit 0.11% (0.17-0.35%) Large platelet ratio 22.70% (13.00-43.00%) High-sensitivity CRP 6.9 (0-10.0 mg/L) Serum amyloid A 10.00 (0-10.00 mg/L)
Gender: Male Age: 12 years old Department: Pediatrics Specimen type: Blood Submission date: June 25 16:38 Receipt date: June 25 16:39 Report date: June 25 16:50 Clinical diagnosis: *** White blood cell count 6.15 (4.00-10.00 × 10⁹/L) Red blood cell count 4.95 (3.50-5.50 × 10¹²/L) Hemoglobin 143.00 (110.00-160.00 g/L) Hematocrit 40.00 (36.00-50.00%) Mean corpuscular volume 80.80 (86.00-100.00 fL) Mean corpuscular hemoglobin 28.90 (26.00-31.00 pg) Mean corpuscular hemoglobin concentration 358.00 (310.00-370.00 g/L) Platelet count 165.00 (100.00-300.00 × 10⁹/L) Neutrophils 57.40% (45.00-77.00%) Lymphocytes 29.60% (20.00-40.00%) Monocytes 11.40% (3.00-8.00%) Eosinophils 1.30% (0.50-5.00%) Basophils 0.30% (0-1.00%) Neutrophil count 3.53 (2.00-7.70 × 10⁹/L) Lymphocyte count 1.8 (0.8-4.0 × 10⁹/L) Monocyte count 0.70 (0.12-0.80 × 10⁹/L) Eosinophil count 0.08 (0.05-0.50 × 10⁹/L) Basophil count 0.02 (0-0.10 × 10⁹/L) Red cell distribution width 35.10 (37.00-50.00%) RDW-CV 12.00% (11.60-14.50%) Platelet distribution width 7.90 (9.00-17.00 fL) Mean platelet volume 9.40 (9.00-13.00 fL) Plateletcrit 0.15% (0.17-0.35%) Large platelet ratio 18.50% (13.00-43.00%) High-sensitivity CRP 1.0 (0-10.0 mg/L) Serum amyloid A 7.00 (0-10.00 mg/L)
The family sent several messages via instant messaging The child developed leg swelling, pain, and fever on June 13. He was transferred from the emergency department to surgery and then to dermatology. The initial diagnosis was erysipelas. After 10 days of penicillin infusions, he underwent debridement surgery in general surgery on June 22. Up until tonight (June 25) at 9:00 PM, he has also been on cephalosporins for 3 days, but the high fever still has not subsided. The parents are wondering whether they should go to the night emergency department now. This afternoon (June 25), the temperature reached 39.1°C. He took ibuprofen oral suspension at 5:30 AM. At 15:00 the temperature was 38°C, and at 17:00 it rose again to 39°C. The June 25 billing statement included a microwave (throat) treatment item. Fever plus sore throat started on June 21. He saw internal medicine on Sunday, and ulcers were found in the throat. At this moment (9:00 PM on June 25), the temperature is between 38°C and 39.1°C. There is no cough and no sputum, only throat ulcers. In fact, the throat started hurting from the day of the surgery. The above information involves 3 hospitals. The illness has lasted 2 weeks, with high fever that still has not subsided up to this moment. What should be done?