Chief Complaint: Eb was transferred from OSH for PICC Line for Osteomyelitis of toe of

right foot
History of Present Illness
The patient is an 11 year old male with no signficant PMHx. He has been transferred
from OSH for PICC line placement for long term abx tx for osteomyelitis in right foot. On
3/9 the patient injured his great toe on the right foot during a basketball game striking a
concrete block. That evening he had pain in the foot however no signs of gross
malformation. His mother states he had some blood where the nail inserts and she
washed it with hydrogen peroxide. A few days later on the 12th, he had a lot of pus
leaking from the site, his foot was swollen, very warm and was still very tender so his
mother took him to a podiatrist to drain the foot. The podiatrist was concerned of
possible osteomyelitis and so he went to homestead hospital for evaluation on the 13th.
A Salter-Harris II fracture was identified on XR and an MRI showed osteomyelitis of 1st
distal phalanx, Salter-Harris II fracture of the same digit, and first interphalangeal joint
effusion. His ESR was 26, he had an elevated CRP, and wound Cx showed MSSA. He
was placed on both zosyn and clindamycin with IVF, bactroban, pepcid, and pain
medication. He was transferred here on the 18 th for a PICC line. During this episode he
denies having ever had fevers, other symptoms including pain or swelling in other
nearby joints.
Review of Systems
Constitutional: No fever, No sweats, No weakness, No fatigue, No decreased
activity.
Eye: No discharge, No visual disturbances.
Ear/Nose/Mouth/Throat: No nasal congestion, No sore throat.
Respiratory: No shortness of breath, No cough, No sputum production, No
hemoptysis, No wheezing, No cyanosis, No apnea.
Cardiovascular: No chest pain, No palpitations, No peripheral edema, No
syncope.
Gastrointestinal: No nausea, No vomiting, No diarrhea, No constipation, No
abdominal pain.
Genitourinary: No dysuria, No hematuria.
Hematology/Lymphatics: No bruising tendency, No bleeding tendency.
Endocrine: No excessive thirst, No polyuria.
Immunologic: Not immunocompromised, No recurrent fevers, No recurrent
infections.
Musculoskeletal: Trauma, No neck pain, No joint pain, No muscle pain, No
decreased range of motion.
Integumentary: No rash.
Neurologic: Alert and oriented X4.
Health Status
Allergies: No Known Medication Allergies
Past Medical History: NO PMH
Birth History
Born to a25 year old g1p1 via nsvd. Weight approximately 6.5 lbs No complications.
Delivered at 39 weeks

Immunizations UTD per parent.

No hospitalizations or prior surgeries
No current medications
Development: no gross developmental delay, in school and no need for special
education or therapy
Nutritional: WNL
Social History: Denies cigarette, illicit drugs, or sexual activity. Lives at home with
mother, father, sister. In 5th grade and his favorite class is mathematics
Family History: mother 36 no health issues
Father 41 no health issues
Grandmother 69 has diabetes.
Family is aware that EB will be getting a special IV in his arm to get his medicine for his
infection and that a nurse will be coming to their house periodically to help with the
medicine. They are also aware of need for followup with ID
.
Physical Examination
Vital Signs HR 61 RR 19 BP 95/60 T 97.6F
General: Alert and oriented. No apparent distress
Eye: PERRL, EOMI, Normal conjunctiva.
HENT: MMM, No pharyngeal erythema.
Neck: Non-tender.
Respiratory: CTA,
Cardiovascular: RRR, No murmur, No gallop, s1+s2 present no s3+s4
Gastrointestinal: Soft, Non-tender, Non-distended, Normal bowel sounds.
Genitourinary: No CVA tenderness.
Musculoskeletal: Right large toe wrapped in gauze, tender to palpation, limited
ROM. Unable to bear weight.
Integumentary: Warm, Pink, Moist, No rash.
Neurologic: Alert, Oriented, No focal defects.
Cognition and Speech: Speech clear and coherent.
Psychiatric: Cooperative.
Health Maintenance- sees pediatrician once a year or so
Immunizations: Up to date per parent.
Labs and imaging: as per HPI from outside facility.
Assessment and Plan*:
EB is an 11 year old boy with no PMH who has begun IV abx treatment for
osteomyelitis secondary to trauma in the great toe of the R foot. Previously the
foot had been swollen and draining pus. It is still very tender but is improving. He
has been transferred to MCH for placement of a picc line for IV abx for the
recommended 28 days. And is scheduled for placement tomorrow.
- Admit to 3NE under hospitalist
- Regular Diet for Age, NPO at midnight
- Continue IV Clindamycin
- Ortho consult to evaluate for further intervention