SPECIALTY
Dermatology
CHIEF COMPLAINT
Hidradenitis suppurativa
COMMENTS TO SPECIALIST
A 26-year-old male presents with an 8-year history of hidradenitis suppurativa (HS). He does not have a primary care provider or dermatologist. The patient has made multiple visits to the emergency department (ED) for incisions and drainage but has never been hospitalized. He does not take any routine medications. Cocaine/marijuana use, Ethyl alcohol (EtOH) abuse12pack+1/5daily prior to admission to this facility. He does not smoke cigarettes. Hereportshavingover25incisionsanddrainagesintheEDrelated to his HS.HS affects the bilateral axilla, groin, and lower back. He was started on Bactrim 3 days ago for an acute abscess to the right axilla. Exam: The patient demonstrated a full range of motion in all extremities with no distress. The patient’s vital signs were within normal limits, and he denies any complaint other than the HS.**DERM: There is a 1 cm nodule ”at 2 o’clock” with a small amount of purulent/sanguineous drainage upon manual expression with a 2 cm circumferential area of light erythema and warmth. There are varying degrees of induration/cyst-like features, mostly around the superior lesion, with multiple areas of ropelike scars and pitted skin in the R axilla. Flat lesion at 8 “o” clock with a peri-wound area that is soft, draining a scant amount of purulent fluid.
MAIN QUESTION
Currently on Bactrim for acute infection. He needs long-term treatment. Please recommend a plan of care. See attached photos.
For reference only. This eConsult is based on an actual request for specialist consultation. The primary care provider, specialist, and patient are de-identified to protect private health information (PHI).
Elevating Care Impact: The Power of eConsults in Healthcare
The implementation of eConsults has profoundly impacted the quality and accessibility of patient care in healthcare settings. eConsults are a key clinical innovation that can assist in addressing inequities in access to specialty care. One of the critical aspects where eConsults have significantly elevated care impact is improving patient outcomes. Through eConsults, healthcare providers can collaborate more efficiently, leading to faster and more accurate diagnoses, timely treatment interventions, and better management of chronic conditions. This results in improved patient health outcomes, reduced hospital readmissions, and enhanced quality of life.
What is the impact on a patient’s care plan?
Diagnosis and treatment of new conditions
The care impact of eConsults is most notable in their ability to significantly improve the diagnosis and treatment of new conditions. This is particularly evident in scenarios such as the evaluation of new symptoms, interpretation of abnormal lab results and imaging studies, and assessment of changes in behavior. Through eConsults, healthcare providers can collaborate quickly and effectively, leading to more rapid and accurate diagnoses. This streamlined communication allows for prompt treatment initiation, reducing patient uncertainty and accelerating their path to recovery. Additionally, eConsults empowers healthcare teams to access a collective wealth of knowledge and resources, enabling comprehensive assessments and personalized treatment plans that optimize patient outcomes.
In a recent case involving a 65-year-old individual with a history of multiple strokes experiencing worsening upper extremity tremors, an eConsult proved instrumental in providing timely and effective care. The patient’s primary care physician (PCP) sought assistance in diagnosing and treating the tremors, prompting an eConsult with a neurologist. Through this eConsult, the neurologist suggested a differential diagnosis of vascular parkinsonism versus myoclonic jerking and recommended further evaluation through an MRI scan. Additionally, the neurologist proposed a trial of Keppra, an antiepileptic medication known for its efficacy in managing tremors. Thanks to the eConsult, the patient’s tremors were successfully controlled, and the need for a separate neurology appointment was eliminated. This expedited the diagnostic process and ensured that the patient received prompt and appropriate treatment, ultimately improving their quality of life and care experience.
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