433.A farmer in Texas presents to the ED with right leg numbness, localized
edema, and tremors. He reports being out in the field when the symptoms
began. He denies contact with insecticides and reports being at his baseline
of health prior to the event. His initial vitals include HR of 105 beats per
minute, BP of 175/90 mm Hg, and RR of 22 breaths per minute with oxygen
saturation of 97% on room air. Which of the following is the most appropriate
initial treatment of choice in this patient?
a. Antivenin
b. Tetanus prophylaxis
c. Antibiotic prophylaxis
d. Sedation
e. Atropine
434.A 23-year-old man presents to the ED after sustaining a bee sting. The
patient points to his left arm when asked where the pain is. Upon physical
examination, you see a single puncture wound with surrounding erythema
and swelling. The patient is in no respiratory distress and is phonating well.
Chest auscultation reveals clear breath sounds bilaterally with no wheezing.
The oropharynx is patent without any tonsillar or uvular displacement. Which
of the following is the most appropriate next step in management?
a. Subcutaneous epinephrine 0.01 mL/kg
b. IV epinephrine 0.01 mL/kg
c. Steroids
d. Observation
e. Antihistamines
435.An 18-year-old man is brought into the ED and reports that a stray dog
at the park bit him. The patient complains of right forearm pain, where he was
bitten. Upon physical examination, you note a superficial macerated laceration
on the dorsal surface of the distal forearm with no active bleeding. The patient
is able to freely flex and extend all joints in the right upper extremity. In
addition to localized wound care, antibiotics, and tetanus prophylaxis, what
other expeditious measures should be taken in the care of this patient?
a. Reporting the incident to local authorities
b. Rabies immunization
c. Tight suturing of the laceration
d. Antihistamines
e. Irrigation with povidone-iodine solution
468 Emergency Medicine