CHIEF COMPLAINT: Tick bite.
HISTORY OF PRESENT ILLNESS: This is a (XX)-year-old Hispanic female who presents to the emergency department for removal of a tick from her right flank, which has been present now for approximately 12 hours. The patient denies any fever or chills. No joint pain. No rashes. The patient states that she was working out in the yard earlier in the day and feels that she may have gotten the tick at that time. The patient does not note any other injuries or any other complaints at this time.
PAST MEDICAL HISTORY: Significant for valvular heart disease, CVA/TIA.
PAST SURGICAL HISTORY: Hysterectomy and mitral valve repair.
SOCIAL HISTORY: The patient drinks alcohol, but does not smoke.
ALLERGIES: PENICILLIN.
MEDICATIONS: Nadolol 20 mg daily and aspirin 81 mg daily.
REVIEW OF SYSTEMS: See history of present illness. The patient reports no weight gain or weight loss. No fever or chills. No rashes. No chest pain or shortness of breath. No palpitations. All other systems reviewed are negative.
IMMUNIZATION STATUS: The patient is unsure.
PHYSICAL EXAMINATION:
GENERAL APPEARANCE: The patient is a well-developed, well-nourished Hispanic female in no acute distress.
VITAL SIGNS: Temperature 98.4, pulse 54, respiratory rate 18, blood pressure 178/86, saturation 98%. No pain.
HEENT: Within normal limits. Pharynx is pink and moist.
NECK: Supple. Full range of motion. No adenopathy.
LUNGS: Clear to auscultation. No wheezes, rales or rhonchi.
CARDIOVASCULAR: Regular rate and rhythm. The patient does have a slight murmur over the left sternal border, in the mitral region. No gallops. No clicks. Normal S1 and S2.
ABDOMEN: Positive bowel sounds, soft, nontender.
EXTREMITIES: No clubbing, cyanosis or edema.
SKIN: The patient has an adult tick to her right flank. The tick does not appear to be grossly engorged. There is no erythema or rashes.
EMERGENCY DEPARTMENT COURSE: The patient was given 100 mg of doxycycline.
PROCEDURE: Tick Removal: The tick was grasped with forceps gently and twisted counterclockwise. After multiple rotations, the tick was released from the skin with head intact and jaws. There was no remaining foreign body. There was no erythema or bleeding. The wound was cleansed with Betadine. The patient tolerated the procedure well. There were no complications.
DIAGNOSIS: Tick bite with removal.
PLAN:
1. Rest.
2. Daily soap, water and Neosporin.
3. Doxycycline 100 mg, #20.
4. The patient is to follow up with her primary care doctor within 1 week and return to the ER for any problems.
DISPOSITION: Discharged.
