A febrile 66-year-old female who recently removed a tick presents with a 3 cm erythema migrans lesion. What is the most appropriate immediate action?

• A. assess her vital signs.
• B. administer oxygen.
• C. cleanse the area with soap and water.
• D. apply a moist, sterile dressing.

Answer: (A)

Begin with the most fundamental step: perform a rapid primary survey by obtaining vital signs to assess stability. In any patient with fever and a possible tick-borne illness, you need to know if they’re hemodynamically stable and able to compensate—look for signs of hypoxia, hypotension, tachycardia, altered mental status, or life-threatening distress. A 3 cm erythema migrans lesion suggests early Lyme disease, which may cause fever and malaise, but it doesn’t change the need to first determine how well the patient is currently functioning. Actions like giving oxygen are only indicated if there are signs of respiratory compromise; cleansing the bite area or applying a dressing address local wound care but don’t address potential systemic instability. So the immediate priority is to check vital signs to guide further evaluation and treatment.