Acute onset, hand trauma with partial amputation of the middle finger

Treatment

• Tetanus booster
• Cefazolin
• Morphine
• Zofran
• NPO
• Bedside digital block with lidocaine and then realignment of 3rd digit to minimize ischemia
• Hand surgery consultation and emergent operation (debridement, microvascular repair/reattachment, fixation)

Disposition

• Admitted directly to the operating room roughly 90 minutes after arrival (roughly 150 minutes after initial trauma)

Authors:

• Keith Cross, MD University of Louisville

Editors:

• David M. Spiro, MD, MPH Professor of Pediatrics University of Arkansas Medical Center

Diagnosis

• Finger amputation
• Digit amputation
• Hand trauma

Differential Diagnosis

• Crush injury
• Fractured phalanx (multiple)
• Open fracture(s)
• Partial amputation
• Ischemia
• Nerve injury
• Subungual hematoma
• Compartment syndrome

Patient Workup

• Radiographs

Suggested References

Finger amputation

Patient

• Gender: Male
• Age: 11 years
• Height: Not Available
• Weight: 105.8 lb/48 kg

Vitals

• Temperature: 97.5 F/36.4 C
• Blood Pressure: 129/88
• Heart Rate: 92
• Respiratory Rate: 15
• Pulse Oximetry: 98% RA

Signs and Symptoms

Acute onset, right hand injury

History Medical

• Parents stopped vaccinating at 3 years of age
• S/P Tonsillectomy – no problems with anesthesia

Social

• Lives at home with family, attends school

Medications

• None at home
• Morphine admin by EMS en route

Acute onset, hand trauma with partial amputation of the middle finger

Treatment

Disposition

Authors:

Editors:

Diagnosis

Differential Diagnosis

Patient Workup

Suggested References

Patient

Vitals

Signs and Symptoms

History Medical

Social

Medications

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