Wednesday, June 8, 2011

Trick of the Trade: Fingertip injuries



Fingertips can get injured in a variety of ways such as machetes, meat grinders, and broken glass. You name it, and we've probably seen it. Some don't actually need anything invasive done because the skin is basically just torn off. The wound just needs to be irrigated, explored, and then bandaged to allow for secondary wound closure.

What do you do if the finger injury keeps oozing and the finger tip is too painful for the patient to apply firm pressure? Poking the finger with 2 needles to perform a digital block seems a bit overkill.


Trick of the Trade:
Soak the digit in 1% lidocaine with epinephrine for 5 minutes

Pour 10-20 cc of 1% lidocaine with epinephrine into a small, sterile urine specimen cup. Have the patient dip his/her fingertip into the solution. The lidocaine will anesthetize the wound, and the epinephrine will help achieve hemostasis.

After irrigation and better examination of the wound, you can now apply a topical hemostatic pad (eg. Surgicel, Gelfoam) over it and wrap the finger with tubular gauze.

Thanks to Dr. Mak Moayedi (Univ of Maryland) for this great trick!

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7 comments:

  1. Just wondering is it alright to use epinephrine? Will it cause end artery ischemia/ necrosis of the digits?

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  2. Good question. The classic teaching is to avoid vasoconstrictors in end-vasculature structures because of the risk theoretical tip ischemia. Turns out that this is myth with the fingers in a recent publication in Plastics and Reconstr Surgery (Pubmed: http://www.ncbi.nlm.nih.gov/pubmed/20697319). Regardless, you are just bathing the finger tip with lidocaine plus epi. There is no further tip to ischemi-tize. Thanks for giving me an opportunity to help debunk the myth of "no epi in fingers/toes".

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  3. That is great news, thanks for the info!

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  4. A few years ago my hand slipped as I was removing the safety cover from a razor and I sliced a piece of my left index finger away, maybe 0.5 x 0.5 cm. I grabbed a few mls of XAP (LET) and squirted it into a cup, then plunged in my finger. Within 10 minutes my finger was numb and I could wrap it bloodless in a Band-Aid. It did fine.

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  5. Hey Joe! That's awesome. Good call to have some LET at home!

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  6. The finger tip will be numb w/in 20-30 seconds. No need to keep it in the solution for 5 minutes. Actually the pt will make that call.

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  7. Thanks for clarifying Mak. Will have to try this in the future.

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