razhan

Internal Medicine Resident

They brought this 7-year-old girl to ER with a cut-wound on her index finger of the right hand. The bleeding was stopped and she had minimal erosion to the bone. I referred her to plastic surgery in the urban area. My question is, is this suturable or not? If I suture it, what is the risk score for gangrene and complications?

Case Commentary

Similar Cases

Update to the 40-year-old male with the infected Achilles tendon repair 4 weeks postop. I took him for an I&D. I removed all the sutures I could find and left the swivelocks in the calcaneus. Intraop cultures were taken. Interestingly, his Achilles had healed a nice bridge of tissue over his rupture. I approximated the wound and put on an incisional wound vac. Cultures isolated MSSA, so he was treated with Keflex. Once his wound healed, I put him back on the normal rehab protocol. He has returned to full activity.

A patient came injured by a bomb shell, and there was a severe loss in the muscles and the vessels. The first decision was amputation, but then I decided to try to save it, so I did external fixation for the multiple fractures and then planted this arm in the wall of the chest to provide blood and protection. I will take it out with the skin of the chest maybe after 45 days. Was I right to do this?

Salter-Harris classification 2 fracture of the proximal phalanx of 5th digit. Glad I got the XR before I tried to reduce this obvious dislocation.

I am being asked: 'happy with the reduction doctor?' What should I say? Patient in mid 70s.

Further Cases

A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis. He had a history of hypertension, long-term smoking, and a sedentary lifestyle. Upon physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed, and the patient was promptly referred to the emergency department.

A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets. Upon examination, multiple small vesicles were observed, some clustered and others scattered, predominantly involving the lumbar region and left gluteal area.

A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.

Patient in late teens presenting after a collapse, no chest pain noted, with no previous cardiac history or history of sudden death in the family. Are there any features in this EKG that would warrant further work-up, or is this just a pediatric EKG?