humbly_homo_sapien

Internal Medicine Resident

Hand in the Machine

Ortho Casuality Day 1

28/Male
Came with a right hand wound. Massive bleeding and extremely contaminated. The person assisting claimed he is a fellow worker whose hand got stuck in a mill. The fingers were brought in a frozen box, not very well preserved and unfortunately were not viable for surgical reconstruction.

The wrist block of 2% lignocaine was given at the median nerve and the ulnar nerve blindly. The wound was thoroughly cleaned with normal saline. The bleeding vessel was clamped and treated with hydrogen peroxide. There wasn't much that we could do, hence we did bone nibbling and removed the bone shards that were popping out. Next we did bandage and sent it to the surgical department for flap reconstruction. They plan to take a flap from his abdomen to cover the site.

Sorry, I don't have an X-ray or post bandage treatment.

Tips I learnt-

1. Any wound clean rigorously with NS.
2. Use Hydrogen peroxide if a bleeding vessel, and let it act for 1 minute.
3. Never break the rule of disinfection.

Diagnosis added by author

Crush injury on hand

More about this case

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only took one angle before sending him out.
59 yo man hand vs skill saw. Injury to the bone, ligament, and tendon (which was not complete) Required surgical repair and pins placed. PCP office we did an initial cleaning and bandage then sent him to the hospital to meet ortho.

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