Don't say I didn't warn you.
Remember: I have a higher tolerance for "gross" than some of you seem to... these pictures don't bother me one bit.
A man walked into the ER today with this:
He had stuck his hand into an air conditioner fan.
Yes, by accident.
That piece dangling off the top right end of his finger? That's what's left of his fingernail.
I got to do the digital nerve block (much less intimidating than it sounded, actually) to numb the guy's finger, and then assist the surgeon in attempting to fix it.
After the fixing attempt:
Not too bad.I guess.
We cut off his fingernail (it was just dangling by a thread, so no good anymore), and stitched some of his remaining attached skin back into place. He's still missing the top part of his finger, but it will fill back in. Whether his nail comes back remains to be seen. At least it looks like a finger again now.
We could have sent him to Lexington to see a hand surgeon, but when he got wind of that idea, he vetoed it, because he didn't have any insurance. We told him there was a risk he might have to lose the tip of his finger completely, and he was OK with it, since it would be cheaper than seeing a hand surgeon. Sad and depressing. Luckily, once I got his finger numb and we were able to explore it without him wanting to jump off of the bed, we realized the bone and bottom half of his fingertip were OK, and the thing was bleeding profusely, which is always a good sign. So he didn't need a mini amputation, and he will only be slightly deformed in the end.
I saw another really awesome wound today also, as soon as I walked in this morning, but I completely forgot to take pictures, dammit! A teenager hit himself in the shin with a moving chainsaw by accident, and I got to sew him up all by myself. Keep in mind that I've never had really good training on suturing wounds (as opposed to incisions, which I'm good at), and it turns out that there's a lot of theory behind why and how you do what you do. I learned about it all after I sewed up this kid's shin, so as it turns out, he might have a pretty good scar. Oh well -- when you're 14 and you get hit with a chainsaw, I guess you want a good scar. Now that I know more about suturing theory, the next one won't be so bad. And that would be reason #113 not to go to a teaching hospital... Now if only I could remember that I have my camera with me so I don't miss any more good pictures!
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3 comments:
So cool ! I love this kind of stuff ! Did he have a lot of nerve damage? Wouldn't he need to see a hand surgeon?? Yeesh...
If it were an index finger or thumb, I think we could have made a stronger case for sending him to a hand surgeon. If he had health insurance, we could have made a stronger case for sending him to a hand surgeon. And when I say "made a stronger case for" I mean to HIM. Because he knew his middle finger wasn't totally important, and he knew that he already wasn't going to be able to afford the ER bill as it was. So he made a choice.
Should he have gone to a hand surgeon? Possibly -- I'm still not sure how much more could have been done. Right now, he'll just have to wait for new flesh to grow back in, and it's possible some nerves may grow back. You'd be surprised how many people there are around here with crooked tips of fingers that were former traumas. Really, really sad.
This is awesome -- rural medicine is turning out to be such an amazing learning experience!
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