Derm

Finger Wound Hemostasis

search

Finger Wound Hemostasis, Digital Laceration Bleeding Control, Bleeding Control of Digital Vessel Laceration

  • See Also
  1. Finger Laceration
  • Precautions
  1. Avoid clamping any bleeding digital vessels
  2. Avoid narrow width Tourniquet use (e.g. belts)
  • Management
  • Initial
  1. Step 1: Apply direct pressure to wound for 15 minutes
  2. Step 2: Apply digital Tourniquet
    1. Impromised
      1. Penrose drain clamped with hemostat or
      2. Cross section of glove finger
    2. Commercial
      1. Tournicot
      2. T-Ring
  3. Step 3: Apply compression dressing (e.g ace wrap)
    1. Start wrap proximal to wound site
    2. Ace wrap should also hold bandage at wound site
  4. Step 4: Elevate affected arm
    1. Consider using cast stockinette
    2. Cut stockinette lengthwise 8 inches at each end
    3. Tie one end over patients Shoulder
    4. Tie the other end to top of IV pole
  • Management
  • Refractory to above
  1. Step 1: Wrap and elevate arm as above
  2. Step 2: Obtain Tourniquet
    1. Air-inflated arm Tourniquet (used in orthopedics) or
    2. Blood Pressure cuff
  3. Step 3: Apply Tourniquet to arm
    1. Adult pressure: 250 mmHg
    2. Child pressure: 100 to 200 mmHg
  4. Step 3: Clamp Tourniquet tubes with hemostat
  5. Step 4: Remove ace wrap (from Step 1)
  6. Step 5: Emergent orthopedic or vascular surgeon
    1. Tourniquet use cannot exceed 90 to 120 minutes
    2. Longer Tourniquet times risk ischemic limb injury
  • References
  1. Antosia in Marx (2002) Rosens Emergency Med, p. 493-534
  2. Daniels (2004) Am Fam Physician 69(8):1949-56 [PubMed]
  3. Lahham (2011) West J Emerg Med 12(2): 242–9 [PubMed]