This can’t be good!

The clinical scenerio goes something like this:  35yo male comes in with a swollen finger.  Several days ago he sustained a minor cut to the volar surface of his 2nd digit.  He  noticed over the next few days  increased swelling and redness.  He has a fever on exam.  What is the diagnosis?

Simple Hand Laceration? I think not!

Imagine you are working a busy shift in the ED when you pick up this patient with a hand laceration.  Simple laceration, right?  Just some quick sutures and out the door, right?  Well thats what happened with this patient at an out-of-state ED.

This photo was taken several hours after the patient arrived home.  The patient was discharged with a prescription for keflex.  Do you notice the redness starting around the wound?  The patient went to the ER again, was started on IV clindamycin, and the sutures were removed.  What happened here?  Why did this simple hand laceration become almost immediately infected?

Conference Notes…..The Hand….The Heart!!!

Conference was really great this morning!  We started with two great guest lectures on hand anatomy and amputations.  After that Dallon Jones, MD one of our third years gave an excellent lecture on chest pain dispositions (when to send home and when to admit.)  I’m going to start with a brief refresher on hand anatomy.