Trick of the Trade: Fingertip injuries

Fingertips can get injured in a variety of ways such as machetes, meat grinders, and broken glass. You name it, and we've probably seen it. Some don't actually need anything invasive done because the skin is basically just torn off. The wound just needs to be irrigated, explored, and then bandaged to allow for secondary wound closure.

What do you do if the finger injury keeps oozing and the finger tip is too painful for the patient to apply firm pressure? Poking the finger with 2 needles to perform a digital block seems a bit overkill.

Trick of the Trade:
Soak the digit in 1% lidocaine with epinephrine for 5 minutes

Pour 10-20 cc of 1% lidocaine with epinephrine into a small, sterile urine specimen cup. Have the patient dip his/her fingertip into the solution. The lidocaine will anesthetize the wound, and the epinephrine will help achieve hemostasis.

After irrigation and better examination of the wound, you can now apply a topical hemostatic pad (eg. Surgicel, Gelfoam) over it and wrap the finger with tubular gauze.

Thanks to Dr. Mak Moayedi (Univ of Maryland) for this great trick!