Finger Tip avulsion

in this video I'd like to demonstrate a simple technique for management of fingertip of vull shin injuries these are a common injury that we all see in the emergency department usually a person who slices the tip of their thumb or another finger while they're slicing

vegetables what we often see is that no matter how much direct pressure you hold on these injuries they just keep bleeding and this is a real nuisance which is why the patient comes to see us in the ED here's a simple technique that

you can employ in the emergency department to manage these injuries firstly what you're going to do is place a tourniquet at the base of the affected digit in order to stop further active bleeding make sure it's nice and snug

then instruct the patient to elevate that limb at least above the level of their heart the next thing you'll do is blot away the existing bleeding and then use your fingers to manually milk that digit and exsanguinated you want to now

observe the wound for several minutes to ensure that there's complete hemostasis and no further bleeding from that wound once you're sure that's the case you can proceed to the next step which is the application of a layer of tissue

adhesive glue to act as a sealant over that avulsion injury you can go ahead and dab away extra glue around the wound edges and ultimately you're going to apply about three to four layers of adhesive glue over the wound once that

glue is completely dried and only once it's completely dried you'll go ahead and remove the tourniquet what you end up with is this scab leg wound over the avulsion with no further active bleeding like any layer of tissue adhesive glue

it will fall off in approximately a week and you'll end up with this nice clean scab with no further bleeding from the wound site I'd like to summarize with some key points for the success of this procedure firstly this procedure is for

use with superficial minor wounds only this is not something to use if you've got an amputated digit if you've got exposed bone or if you have a large pumping blood vessel secondly complete hemostasis is required before you apply

that glue that's why elevation of the limb and tourniquet application is so important for success to the technique finally make sure to instruct that patient not to put on any ointment lotions or excessively wet the

glue which should cause it to slough off prematurely and lead to failure of hemostasis