Fingertip injuries

Open fingertip injuries may be treated effectively by primary wound care followed by secondary intention wound healing. More sophisticated techniques of wound closure have only limited applicability and are associated with a significantly increased risk of failure.     

Fingertip injuries

Fingertip injuries are a potential cause of significant morbidity within the workplace and the community. Although they account for a low proportion of ED presentations, importantly they can frequently be managed entirely by emergency staff. A literature review was undertaken to identify the epidemiology, the assessment process and the management options for fingertip injuries as relevant to emergency medicine.     

无可供吻合静脉的指尖离断再植

【目的】探讨无可供吻合静脉的指尖离断再植的方法及临床效果。【方法】对59例66指无可供吻合静脉的指尖离断分别以三种血运重建方式行再植术：吻合双侧指动脉、结扎一例近端指动脉（22例27指）;吻合1条指动脉、扩大近端骨髓腔经骨髓腔静脉回流（13例15指）;仅吻合指端动脉弓分支通过指动脉吻合口近端的侧支回流（24例24指）。【结果】再植59例66指,成活61指,成活率为92．4％。随访6～24个月,再植指指腹饱满,指甲生长良好,两点辨别觉4～7mm,外观及功能满意。【结论】对无可供吻合静脉的指尖离断,根据其血管条件,选用不同的血运重建方式行再植术,效果良好。     

吻合掌侧静脉的指尖再植

目的 探讨吻合掌侧静脉治疗手指指尖离断的方法和疗效.方法 根据田万成的指尖分型法,并运用逆行法对指尖离断行吻合掌侧静脉的指尖再植手术.结果 本组152例168指,成活157指,成活率93.5%,术后随访2～20年,手指长度同健侧相似,外形满意,功能良好.结论 手指尖离断绝大多数可找到可供吻合的掌侧静脉,逆行法指尖再植对吻合掌侧静脉极为方便.     

Diagnosis and Management of Common Pediatric Fingertip Trauma

Fingertip trauma commonly presents to pediatric emergency departments. Most injuries can be managed at the bedside with anesthesia, irrigation, soft tissue repair, immobilization, and follow-up. A comprehensive team approach allows for a nurse practitioner as the first point of contact with involvement of a hand surgeon and hand therapist as necessary to provide optimal care. This topical review provides an anatomical framework to assist first-line providers in the appropriate diagnosis and management of common pediatric fingertip injuries as well as identify and rule out conditions that warrant time-sensitive surgical intervention such as Seymour fracture, tendon laceration/avulsion, or dysvascular digit.     

Fingertip Representation in the Human Somatosensory Cortex: An fMRI Study

Eight right-handed adult humans underwent functional magnetic resonance imaging (fMRI) of their brain while a vibratory stimulus was applied to an individual digit tip (digit 1, 2, or 5) on the right hand. Multislice echoplanar imaging techniques were utilized during digit stimulation to investigate the organization of the human primary somatosensory (SI) cortex, cortical regions located on the upper bank of the Sylvian fissure (SII region), insula, and posterior parietal cortices. Thettest and cluster size analyses were performed to produce cortical activation maps, which exhibited significant regions of interest (ROIs) in all four cortical regions investigated. The frequency of significant ROIs was much higher in SI and the SII region than in the insula and posterior parietal region. Multiple digit representations were observed in the primary somatosensory cortex, corresponding to the four anatomic subdivisions of this cortex (areas 3a, 3b, 1, and 2), suggesting that the organization of the human somatosensory cortex resembles that described in other primates. Overall, there was no simple medial to lateral somatotopic representation in individual subject activity maps. However, the spatial distance between digit 1 and digit 5 cortical representations was the greatest in both SI and the SII region within the group. Statistical analyses of multiple activity parameters showed significant differences between cortical regions and between digits, indicating that vibrotactile activations of the cortex are dependent on both the stimulated digit and cortical region investigated.     

Distracting injuries in patients with vertebral injuries

To describe the prevalence and types of distracting injuries associated with vertebral injuries at all levels of the spine in blunt trauma patients. A prospective cohort study was conducted at an urban Level I trauma center. All patients undergoing radiographic evaluation of the cervical, thoracic, or lumbar vertebrae after blunt trauma were enrolled. Patients had a data collection form completed by the treating physician before radiographic imaging and were evaluated for the following upon initial presentation: tenderness to the cervical, thoracic, or lumbar spine, distracting injuries, altered mental status, alcohol or drug intoxication, or neurological deficits. Patients with distracting injuries as the sole documented indication for vertebral radiographs were reviewed for the types of injuries present. A total of 4698 patients were enrolled in the study. There were 336 (7.2%) patients who had distracting injuries as the sole documented indication for obtaining radiographic studies of the vertebrae. Eight (2.4%, 95% CI 1.0-4.6%) of the 336 patients had 14 acute vertebral injuries including compression fractures (5), transverse process fractures (7), spinous process fracture (1), and cervical spine rotatory subluxation (1). There were 13 thoracolumbar injuries and one cervical spine injury. Distracting injuries in the eight patients with acute vertebral injuries included 13 bony fractures. Distracting injuries in those patients without vertebral injuries included bony fractures (333), lacerations (63), soft tissue contusions (62), head injuries (15), bony dislocations (12), abrasions (11), visceral injuries (8), dental injuries (5), burns (3), ligamentous injuries (3), amputation (1), and compartment syndrome (1). In conclusion, in patients with distracting injuries, bony fractures of any type were important for identifying patients with vertebral injuries. Other types of distracting injuries did not contribute to the sensitivity of the clinical screening criteria in the detection of patients with vertebral injuries.     

Whiplash injuries

The term “whiplash” is not a medical diagnosis, but is the result of soft-tissue trauma to the neck. A whiplash injury occurs as a result of a sudden acceleration or deceleration of the head and neck with respect to the body. This article recommends that patient treatment be individualized.     

Diving injuries

This is a collective review about the pathophysiology, diagnosis, and management of SCUBA and diving injuries by the emergency physician. These injuries can be classified into those resulting from the toxic effects of the inhaled gas, from the pressure changes in the water and gas mixture while diving, and from decompression sickness. With the increasing popularity of SCUBA diving, it is hoped that this discussion will enable a recognition of these injuries and therefore minimize the morbidity and mortality from them.     

Inhalation injuries

Inhalation injuries comprise three distinct clinical entities that may be classified according to the time of onset of symptoms, etiologic agents, and the anatomic location of injury. These entities are carbon monoxide toxicity, upper airway obstruction, and smoke inhalation or chemical injury. Each has a distinct pathophysiology, clinical manifestations, treatment, and prognosis. The emergency management of inhalation injury is frequently based on the health professional's degree of suspicion despite the availability of sophisticated diagnostic tests. Early aggressive treatment, including maintaining a patent airway, administering humidified oxygen and bronchodilators, and providing pulmonary toilet, is necessary to ensure the best possible outcome. Understanding the pathophysiology, clinical manifestations, diagnosis, medical management, and nursing implications of inhalation injuries can improve patient survival.     

Traumatic injuries

Patients with certain types of dental injuries must be referred immediately to a dentist or oral surgeon. The physician may be called on to treat oral lacerations and to determine if bone fracture is present.     

Lightning injuries

Lightning is persistently one of the leading causes of death caused by environmental or natural disaster. To understand the pathophysiology and treatment of lightning injuries one must first discount the innumerable myths, superstitions, and misconceptions surrounding lightning. The fundamental difference between high voltage electrical injury and lightning is the duration of exposure to current. Reverse triage should be instituted in lightning strike victims because victims in cardiopulmonary arrest might gain the greatest benefit from resuscitation efforts, although there is no good evidence suggesting that lightning strike victims might benefit from longer than usual resuscitation times. Many of the injuries suffered by lightning strike victims are unique to lightning, and long-term sequelae should be anticipated and addressed in the lightning victim.     

Lightning injuries

Lightning strikes may cause a constellation of injuries. Blunt head trauma, neurologic injury, and cardiac injury are common in these patients. In contrast to high-voltage electrocutions, blunt trauma after a lightning strike is common. Thorough evaluation of all organ systems is crucial. This report discusses mechanism of injury and describes initial evaluation and treatment of lightning strike victims.