Friday, January 13, 2012

Kitchen Nightmare Recipe

Triage note states: Left finger laceration from cutting an onion (personal notes in parentheses)

1- (very pleasant young lady) patient with cut on (dominant hand) finger
2- visitors, a friend and a 2 month-old newborn in a cradle (optional, but helpful)
1- box of pizza (adds to atmosphere)
1- technician (yours truly)
1- (busy) physician's assistant
1- suture removal kit, soaking solution
length of time: 2 hours

First assess patient (she is in no apparent distress).

Uncover the finger gently (patient winced and barely allowed me to gently lift gauze from finger)

Assess quality of cut. (the smell and appearance verified that:
1, The cut actually occurred 2 days ago.
2, Patient never sought care until today.
3, The fingertip is horrifyingly puffy, crusty, leaking fluids, and green.)

Staunch bleeding and flush debris from cut. Discourage patient from eating pizza with the same hand. (In this case, I had her soak her finger, to her relief in some sterile water/soap)

Inform PA of situation, help prepare bandages.

(Hold patient's hand as she flails and shrieks at the size of the needle as) PA administers tetanus shot.

Assess cut (and realize that part of soft tissue is necrotic to bone and may need debridement/surgery. Explain to patient that debridement means to scrape off necrotic tissue. Allow patient to squeeze my hand and screech in fright as friend laughs at her misery), cut away some dead tissue and skin flap

Call hand/plastics (who refuses to come see patient and refers her to a clinic for the next day)

Wrap finger in antibiotic cream and gauze bandages, send her away with antibiotic cream, follow-up information, (and misgivings).

(Wonder what is happening with her now.)

Enjoy newfound appreciation for having all my appendages intact.


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