In anticipation of episode number 29 on hand emergency pearls and pitfalls, we have with us Dr. Laura Tate,

plastic surgeon from Toronto East General Hospital.

She's going to tell us about her best case ever when it comes to hand emergencies.

Dr. Tate, let it rip.

We had an interesting case that was presented through the emergency department

with a young man who's a laborer, and he presented with tingling of his fingertips and pain

that had occurred from the day before when he'd been mixing some cement, and we had concerns

about why his pain seemed to be much greater than we would see just topically.

And when we questioned him further, it turned out that he had some exposure to hydrofluoric acid.

And with that information, then, we were able to think about how we could deactivate the hydrofluoric acid.

And rather than doing injections into the fingertips or pulp, which sometimes you can see in the

literature for some of these more massive injuries, really for fingers and hands, you can just put the

calcium gluconate gel in a glove, and they can wear that glove on the hand for 24 hours. And he

noticed some improvement in the return of sensation

within a few hours of the emergency department. And we were able to let him go home with gloves in

place. He was a reliable patient. He'd come back if there were any problems. And the next day,

he did return and still had some sensation loss, but his range of motion was

improved and we could tell that he wasn't going to have any tissue necrosis. It's a rare injury,

and it was good to see a good result in a pickup from that history, that kind of numb, tingling

feeling to the fingers, which was a little unusual. So hydrofluoric acid, even if you don't see much on the skin, it can really

penetrate deep and cause major tissue damage. If it was a whole limb, then we might get into

problems with renal failure and needing intramuscular or intra-chial injections, but not for the hand itself.

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