Ep 178 Hand Injuries – Pitfalls in Assessment and Management

Emergency Medicine Cases

Dr. Anton Helman

Education, Health & Fitness, Courses, Medicine, Science

4.7 • 602 Ratings

🗓️ 31 January 2023

⏱️ 66 minutes

🔗️ Recording | iTunes | RSS

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Summary

The hand is anatomically complex. Having an anatomical-based approach to the assessment of patients who present to the Emergency Department is important to preserve quality of life following a hand injury. Hand injuries are the second most common injury leading to days without work. It is no surprise then that open finger injuries land in the top 10 most common diagnoses that end up in court. In this first part of our two-part series on hand injuries Dr. Matt Distefano and Dr. Arun Sayal guide us through the principles and pitfalls of assessment and management of hand injuries and answer questions such as: what is the differential diagnosis of a globally swollen hand? What is the intrinsic minus hand position? When should we suspect compartment syndrome of the hand? How should we best locate retracted lacerated tendons of the hand? What are the best ways to control bleeding of a finger tip amputation? What are the best analgesic choices? How large of a skin avulsion hand injury should we let heal by secondary intention rather than recommend a flap/skin graft? and many more...

Transcript

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0:00.0	Welcome to the Emergency Medicine Cases podcast.
0:05.0	I'm your host, Dr. Anton Hellman, bringing you Canada's brightest minds in emergency medicine from EMC studios in Toronto.
0:13.9	EM cases is part of SREMI, Schwartz-Risman Emergency Medicine Institute, the nonprofit organization dedicated to improving EM care through research and
0:21.3	education. The opinions expressed on this podcast are intended for information and education
0:24.3	purposes only and should not be used to diagnose treat or prevent any medical condition,
0:26.4	nor should they be used as a substitute for medical advice from qualified practicing physician.
0:30.8	We need our hands. They're part of what makes us human, you know, opposable thumbs. And when we injure them, it can be bad news.
0:39.4	In fact, hand injuries are the second most common injury leading to days without work.
0:44.6	And open finger injuries are in the top 10 most common diagnoses ending up in court.
0:50.5	In this episode, we're going to explore some general principles of identification and management
0:55.3	of hand injuries, and then in part two, we'll dig into some of the more commonly missed
1:00.0	or missed managed ones.
1:01.9	When I started reading more on this topic, I soon realized it's a huge one, so we're
1:06.3	going to save carpal bone injuries for a future podcast on wrist injuries. Now, part of what inspired me to cover
1:13.6	this topic is taking one of Dr. Aaron Ciel's casted courses on hands and plastics. And in taking
1:19.7	the course, I discovered the very knowledgeable and talented Matt DeStefano, one of the course
1:23.8	instructors. He was kind enough to agree to join Dr. Cial and I on this podcast.
1:28.9	Welcome Dr. DiStefano and welcome Dr. Ciel. Thank you. Thanks. So Dr. DeCephano is new to EM cases.
1:35.3	So could you just tell us a little bit about your professional background? Yeah. Thanks for having
1:38.8	me here, Anton. So I have worked in Collingwood, the emergency department, for almost 20 years and recently
1:47.0	wrapped up working there about a year ago. And now in my dotage, work a part-time emerge
1:53.1	in some small rural hospitals in Grey Bruce Health. During that time, I've also spent some
	...

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