310.A 31-year-old homebuilder is cutting a piece of wood when the table
saw backfires and slices through the base of his left thumb. In the ED his
BP is 135/70 mm Hg, HR 87, RR 18, and pulse oxygen is 99%. You stabi-
lize the patient and call the vascular surgeon. In the meantime, what is the
best method of preserving the amputated finger?
a. Irrigate it with 10% povidone-iodine solution to remove gross contamination,
wrap it in sterile gauze moistened with normal saline and place it between two
ice packs.
b. Irrigate it with normal saline to remove gross contamination, wrap it in sterile
gauze moistened with normal saline and then place it on ice.
c. Irrigate it with normal saline to remove gross contamination, wrap it in sterile
gauze moistened with normal saline, place it in a sterile water-tight container
and store this container in ice water.
d. Place it in a container of 10% povidone-iodine solution and store this container
in ice water.
e. Attempt to partially replant the part with 3-0 nylon sutures until the vascular
surgeon arrives.
311.A 47-year-old man presents to the ED complaining of knee pain after
slipping on ice on his way to work. On examination, you note significant
swelling to his knee and palpate a large effusion. The patient has limited
range of motion as a result of the swelling. You perform a palliative arthro-
centesis and note blood and fat globules in the syringe. Which of the fol-
lowing findings is the presence of fat globules most suggestive of?
a. ACL tear
b. PCL tear
c. Medial meniscus tear
d. Fracture
e. Vascular injury
326 Emergency Medicine