Wound Care 513474.A 30-year-old chef presents to the ED with a complete fingertip ampu-
tation.She says her knife slipped while she was chopping vegetables. She
brought the amputated pulp in a plastic bag. On examination, the patient
has a clean, 5-mm diameter dermal slice on the distal volar tip of the second
digit. There is profuse nonpulsatile bleeding. There is no trauma to the DIP
joint, proximal interphalangeal (PIP) joint or the nail. Her most recent tetanus
booster was 1 year ago. Which of the following is the most appropriate next
step in management?
a. Consult hand surgery for replantation of the pulp in the operating room.
b. Irrigate the hand and replant distal tip in the ED as soon as possible.
c. Perform a digital block with lidocaine and epinephrine to control bleeding.
d. Immediately place the amputated tip on ice to prevent cell death.
e. Discharge the patient with a pressure dressing and splint after the wound is irrigated
and the bleeding is controlled.