Author: Jonathan Kinnear / Editor: Steve Corry-Bass / Reviewer: Jonathan Kinnear / Codes: SLO4, TC6 / Published: 17/12/2021 / Reviewed: 04/12/2024
A 58-year-old right hand dominant male construction worker re-presents to your Emergency Department (ED). This is his third attendance.
Initially, he presented 42 days prior, with a 3 day old dog bite to his right middle finger.
Examination showed a healing wound to the volar aspect of the middle and distal phalanges. He was discharged with an Inadine dressing, high sling and co-amoxiclav.
He returned 3 days later (2nd attendance) with the sensation of a foreign body (FB) in the wound. An xray showed no radio-opaque FB. A consultant colleague performed a digital nerve block and excised a small piece of resin from the pulp of the finger. He was discharged to continue on his antibiotics.
He tells you that there has been no new injury, but the FB sensation has returned, with new swelling and tenderness. He has commenced a further course of co-amoxiclav from his GP.
Upon examination, you note the pulp of the finger is swollen, measuring 0.5 x 0.5cm. It is tender, not erythematous, with the appearance of a puncture wound at the maximal point of swelling. He is systemically well, with no erythema, no lymphangitis and he denies fevers or chills, myalgia, arthralgia or other rashes.
He asks if there could be another piece of resin within the wound, since that was what was removed previously.
3 responses
very com mon presentation
Very useful. More benefits for ultrasound in ED.
US for the win! Good module/ Good learning