Paramedics bring a 24-year-old man who was involved in a motor vehicle accident to the emergency department of a small community hospital. At the accident scene, the medics noted that he had sustained a traumatic amputation of his right thumb. They were able to retrieve the severed digit and bring it to the hospital. The patient undergoes initial wound care and hemostasis with a compression dressing. The hospital does not have a facility for digit replantation and reconstructive surgery, and a decision is made to transfer the patient to a nearby tertiary care center. Five minutes later, the nurse asks, "How do you want me to preserve his severed digit?"
Which of the following is the most appropriate response?

Question

Paramedics bring a 24-year-old man who was involved in a motor vehicle accident to the emergency department of a small community hospital.  At the accident scene, the medics noted that he had sustained a traumatic amputation of his right thumb.  They were able to retrieve the severed digit and bring it to the hospital.  The patient undergoes initial wound care and hemostasis with a compression dressing.  The hospital does not have a facility for digit replantation and reconstructive surgery, and a decision is made to transfer the patient to a nearby tertiary care center.  Five minutes later, the nurse asks, "How do you want me to preserve his severed digit?"
Which of the following is the most appropriate response?

Quizplus · Accepted Answer

Explanation: Recent surgical advances have led to successful replantations of body parts, including fingers, thumbs, ears, genitalia, and arms, amputated in various accidents. This has led to the preservation of the function and appearance of most body parts and improved quality of life for patients. In general, amputated body parts should be retrieved and brought to the emergency department with the patient. Because thumb or finger amputation can compromise hand function, an attempt should be made to replant the digit after taking into account such factors of successful replantation as the type and level of the amputation, time since amputation, and history of vascular disease, smoking, and diabetes. For transportation purposes, the amputated part should be wrapped in sterile gauze, moistened with saline and placed in a sealed, sterile plastic bag. (Choice A) Placing the digit directly in a dry plastic bag will increase the risk of tissue damage to the digit from desiccation. (Choice B) Although the patient may receive intravenous prophylactic antibiotics depending on the wound type, soaking the amputated digit directly in an antibiotic solution is not recommended. Soaking the digit in any solution may cause maceration of the tissues and make replantation more challenging. (Choice C) It is important to limit preoperative handling of an amputated part to avoid further damage to the tissues. Although pressure dressings may be required to control bleeding of the stump, there is no such risk from the amputated digit, and pressure dressings require unnecessary handling compared to moist gauze. Educational objective: In general, all amputated body parts should be retrieved and brought to the emergency department. Handling of the amputated part should be as limited as possible with care taken to prevent it from drying or being soaked in liquid. References: Indications and surgical techniques for digit replantation. (http://www.ncbi.nlm.nih.gov/pubmed/12102407) Digit and hand replantation. (http://www.ncbi.nlm.nih.gov/pubmed/20012069)

Paramedics Bring a 24-Year-Old Man Who Was Involved in a Motor