2. Naming the digits
The Birmingham Hand Centre Assessment and Early Management of the Injured Hand
University Hospitals Birmingham NHS Foundation Trust
87. Bleeding
• Practically all upper limb bleeding will
stop!
• EXCEPTION: partially injured large artery
• Treat bleeding with elevation and firm dressing
• DO NOT attempt to tie off bleeders in A&E
• RARELY should a tourniquet be used
89. Replantation
The decision of whether to replant lies with
the surgeon in conjunction with the patient.
• Urgent transfer, only if the patient is stable
• Correct packaging of parts
• X-ray limb & amputated part
• Cold not frozen
• Damp not soggy
90. De-vascularised parts / doubtful
vascularity
• Speed important
• Often venously congested
• Align digits correctly
• No tight bandages
• Resting Volar POP for comfort in transit
92. Hydrofluoric acid burns
• Lethal due to precipitation of Ca++
• Calcium gluconate
• pain relieving
• Emergency transfer to regional burns unit
• Accept advice from patient –if they work with the stuff they probably know about it!
93. High pressure injection injuries
• Grease, oil, paint, hydraulic fluid, air
• Ischaemia/necrosis
• Mechanical
• Toxic effect
• Early transfer
• Early washout