Finger Wound Hemostasis

Aka: Finger Wound Hemostasis, Digital Laceration Bleeding Control, Bleeding Control of Digital Vessel Laceration

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II. Precautions

  1. Avoid clamping any bleeding digital vessels
  2. Avoid narrow width Tourniquet use (e.g. belts)

III. Management: Initial

  1. Step 1: Apply direct pressure to wound for 15 minutes
  2. Step 2: Apply digital Tourniquet
    1. Impromised
      1. Penrose drain clamped with hemostat or
      2. Cross section of glove finger
    2. Commercial
      1. Tournicot
      2. T-Ring
  3. Step 3: Apply compression dressing (e.g ace wrap)
    1. Start wrap proximal to wound site
    2. Ace wrap should also hold bandage at wound site
  4. Step 4: Elevate affected arm
    1. Consider using cast stockinette
    2. Cut stockinette lengthwise 8 inches at each end
    3. Tie one end over patients Shoulder
    4. Tie the other end to top of IV pole

IV. Management: Refractory to above

  1. Step 1: Wrap and elevate arm as above
  2. Step 2: Obtain Tourniquet
    1. Air-inflated arm Tourniquet (used in orthopedics) or
    2. Blood Pressure cuff
  3. Step 3: Apply Tourniquet to arm
    1. Adult pressure: 250 mmHg
    2. Child pressure: 100 to 200 mmHg
  4. Step 3: Clamp Tourniquet tubes with hemostat
  5. Step 4: Remove ace wrap (from Step 1)
  6. Step 5: Emergent orthopedic or vascular surgeon
    1. Tourniquet use cannot exceed 90 to 120 minutes
    2. Longer Tourniquet times risk ischemic limb injury

V. References

  1. Antosia in Marx (2002) Rosens Emergency Med, p. 493-534
  2. Daniels (2004) Am Fam Physician 69(8):1949-56 [PubMed]
  3. Lahham (2011) West J Emerg Med 12(2): 242–9 [PubMed]

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