CHIEF COMPLAINT: Finger laceration.
HISTORY OF PRESENT ILLNESS: This is a (XX)-year-old male with no medical history who cut himself with a kitchen knife on the volar aspect of his right index finger. He is right handed. He says it happened about an hour prior to arrival. He was cutting onions at that time. He notes that he has a slight amount of sensation loss in the distal finger, on the sides, but volarly has intact sensation. Otherwise, notes no weakness in the distal part of his finger. He notes no other injury.
PAST SURGICAL HISTORY: None.
ALLERGIES: None.
MEDICATIONS: None.
FAMILY HISTORY: Noncontributory.
SOCIAL HISTORY: Positive tobacco. No alcohol. No illicit drugs.
REVIEW OF SYSTEMS: All other systems negative other than per HPI.
PHYSICAL EXAMINATION:
VITAL SIGNS: Blood pressure 126/74, pulse 86, respirations 18, temperature 98.6 and O2 saturation 99% on room air.
GENERAL: Well-developed, well-nourished male with adequate hygiene, normal affect, in no acute distress.
HEENT: Normocephalic, atraumatic.
LUNGS: Clear bilaterally.
HEART: Regular rate and rhythm. No gallops, rubs or murmurs.
ABDOMEN: Soft, nontender and nondistended. Positive bowel sounds. No rebound or guarding.
EXTREMITIES: Right upper extremity radial pulses 2+. He does have intact FDP and FDS function of his index finger. His 2-point sensation is somewhat diminished collaterally around his finger, but on the volar pulp, he has intact 2-point discrimination. Capillary refill is less than 2 seconds. He otherwise has intact extensor strength. Exploring the wound to its depth in a bloodless field, we did not appreciate any tendon involvement or any digital nerve involvement. Otherwise, there was no foreign body appreciated. The patient does have a laceration just distal to the flexor crease distally that is about 1 cm and does not go into the pulp of the finger otherwise.
NEUROLOGIC: The patient is alert, oriented, appropriate and following commands.
EMERGENCY DEPARTMENT COURSE: The patient remained stable throughout his course. He had his wound irrigated out, tetanus updated, and subsequently, his wound was repeatedly explored to its depth. No evidence of tendon involvement was noted. He was subsequently sutured with simple interrupted 5-0 Ethilon sutures and placed in a finger splint and advised to return in 7-10 days for suture removal.
MEDICAL DECISION MAKING: This is a (XX)-year-old male who presents with a finger laceration. There is no evidence of joint space involvement or no evidence of FDP involvement. He does have some diminished sensation laterally but is intact volarly on the pulp of his finger. No other injuries were appreciated. He was sutured here and subsequently will follow up in 7-10 days for suture removal. He otherwise remained stable.
PLAN:
1. Discharge the patient home.
2. Follow up with ED or primary care doctor for removal of sutures in 7-10 days.
DISPOSITION: Home in good condition.
DISCHARGE DIAGNOSIS: Finger laceration.
