Thursday, May 3, 2012

Fingers and SI joint

Well... being the only nurse in the family, I got a panicked phone call on Saturday from my sister, saying my brother cut his finger off.. well, partly off. He was using dads band-saw and made a mistake... got a super nasty 6-stitch cut on his middle finger, and lost about 1/2 inch or so off his index finger, at an angle, including the whole exposed nail, has most of the pad still. Apparently he went into shock and didnt want to goto the hospital etc, eventually dad agreed to take him in to URGENT CARE instead of the ER... I met him there and the lady ended up just reattaching the end, without doing any sort of vascular surgery. Cleaned everything well while he was moaning in agony and biting onto a towel =( was hard to watch.. she eventually got him numb with a local nerve block (tho what im reading is saying they shouldnt have done that either...). She Told us it had about a 70% chance of failure.. and told him to goto the ER for an ortho eval, initially suggesting he go that evening and then saying he should go by the following Monday. Well, my brother came over on Monday so i could do his dressing change, since he MIGHT have an inn with an ortho doc through the free clinic our church (find out in the morning). - anyway, so I looked at it on Monday and it didn't look good.. pale as heck on the tip, no signs of blood flow to the very tip. Did the dressing change again today, and the nail is black and the skin is basically blueish greyish black? and hard.. He promises he will goto the ER if he can't see the ortho doc tomorrow. (no insurance, hence the run around). What bothers me... is if he went to the ER to begin with, would they would have been able to save it? And now that he has a more-than-likely dead finger tip stitched onto his finger, how much more is that going to cost than if he just went there to begin with?! and the infection risk? He had exposed bone. Hes on oral antibiotics thankfully but... man. He is pretty bummed about it all, esp cuz he lays floors for a living right now, and sorta needs his hands.. been forced to take the week off and is having a hard time. Been telling him for awhile that he needs to go back to school and stop relying on physical labor to get by... I feel bad for him, maybe i should have insisted he goto the ER more, or maybe I should have done my research earlier.. and then insisted =( damn. Feel like i shouldda done more or known more or helped more? The doc shouldnt have just stitched it back on and told him it'll probably be fine though dangit cuz everything im reading, is saying he needed at least a touch of micovascular surgery to make sure there was gunna be adeqate blood flow and she didnt do any of that or SAY anything about that.. Lady shouldda admitted when she didnt know something dangit. I don't know much about amputations and replantations, kinda learning now though.. =( poor finger.. least he'll eventually get by, its not enough of it to hinder quality of life or anything, but its enough to leave an impact and hafta do a lot of PT and stuff when they finger out what to do. Apparently i stood wrong when I was doing his first dressing change cuz it screwed up my SI on the left.. its been super temperamental lately =( and it started spasming badly, and i had to run to work.. Tried the thing that usually fixes it but it didn't work. Ended up taking an old expired prednisone tab, cuz i was in too much pain from the spasm when i was trying to move.. and remembered it helping in the past when I had to work with it. Guess what? The 10mg prednisone fixed it! So weird. The muscle is one massive KNOT and is super tender to the touch, hafta be careful laying on my back esp on that side, but its not tightening up and spasming anymore when i move, so its manageable. Gunna put some ben-gay on it tonight and maybe topricin cream.. Alright, gunna try to go do something productive. ta ta!

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