True Hand Emergencies that should be referred by Provider
Call On-Call Surgeon Immediately
- Dislocations: Do not leave ER until reduced
- Compartment syndrome: Stryker stick
- Dysvascular limbs: Warm room and water bath
- Major crush injuries
- Traumatic arthrotomies: Methylene blue injection
- Septic arthritis: BMP, CBC, ESR, CRP, synovial fluid for glc, prot, cell cts, cx, Gram, crystals
- Flexor tenosynovitis
- Necrotizing fasciitis (mark area with date and time)
Examples of conditions when patients need a same day evaluation:
- Dislocated joints
- Suspicion of a fracture or major ligament injury – a sudden traumatic event with near immediate swelling and pain that limits motion of a joint
- Animal bites – particularly cat bites with any degree of pain or redness
- Crush injuries with increasing pain, numbness and/or swelling
- Any injury with an inability to move a joint – at all
- Any fracture or laceration
- Injuries where a finger is amputated
Conditions for primary care / urgent care doctors to refer immediately:
- All of the above
- Fracture with inability to bear weight
- Acute fracture with deformity (or swelling to the point that anatomy is indistinct)
- Signs of spreading infection (mark line of redness in your office)
- Traumatic injuries attended by neurologic deficit
- Penetrating injuries with suspected vascular, tendon or neurologic involvement
When in doubt, call. There is always a specialist available to discuss your patient with you.
