Injuries — fingers

Taking out splinters

Attention

• Wood splinters (eg from mulga) common in remote areas
• Can become infected if left in skin, especially if large
• If deep — consider underlying structures

What you do

Very small, shallow splinters

• If visible, attempt removal with fine tweezers
• If splinter remains — put on drawing dressing for 1–2 days. Splinter may come out on its own

Larger splinters

• Sit or lie person comfortably
• Lay out dressing pack and equipment
• Wash hands, put on sterile gloves
• Clean site, drape with sterile towels
• Give local anaesthetic — wait 3–5 minutes for LA to work before starting the procedure or ring block if needed
• Spear splinter with fine needle, lever out of skin
• OR cut skin with scalpel over length of splinter and then pull it out with forceps
• OR if wound shallow and splinter has jagged edges that will tear the flesh if pulled back through entry site — cut opening at base of splinter, pull it through with forceps
• Suture if needed or leave open if risk of infection and review in 3 days
• OR if splinter under fingernail or toenail and unable to easily grasp end of splinter with tweezers — Figure 7.3
• Use sharp scissors to cut small V shaped area out of nail over splinter — Figure 7.4
• Pull splinter out with small forceps — Figure 7.5

Taking ring off finger

Attention

If finger swollen from illness or injury — rings must be taken off to stop loss of blood supply to finger

• If a lot of pain — ring block may be needed
• If following methods fail — ring may need to be cut off using metal ring cutters (best) or wire cutters (if nothing else)

What you need

• Soap or grease
• Dental tape, fine string, mersilk
• Paperclip or fine wire

What you do

• Rub soap or grease finger, try to slide ring off

If that doesn't work

• Slide paperclip or fine looped wire under ring and loop dental tape through bend. Pull one end of tape through under ring — Figure 7.6
• Hold tape end A and wind tape end B around finger toward fingertip, covering middle joint — Figure 7.7

• Hold tape end B tightly, pull tape end A straight back over ring toward fingertip, unwinding tape — Figure 7.8

Pressure of tape wound evenly around whole finger helps to reduce swelling. Ring should slide over tape as tape unwinds

Taking out fish hooks

Attention

• Large hooks may need surgical removal — medical consult

What you need

• Strong string
• Sterile gloves
• Sterile dressing pack
• Chlorhexidine antiseptic solution
• Lidocaine (lignocaine) 1%, syringe and needles if needed
• Extra 5mL syringe and 16–18G needle
• Sterile suture set and sutures, if needed
• Pair of wire cutters, if needed
• Pair of pliers
• Goggles (fish hooks can become missiles!)
• Dressing

What you do

• Sit or lie person comfortably
• Clean area with chlorhexidine
• Lay out dressing pack and equipment
• Wash hands, don PPE including gloves and googles, put on sterile gloves
• Clean site, drape with sterile towels
• Give local anaesthetic — wait 3–5 minutes for LA to work before starting the procedure or if trained and competent ring block

• Following curve of hook, push barb end of hook all the way through skin until it is easily seen — Figure 7.9
  
• Cut off shank — Figure 7.10, pull hook out through exit hole
• OR Cut off barb — Figure 7.9,  pull hook out through entry hole — Figure 7.10

• OR Loop some string or fishing line around hook where it enters skin
• Push down on hook shank while giving firm, sharp tug on string to pull out hook — Figure 7.11. Be bold! — be careful of flying hook, keep out of its path and wear eye protection
• OR Push 16–18G needle attached to small syringe through hook entry site so needle bevel is over barb point — Figure 7.12. Bring both needle and hook back out through entry site

• OR Make small cut in line with curve of hook — Figure 7.13
  
• Pull hook out gently through hole — Figure 7.14
• Suture if needed

• Clean puncture sites with normal saline OR water — apply a dry dressing if required — give education on wound care