I've just come back from the ER. The resident wanted me to see this patient who had torn his toe open. Last night I was walking back to the hospital to get my car when I saw a well known patient who had done the same thing.

Both have no feeling in their feet. Today's' patient has a spinal cord injury and is in a motorized wheelchair. He wasn't paying attention and turned the chair around in his room. He heard a 'crunch' but didn't see anything broken on the floor. Later that night, in bed, he looked at his foot and saw a bloody sock. That was Wednesday. Shame and embarrassment kept him home hoping the toe would heal. It didn't.

Last night's patient is a diabetic. Better controlled now with HgA1c's around 8. He's lost a lot of weight and now only weighs 285 pounds or so. His other side is a BKA due to non-healing ulcer. At the time he had a bizarre deformity and we decided it was a Charcot induced club foot deformity. ufff,,, his other, nonexistent side, could take up a book. SO, he's neuropathic, missing his big toe. Well, not really missing, it was amputated. It's gone. He uses a motorized scooter. He said he got into an argument with his wife in the morning. He ended up on the floor. A bit later someone pointed out that his sock was bloody. It took him awhile but he made it here the same day.

Both guys' had/have clean wounds with sharp margins. No debris in either wound. They are a bit deep with reducible deformity and easily coapted. Today's guy has some granulation tissue there [the injury happened 2 days ago]. Last night's guy was still bleeding when I saw him. I had to get Housekeeping to clean his bloody trail in the waiting area.

Today's Guy we are treating by reducing the deformity [distal aspect of 2nd toe is sharply laterally deviated] and holding it with Steri-Strips then covered with Acticoat.

Last Night's Guy I washed with chlorhexidine and sutured. Dressed with adaptic, povidine, gauze and kling.

Both got tetanus prophylaxis and antibiotics prophylactically.

What a way to end the week.

  • Comments (2)
  • You know, the ER docs ordered the antibiotics after I left both times. I don't really know.

    If it was an inpatient they'd get vanc and zosyn because everyone seems to get vanc and zosyn when they come in from the ER.

    When I mentioned last night's story to one of the regular ER guys he said it must have been a new late night ER resident involved because obviously the Attendings [who are ER Attendings] know how to suture.