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Finger Pain

UnFiNiShEd CaSe CoMe BaCk LaTeR

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History of Present Illness:

A 52-year-old male with diabetes presents to the ED for left middle finger pain.  He is seen by the PA who thinks it’s an infection, maybe an early felon.  The pain has been gradually getting worse for about 2 weeks with occasional drainage.   He denies any fever, trauma or other complaints

Vital Signs & Physical Exam:

Vital signs are normal.   Physical exam is notable for nail-bitten finger nails and a firm finger tip with some small scabs.  See image below

Initial Differential Diagnosis:

  • Felon, cellulitis, whitlow, osteomyelitis

Initial Diagnostic Testing:

  • Labs: WBC elevated at 12, glucose elevated at 215, CRP normal, rest of CBC and BMP normal
  • Imaging: X-ray, normal, no evidence of osteomyelitis or foreign body

QUESTIONS:

  1. What does the case image show?  
  2. What should you do next?  
  3. Want a 1-minute consult/tutorial on this case? 
  4. Want to know what happened with this patient?

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ANSWERS:

  1. What does the case image show?  The image shows a pale finger tip with scabs.
  2. What should you do next?  Get a pulse ox on that finger, do an EKG to rule out A-fib, arrange f/u
  3. Want a 1-minute consult/tutorial on this case?  See yellow area from sample page below.
  4. Want to know what happened with this patient?  See case conclusion below tutorial page.

1-Minute EM Consult on the topic for this case from the Emergency Medicine 1-minute Consult Pocketbook

 

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CASE CONCLUSION: Pulse ox was 90% on that finger and 98% on other fingers.

CASE LESSONS:

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