From the Guidelines
For a 77-year-old female with a superficial avulsion laceration on the left ring fingertip that continues to bleed despite pressure and over-the-counter hemostatic agents, I recommend wound cleaning with running tap water or sterile saline solutions, as suggested by the 2024 American Heart Association and American Red Cross guidelines for first aid 1. This approach is supported by the guidelines, which state that it is reasonable to use running tap water or sterile saline solutions for wound irrigation instead of antiseptic agents such as povidone-iodine. The patient should then apply direct pressure for 10-15 minutes using sterile gauze, as this is the most effective method for controlling bleeding, according to the 2010 American Heart Association and American Red Cross guidelines for first aid 1. Some key points to consider in the management of this patient's wound include:
- Cleaning the wound thoroughly to prevent infection
- Applying direct pressure to control bleeding
- Using a non-adherent dressing to promote wound healing
- Monitoring for signs of infection, such as increasing redness, warmth, swelling, pus, or fever
- Considering the potential impact of blood thinners, such as warfarin, aspirin, or DOACs, on bleeding duration
- Evaluating the need for medical attention if bleeding persists after 15-20 minutes of direct pressure. Given the rich blood supply to the fingertips, most avulsion lacerations heal well with proper care, although healing may be slower in elderly patients due to decreased tissue regeneration capacity.
From the Research
Patient Evaluation
- The patient is a 77-year-old female who presents with a cut on the tip of her left ring finger after cutting vegetables.
- She reports continual bleeding despite applying pressure and using over-the-counter rapid seal.
- The patient denies any pain or other injury, and the wound is described as a superficial avulsion laceration.
Bleeding Control
- According to the study 2, tourniquets were associated with a decrease in mortality when compared with direct manual pressure in cases of severe, life-threatening external bleeding.
- The same study found that hemostatic dressings resulted in a shorter time to hemostasis than direct manual pressure using standard dressings.
- However, the patient's bleeding is not described as severe or life-threatening, and the use of a tourniquet or hemostatic dressing may not be necessary.
Emergency Management
- The study 3 emphasizes the importance of a thorough and focused history in patients presenting with bleeding symptoms, including exploring bleeding symptoms, medications, and personal and family history of diagnosed bleeding disorders.
- The study 4 highlights the importance of risk stratification, aggressive resuscitation, and a holistic individualized approach to managing major bleeding in the emergency department.
- In this case, the patient's bleeding is not severe, and her vital signs are not reported to be unstable, so aggressive resuscitation may not be necessary.
Treatment Options
- The study 5 discusses the use of tranexamic acid (TXA) as an antifibrinolytic agent for the treatment or prevention of bleeding, but its use is not indicated in this case as the patient's bleeding is not severe or life-threatening.
- The study 6 discusses the importance of restoring circulating blood volume and reversing coagulopathy in patients with massive bleeding, but this is not relevant to the patient's current condition.