J.T. has injured his hand at work and is accompanied to the emergency department (ed) by a co-worker
you examine his left hand and find a piece of a drill bit sticking out of the skin between the third and
fourth knuckles.
There is another puncture site about an inch below and toward the center of the hand.
Bleeding is minimal. J.T. is 41 years old and has no significant medical history. He states the accident
occurred when a mill at work malfunctioned and knocked his hand onto a rack of drill bits. His last tetanus
booster was 12 years ago. It is your job to provide the initial care for J.T.'s injury.
You examine J.T.'s hand. What is the priority action? What should you include in your initial
assessment, and why?
What will be an ideal response?
• The priority action is to control bleeding.
• Assess blood supply to each digit. If necessary, use a Doppler device to confirm the arterial flow
to each digit. Document capillary refill, color, and temperature. Swelling in a digit can quickly
compromise circulation.
• Assess sensory perception (sharp or dull) of each digit, palm, and back of hand to identify nerve
damage.
• Assess his level of pain.
• Assess his vital signs.
• Assess motor function (flexion and extension) of each digit to identify injury to tendons and
ligaments.
• Ask J.T. whether he has any allergies to medications.
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