A 27-Year-Old Painter Comes to the Emergency Department Due to Severe

A 27-year-old painter comes to the emergency department due to severe pain in his left hand.  Towards the end of the workday yesterday, he was using an industrial sprayer to paint a deck when he accidentally placed his left index finger over the sprayer nozzle, injecting paint into the finger.  The patient initially had only localized soreness in the finger, but he awoke in the middle of the night with severe pain.  The patient has no chronic medical conditions, and immunizations including tetanus are up to date.  Blood pressure is 144/86 mm Hg, pulse is 100/minute, respirations are 18/minute, and temperature is 37.3 C (99.1 F) .  On examination, the patient's left index finger, hand, and forearm are swollen.  There is a 4 mm puncture wound on the flexor surface of the left index finger near the proximal interphalangeal joint.  There is tenderness along the flexor surface of the entire digit, and passive extension of the index finger causes severe pain radiating up the arm.  Capillary refill is <2 seconds in the hand and all digits.  Which of the following is the best next step in management of this patient's condition?

A) Administration of systemic thrombolysis
B) Fasciotomy and debridement in the operating room
C) Limb immobilization and elevation
D) Local injection of a neutralizing agent
E) Wound irrigation and discharge with antibiotics

Correct Answer:

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