SAQ Stack

Case: Hydrofluoric acid burn

A 42-year-old man presents to your emergency department at midnight with a history of gradually increasing pain to the fingertips of both hands over the previous 3 to 4 hours. The pain has become unbearable and he cannot sleep. The triage nurse assesses him and does not note any skin changes to his hands The nurse gives him two Panadeine tablets, triages him as a category 4 and asks him to be seated in the waiting room. Thirty minutes later the pain is no better and the patient is angry and demands to be seen by a doctor. He says that he was cleaning his car wheels earlier this evening with a wheel cleaner given to him by a friend who works in the car detailing industry. Despite instructions that he should wear gloves, he did not do this. On examination: P 96 bpm, BP 150/90, afebrile. The patient is angry and in obvious pain. Slight erythema to the tips of the index, middle and ring fingers of the right hand is noted. There is marked tenderness on palpation of these digits. The physical examination is otherwise normal.