A 30-year-old chef presents to the ED with a complete fingertip amputation.

A 30-year-old chef presents to the ED with a complete fingertip amputation. She says her knife slipped while chopping vegetables. She brought the amputated pulp in a plastic bag. On examination, the patient has a clean, 5-mm-diameter dermal slice on the distal volar tip of the second digit. There is profuse nonpulsatile bleeding. There is no trauma to the DIP joint, proximal interphalangeal (PIP) joint, or the nail. Her most recent tetanus booster was 1 year ago. Which of the following is the most appropriate next step in management?

a. Consult hand surgery for replantation of the pulp in the operating room.

b. Irrigate the hand and replant distal tip in the ED as soon as possible.

c. Perform a digital block with lidocaine and epinephrine to control bleeding.

d. Immediately place the amputated tip on ice to prevent cell death.

e. Discharge the patient with a pressure dressing and splint after the wound is irrigated and the bleeding is controlled.

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