Daily Em Pearl, 4/18/12

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    Daily Em Pearl, 4/18/12

    Early in the morning, a young man p/w R-great toe pain after having his foot stepped on while dancing last night (a few hours ago). On exam, you appreciate full ROM and strength but your patient is pretty uncomfortable. He took paracetamol and ibuprofen at home with minimal relief. There are no signs of infection and he has strong distal pulses but there is a large subungal hematoma present and he finds it painful for you to palpate. What can you do to relieve his pain?

     

    Do a nail bed trephination. He’ll thank you.

    There are a few techniques, here are a couple videos:

    http://emedicine.medscape.com/article/82926-overview#a15

    http://www.youtube.com/watch?v=eSzif8qS7sQ  (please use gloves and an 18gauge needle, rather than a paperclip)

     

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