Daily Em Pearl, 5/6/12

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    Daily Em Pearl, 5/6/12

    A middle aged male p/w L-great toe pain for 3days, unresponsive to acetaminophen and ibuprofen. He denies fever or other complicating sx. On exam, the medial aspect of the L-great toe is erythematous w/TTP. No areas of fluctuance are appreciated. You need to remove this ingrown toenail. What’s your plan?

    1. Clean the area (w/chlorhexadine or some similar agent) and perform a digital block.

    2. When the patient is numb, grasp the offending side of the nail with a hemostat  and rotate your wrist toward the center of the nail.

    3. Once you’ve lifted the nail, cut it vertically, and then pull/remove the nail, so that no nail touches the affected nail wall.

    4. Clean away the blood (and if you used betadine, that too, pls).

    5. You can put some generic ointment on the area and wrap w/gauze.

    6. Update tetanus, PRN.

    7. Open toe shoes and plan for f/up.

    There are a few varying techniques:

    http://emedicine.medscape.com/article/149627-overview#a15

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