Please Poke My Paronychium!

THE BASICSWhat is more satisfying than draining a pus-filled paronychium? Seeing the look of relief on the face of your patient when his painful, pulsating digit is relieved of all that tension! This rather elementary procedure could be perceived as stale and uneventful for some of you. The more thorough and astute clinicians, however, realize these tiny infections around the nail root may open the door to a mixed bag of insidious and harmful bacterial infections including MRSA, chronic reoccurrences, cellulitis, subungual abscesses, osteomyelitis, herpetic whitlow, or even the dreaded felon.   Whatever your pleasure, this “routine” procedure requires a quick and steady hand by a caring and thoughtful provider. It is important not only to provide immediate and proper pain relief, but also prevent a bounce-back patient who did not understand the discharge instructions. You may not have a fiery passion for a red-hot eponychium, but this procedure is truly appreciated by pediatric and adult patients alike.   Photo from Atlas of Adult Physical Diagnosis, Lippincott Williams & Wilkins, 2006.   THE APPROACHDigital Nerve Block with Incision and Drainage   THE PROCEDURENot all paronychia require a digital nerve block, but more angry-looking or aggressive digits may require adequate anesthesia. We will highlight digital blocks in future posts of The Procedural Pause.   • Start a warm soak with antibacterial soap when the patient arrives in triage.• Lie the patient c...
Source: The Procedural Pause - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs