Evacuating the Nefarious Subungual Hematomas

​Subungual hematomas can be a terror. They are painful, ugly-looking, nefarious, and sometimes confusing. The ultimate goal is to drain the accumulated blood and relieve the painful pressure.The best intervention is easy and straightforward: Leave the nail in place, and evacuate the blood under it. (Hand Surg. 2012;17[1]:151; Am J Emerg Med. 2006;24[7]:875; Emerg Med J. 2003;20[1]:65, http://bit.ly/2mHV1cO.) Then, provide excellent discharge information without prescribing antibiotics.A subungual hematoma in a 21-year-old man who slammed his thumb in a car door about 12 hours before ED arrival. Photo by M. Roberts.Distal extremities have millions of nerve endings, and preservation of the tissue and bone is crucial. Clinicians should test circulation and motor and sensation of the digit. Blood under a fingernail or toenail is usually caused by direct trauma such as crush injury or a stubbed toe to the distal phalanx.The accumulation of blood causes the nail to discolor (to black, blue, or purple). The blood comes from a laceration to the nail bed or a tuft fracture. A significant collection of blood around the paronychium may be a clue that the patient has an avulsed nail and that removal of the nail may be indicated. It is important to treat all types of injuries within 48 hours of injury. (StatPearls Publishing. May 18, 2019; http://bit.ly/2ndcZDO; Roberts and Hedges' Clinical Procedures in Emergency Medicine, 7th Edition. Philadelphia: Elsevier; 2018, p. 744-756.) AP...
Source: The Procedural Pause - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

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Source: Scandinavian Journal of Gastroenterology - Category: Gastroenterology Tags: Scand J Gastroenterol Source Type: research
Authors: Sumida Y, Yoneda M, Ogawa Y, Yoneda M, Okanoue T, Nakajima A Abstract Introduction: There is an unmet medical need for an effective anti-fibrotic treatment for NASH with advanced fibrosis.Areas covered: The authors review the current and novel agents for the treatment of NASH with fibrosis. They also consider the potential future strategies of combination therapies.Expert opinion: Farnesoid X receptor (FXR) agonist (obeticholic acid [OCA]) significantly ameliorated hepatic fibrosis in NASH stage 2/3 fibrosis in an interim analysis of phase 3 trial. Because OCA has several drawbacks such as itching and elev...
Source: Expert Opinion on Pharmacotherapy - Category: Drugs & Pharmacology Tags: Expert Opin Pharmacother Source Type: research
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Source: TIME: Health - Category: Consumer Health News Authors: Tags: Uncategorized COVID-19 feature remembrance Source Type: news
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Source: Diabetes and Metabolic Syndrome: Clinical Research and Reviews - Category: Endocrinology Source Type: research
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Source: Current Medicinal Chemistry - Category: Chemistry Authors: Tags: Curr Med Chem Source Type: research
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Source: Medscape Diabetes Headlines - Category: Endocrinology Tags: Diabetes & Endocrinology News Source Type: news
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