Emergency Cases Northwest Group

047 Under Pressure

Situation

Child had subungal haematoma trephined.

Background

5 year old had a distal finger phalanx injury, subungal haematoma, though no suspicion of nail bed injury. It had been crushed under a kettlebell. The subungal haematoma was >50% nail bed surface. Electrocautery trephining device used to release the trapped blood. Discharged.

Assessment

The blood under the nail was under pressure causing a lot of pain. Releasing it was the correct treatment.

Recommendation

The patient will be in pain unless the haematoma is released. Usually trephination is for subungal haematomas >50% nail bed surface.

The electrocautery trephining device is usually in the minors area.

Consent, clean, trephine. [No local anaesthetic needed]

Stop at the release of blood, don’t touch the nail bed.

Warn re-infection, re-accumulation.

This is what it looks like:

https://www.emrap.org/episode/trephinationofa/trephinationofa

PLEASE DO NOT INCLUDE ANY PATIENT IDENTIFIABLE DATA OR GEO-LOCATION DATA IN THE SUBMISSION OR IN ANY ATTACHED IMAGES

Emergency Cases Northwest Group