Wednesday, October 8, 2008

Should've been a Boy Scout

So the other night I did a procedure I didn't learn about in school, but I may have learned about it had I been a Boy Scout (and hence a boy). The pt has a myriad of things gone wrong without getting into all the jazz and does NOT heal very well. Somehow, he hurt his pinky while at the hospital, on bed rest - it's swollen, the nail looks like it wants to fall off, it's purple at the tip and the skin is missing basically from the PIP to the DIP (between the knuckles). Some less than stellar provider during the day suffocated it with a tagaderm. I think he might benefit from having the nail drained to relieve some of the pressure, sounds easy enough - get a cautery tip and poke a hole in the nail, allow to drain. Well, at least that would be the case if a cautery tip were available but apparently to get them from surgery at 1am for something like this is frowned upon, so the PA says oh that's ok, can we get a paper clip and a lighter? Oh duh, why didn't I think of that? - Why? Because that seems a little insane to me. As I am standing next to the patient's bedside, holding the end of the paper clip into the flame watching it get red hot I feel like I should be on some outdoorsy trip doing this, not in a hospital - but oh well. It worked great, but the blood was too dry under the nail for any to drain. I had a difficult time writing a procedure note for this one: Distal end of paper clip heated by lighter until red hot to be used like a cautery tip (or something like that). I almost felt compelled to draw a picture, but thought the description was adequate enough. Turns out this procedure can be found under the heading Subungal hematoma drainage in the Procedures for Primary care book - good to know. Now how do I log that in Typhon?

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