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Question: Trauma

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You are seeing an adolescent who slammed her finger in a door and has a subungual hematoma. 

Which of the following is a contraindication to trephination with electrocautery?
18 votes

pemsou5_wp • June 2, 2021

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  1. Kelly June 3, 2021 - 11:42 am Reply

    B) Artificial acrylic nails
    Trephination is recommended for subungual hematomas where the nail folds are intact but the blood collection is causing pain. Decision to trephinate is no longer dictated by the % of the nail covered by the hematoma, and nail removal is not generally recommended if the nail folds are intact, even with a 100% subungual hematoma. Presence of a tuft fracture does not obviate trephination; prophylactic antibiotics may be considered. Artificial acrylic nails are flammable, so trephination with electrocautery would be contraindicated, as would nail prep with any alcohol-based solution for the same reason (but not povidone-iodine or chlorhexidine). Trephination in these cases could be done without electrocautery, using a needle in a drill-like fashion.

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