CHIEF COMPLAINT: Right finger pain.
HISTORY OF PRESENT ILLNESS: This is a (XX)-year-old Hispanic female who presents to the emergency department complaining of right third digit pain for the last week. The patient states she smashed her finger in the door one week ago. She had initial pain then, but over the last three to four days, she has had increased pain, swelling, and redness to the tip of the right middle finger. The patient is right-hand dominant. The patient does rate the pain at 10/10 on a 1-10 pain scale, which seems to be worse with movement. She denies any fever or chills.
PAST MEDICAL HISTORY: Negative.
CURRENT MEDICATIONS: None.
ALLERGIES: None.
SOCIAL HISTORY: Noncontributory.
FAMILY HISTORY: Noncontributory.
REVIEW OF SYSTEMS: As above, otherwise negative per the patient.
PHYSICAL EXAMINATION:
VITAL SIGNS: Blood pressure 132/84, pulse 86, respirations 18, temperature 98.8, and O2 sat on room air is 98%.
GENERAL: The patient is alert and oriented x3, in no acute distress, nontoxic in appearance, ambulatory in the emergency department.
LUNGS: Clear to auscultation.
HEART: Regular rate and rhythm.
EXTREMITIES: The patient does have positive edema, erythema, and yellow pus noted surrounding the nail bed of the distal aspect of the right middle digit. She has full range of motion of DIP, PIP, and MCP joint of the right third digit, 5/5 grip strength of the right hand, 2+ radial pulse of the right upper extremity. Extensor and flexor tendon strength is intact of the right upper extremity. She does have some edema noted to the volar aspect of the distal phalanx of the right third digit as well.
NEUROLOGIC: Deep tendon reflexes, sensory, motor, two-point discrimination intact of the right upper extremity.
SKIN: Warm and dry to touch.
DIAGNOSTIC DATA: X-rays: Right third digit x-ray was done, which was negative for any fractures. It did show some soft tissue swelling.
PROCEDURE NOTE: The patient was prepped and draped in a sterile fashion. A digital block was used with 1% lidocaine for the right third digit. A 11 blade was used to make an incision around the nail bed of the right third digit. Copious amount of pus was noted. We also did aspirate the volar surface of the distal phalanx of the right third digit with no pus noted. No Phalen noted. One-fourth inch iodoform packing was placed underneath the cuticle to keep it open to allow drainage. Dressing was placed over the wound. The patient did tolerate procedure well.
DIAGNOSIS: Right third digit paronychia.
PLAN:
1. The patient is to use warm soapy soaks 20 minutes q. 4 hours.
2. The patient is given Vicodin one 4-6 hours p.r.n. pain, #12, as well as Keflex 500 q.i.d. x7 days.
3. She is to have dressing and packing removal in two to three days. Change dressings twice a day.
4. Clinic list was given for followup.
5. If increased pain, swelling, fevers or worse, the patient can return to the emergency department.
DISPOSITION: The patient was discharged in stable condition.
