nail, there is little or no room for that extra swelling and liquid . T his can be very painful and lead to further damage . An interesting way to deal with this is the same way we release pressure within a skull - removing some bone or trephining a hole so the blood can come out . Although the comparison stops there . P ressure in the skull would be released by a neurosurgeon in theatre in a very sterile environment with specially made equipment.
In the emergency department , to release pressure from under the nail bed , we use a paperclip . Yes , a paperclip . T his may sound odd, but I shall tell you the theory . The paperclip is a blunt ended metal, which is small enough to cause a hole to release pressure but , if well protected , will not cause infection . We usually sterilise the paperclip with heat in the form of a burning flame ; it easily burn s through the hard nail and cauteris es the edges . We place the patient’s finger on a hard surface, usually the dressing trolley , and put a waterproof pad underneath it to collect any blood . We wear protective goggles to guard against any blood spurts and then we heat up the paperclip until it is white hot . W ith delicate accuracy and minor pressure, we apply the paperclip and it burn s through the nail quickly . There is usually a little give once the nail has been drilled through and as there is blood under the nail , it may squirt up through the pressure-releasing hole.
D espite this sounding quite barbaric, the patient does not usually feel anything, as the nail isn’t sensitive . They feel immediate relief as the blood drains out from underneath the nail .
Falling
The ambulance service had called through to warn us to expect a male patient who had fallen twenty feet and now had head, back and left arm injuries . H e had been given 10mg of Morphine and an antiemetic drug called Maxalon . He was expected in ten minutes . T he department was busy and short staffed so I continued to do a few minor treatments quickly before going to the resuscitation room and ma king it ready for the patient . Just as I’d finished , I heard the familiar ring of the paramedic doors opening I went to the door and greeted the paramedics, and ascertained that this was my expected patient. For the purpose of confidentiality , I shall call the patient John .
He was strapped securely onto a spinal board and his neck was in a hard collar and his head was taped into head blocks so that he couldn’t move his head and neck out of alignment . Once in the resuscitation room, John was transferred onto the emergency trolley from the paramedic trolley. We lined up the emergency trolley at the side of the narrow paramedic trolley and undid the seatbelts holding him into the trolley. With two paramedics at his left side and two nurse s at his right, one doctor holding his feet and myself holding is head and neck, we informed J ohn about the process of moving him across without bending his spine . He was advised to hold onto his elbows and on a count of three in unison we slightly lifted his right side up with the use of the sheet h e was laid on, keeping his head and spine in line at all times, and placed a pat slide under his right hand half of body, this would assist us to slide him onto the next trolley. Once laid flat again, half on the pat slide, on the count of three , we all worked together and gently moved his body slowly onto the emergency trolley . T he nurses on the right pulled him across with the paramedics on the left gently pushing his body across the slippery surface. Once on the emergency trolley, we all slightly lifted his right side without breaking spine alignment and removed the pat slide from underneath him.
As part of the assessment and high risk to spine after falling 20 meters , we began our assessment by cutting off his blood - soaked clothes . His left arm was bandaged, but it had soaked through a bright red colour . It had the metallic smell of blood . The
In the emergency department , to release pressure from under the nail bed , we use a paperclip . Yes , a paperclip . T his may sound odd, but I shall tell you the theory . The paperclip is a blunt ended metal, which is small enough to cause a hole to release pressure but , if well protected , will not cause infection . We usually sterilise the paperclip with heat in the form of a burning flame ; it easily burn s through the hard nail and cauteris es the edges . We place the patient’s finger on a hard surface, usually the dressing trolley , and put a waterproof pad underneath it to collect any blood . We wear protective goggles to guard against any blood spurts and then we heat up the paperclip until it is white hot . W ith delicate accuracy and minor pressure, we apply the paperclip and it burn s through the nail quickly . There is usually a little give once the nail has been drilled through and as there is blood under the nail , it may squirt up through the pressure-releasing hole.
D espite this sounding quite barbaric, the patient does not usually feel anything, as the nail isn’t sensitive . They feel immediate relief as the blood drains out from underneath the nail .
Falling
The ambulance service had called through to warn us to expect a male patient who had fallen twenty feet and now had head, back and left arm injuries . H e had been given 10mg of Morphine and an antiemetic drug called Maxalon . He was expected in ten minutes . T he department was busy and short staffed so I continued to do a few minor treatments quickly before going to the resuscitation room and ma king it ready for the patient . Just as I’d finished , I heard the familiar ring of the paramedic doors opening I went to the door and greeted the paramedics, and ascertained that this was my expected patient. For the purpose of confidentiality , I shall call the patient John .
He was strapped securely onto a spinal board and his neck was in a hard collar and his head was taped into head blocks so that he couldn’t move his head and neck out of alignment . Once in the resuscitation room, John was transferred onto the emergency trolley from the paramedic trolley. We lined up the emergency trolley at the side of the narrow paramedic trolley and undid the seatbelts holding him into the trolley. With two paramedics at his left side and two nurse s at his right, one doctor holding his feet and myself holding is head and neck, we informed J ohn about the process of moving him across without bending his spine . He was advised to hold onto his elbows and on a count of three in unison we slightly lifted his right side up with the use of the sheet h e was laid on, keeping his head and spine in line at all times, and placed a pat slide under his right hand half of body, this would assist us to slide him onto the next trolley. Once laid flat again, half on the pat slide, on the count of three , we all worked together and gently moved his body slowly onto the emergency trolley . T he nurses on the right pulled him across with the paramedics on the left gently pushing his body across the slippery surface. Once on the emergency trolley, we all slightly lifted his right side without breaking spine alignment and removed the pat slide from underneath him.
As part of the assessment and high risk to spine after falling 20 meters , we began our assessment by cutting off his blood - soaked clothes . His left arm was bandaged, but it had soaked through a bright red colour . It had the metallic smell of blood . The
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