Paronychia in Emergency Medicine Treatment & Management

  • Author: Heather Murphy-Lavoie, MD, FAAEM; Chief Editor: Pamela L Dyne, MD   more...
 
Updated: Oct 20, 2010
 

Prehospital Care

The patient with a paronychia is typically ambulatory. Splinting the finger with clean gauze is necessary to decrease discomfort until definitive treatment is rendered.

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Emergency Department Care

  • The treatment of choice for a paronychia is incision and drainage, as in the illustration below.[25] Paronychia incision and drainage. Paronychia incision and drainage.
  • Provide warm compresses or soaks with half-strength hydrogen peroxide.
  • Elevate the infected nail.
  • Keep fingers clean and dry.
  • Incision and drainage
    • Incision and drainage are not indicated for herpetic whitlow (the most common infection mistaken for paronychia), mucous cyst, glomus tumor, and osteomyelitis.
    • For maximum patient comfort, the digit is anesthetized with an appropriate digital nerve block.
    • The nail plate and surrounding skin are cleaned with an appropriate antiseptic agent. Blunt dissection with the tip of a sharp instrument or point of a surgical blade is used to elevate the lateral nail fold. The operator attempts to enter the sulcus between the lateral nail plate and lateral epithelium. Purulent drainage can erupt when the sulcus is entered by the instrument tip, shown in the image below. The lateral fold of skin should be elevated slightly and irrigated with isotonic sodium chloride solution using a catheter tip syringe. After simple drainage, there is purulent return. After simple drainage, there is purulent return.
    • A "run-around" describes a severe paronychia that extends along the medial and lateral nail edges. In such cases, or when a large paronychia is present, the cavity should be splinted open with a small wick to prevent adhesion and reformation.
    • If purulence has tracked under the nail, excision of the ipsilateral nail may be necessary.
    • The presence of a subungual abscess (ie, "floating nail") requires nail plate removal. The degree of debridement is commensurate with the degree of nail bed infection.
    • The presence of a finger pulp abscess or felon may require an additional incision of the pad of the finger tip to adequately drain. Be careful to avoid the neurovascular bundles that run on the lateral edges of the finger.
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Consultations

It is necessary to consult a hand surgeon if cellulitis, deep space infection, glomus tumor, mucous cyst, or osteomyelitis is suspected.

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Contributor Information and Disclosures
Author

Heather Murphy-Lavoie, MD, FAAEM  Assistant Professor, Section of Emergency Medicine and Hyperbaric Medicine, Louisiana State University School of Medicine, New Orleans; Clinical Instructor, Department of Surgery, Tulane University School of Medicine

Heather Murphy-Lavoie, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Society for Academic Emergency Medicine, and Undersea and Hyperbaric Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

Micelle J Haydel, MD  Associate Clinical Professor of Medicine, Residency Director, Section of Emergency Medicine, Louisiana State University Health Science Center

Micelle J Haydel, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, American Medical Association, Sigma Theta Tau International, Society for Academic Emergency Medicine, and Southern Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Jerome FX Naradzay, MD, FACEP  Medical Director, Consulting Staff, Department of Emergency Medicine, Maria Parham Hospital; Medical Examiner, Vance County, North Carolina

Jerome FX Naradzay, MD, FACEP is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Jeter (Jay) Pritchard Taylor III, MD  Compliance Officer, Attending Physician, Emergency Medicine Residency, Department of Emergency Medicine, Palmetto Health Richland, University of South Carolina School of Medicine; Medical Director, Department of Emergency Medicine, Palmetto Health Baptist

Jeter (Jay) Pritchard Taylor III, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Pamela L Dyne, MD  Professor of Clinical Medicine/Emergency Medicine, David Geffen School of Medicine at UCLA; Attending Physician, Department of Emergency Medicine, Olive View-UCLA Medical Center

Pamela L Dyne, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

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Paronychia incision and drainage.
Paronychial erythema and edema with associated pustule. This suggests a bacterial etiology.
Paronychia, side view.
After simple drainage, there is purulent return.
 
 
 
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