Page 146 - PJ MED OPS Handbook 8th Ed

Subungual Hematoma

SPECIAL CONSIDERATIONS:
1. None

Signs and Symptoms:
1. Pain from the affected nail
2. Purplish-black discoloration under the nail

Management:
1. If there is severe pain – decompress the nail with a large gauge needle by rotating needle through
the nail directly over the discolored area until the underlying blood has been released and the
pressure is relieved. Make sure that it is introduced into the affected nail with a gentle but sus-
tained rotating motion. Some people heat the needle tip first to sterilize and ease the puncture.
2. Gentle pressure on the affected nail may help to evacuate more blood.
3. Treat per Pain Management Protocol.
4. If a fracture is suspected, tape the injured finger or toe to an adjacent digit.
5. If fracture is suspected in a setting of a subungual hematoma, give Moxifloxacin (Avelox)
400mg PO daily for 7 days.

DISPOSITION:
1. Evacuation should not be required for this injury if the subungual hematoma is success-
fully treated.

144 n Pararescue Medical Operations Handbook / 8th Edition