Page 149 - 2022 Ranger Medic Handbook

Subungal Hematoma
DEFINITION: Collection of blood under the nail; typically occurs after trauma to fingernail or toenail.
S/Sx: Pain and purplish-black discoloration under nail.
MANAGEMENT:
DO NOT DRAIN IF NO PAIN or if suspected underlying fracture.
1. Decompress the nail with a large gauge needle or electrocautery 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 intro-
duced into the affected nail with a gentle but sustained rotating motion.
2. Gentle pressure on the affected nail and absorbing/wicking with alcohol swabs 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.
DISPOSITION: Evacuation should not be required for this injury if the subungual hematoma is successfully treated and SECTION 3
healing does not hinder mission performance.

Testicular Pain
DEFINITION: Testicular pain due to torsion, epididymitis, orchitis, STDs, hernias, masses, and trauma.
S/Sx: Testicular torsion: Sudden onset testicular pain; usually associated with activity; associated testicular swelling;
abnormal position of the affected testicle; symptoms may be increased by testicular elevation; usually associated with
pain-induced nausea and vomiting; Loss of cremasteric reflex is the best diagnostic indicator for testicular torsion.
Epididymitis: Gradual onset of worsening pain; may have fever and/or dysuria; can also be traumatic; symptoms may
be relieved with elevation; significant swelling may be present.
MANAGEMENT:
1. If pain is sudden onset and the testicle is lying abnormally in the scrotum, an attempt to manual detorse the testicle
is warranted. A single attempt to rotate the testicle outward (like opening the pages of a book) should be made. If
pain increases, one attempt to rotate the opposite direction should be made. Successful detorsion will result in relief
of pain.
2. Gradual onset pain with a normal lying testicle should be treated per Urinary Tract Infection Protocol.
3. Treat pain per Pain Management Protocol.
4. Treat per Nausea and Vomiting Protocol.
Treat epididymitis with sexually transmitted infection treatment.
1. Ceftriaxone 250mg IM × 1 and azithromycin 1g PO × 1.
DISPOSITION: Urgent evacuation for testicular torsion. For other causes of testicular pain, treat cause and consider
evacuation if symptoms persist more than 3 days.
SPECIAL CONSIDERATIONS:
1. The primary concern in testicular pain is differentiating testicular torsion from other causes of testicular pain.
2. Testicular torsion is a medical emergency requiring urgent correction to prevent loss of the affected testicle.
3. Other common causes of testicular pain include epididymitis and orchitis, infections commonly caused by STDs, as
well as hernias and testicular masses.
4. Consider testicular cancer and further evaluation in cases with persistent mass.

2022 RANGER MEDIC HANDBOOK 135