When you hit the wrong nailFingers often get smashed, pinched or jammed during daily activities. Most finger injuries are not serious. Although they may be quite painful and inconvenient, these injuries heal well with self-care at home. Serious injuries with possible bone fractures, severe bleeding or severed parts require professional medical help.
What you can do Immediately apply an ice pack or insert finger into ice-cold water to decrease the pain and reduce swelling. For protection, place a washcloth between bare skin and ice.Apply ice pack for 10 to 15 minutes every hour for two hours, then leave ice off for two hours. Repeat this cycle for 48 hours or until swelling is gone. Do not use heat as long as there is swelling.Remove any jewelry if you can do so without causing additional pain.If skin is broken, gently wash with soap, then dry. Apply soft, clean dressing.Splint and support injured finger by taping it to a nearby healthy one.Rest and elevate hand for 24 to 48 hours. Immobilize hand in a sling or use hand as little as possible.Take aspirin or ibuprofen to reduce swelling and pain. NEVER give aspirin to children/teenagers. It can cause Reye’s syndrome, a rare but often fatal condition.When swelling is gone, apply warm compresses at intervals for comfort.Resume full range of motion as soon as swelling is gone. Gentle bending and movement will stretch the muscle tissue and prevent limited movement later.Stop any activity that causes pain to the finger.
Dislocated fingernailsTrim the part of the nail that is still attached to avoid catching it on anything. It is not necessary to remove the nail.Keep area clean and watch for signs of infection.Protect the tip of the finger with a soft cloth or covering. A new nail will take one to two months to grow back.
Blood under a nailApply ice as soon as possible. For protection, place a washcloth between bare skin and ice.Make a hole in the nail to relieve pressure and pain:
Straighten a paper clip and hold it with a pair of pliers in a flame until it is red hot.Place the tip of the paper clip on the nail and let it melt through. You need not push. A thick nail may take several tries. As soon as the hole is complete, blood will escape and the pain and pressure will ease.
If the blood and pressure build up again, repeat the procedure using the same hole.Soak the finger three times a day for 15 minutes in a solution of equal parts water and hydrogen peroxide.*18\303\2*

HistoryA complete and thorough history is essential in the initial evaluation of a patient with acute diarrhea. The physician should elicit a detailed description of the diarrheal syndrome, including length of symptoms, quantity and quality of stool, presence of fever, and abdominal symptoms. The history should address recent travel to underdeveloped countries, potential exposures to raw or undercooked food, sick contacts, contact with children, and employment in health care facilities. A sexual history may elicit risk factors for herpes simplex, Chlamydia, Neisseria gonorrhoeae, or Treponema pallidum proctitits.Establishing the immune status of the host is essential. Patients with immune deficiencies due to organ transplant, HIV, and certain drugs (particularly steroids, chemotherapeutic agents, and immunosuppressants) can be more susceptible to less typical gastrointestinal pathogens. Such patients may also exhibit more severe symptoms and experience a more fulminant course, lowering the threshold for antimicrobial therapy and hospitalization.Recent hospitalization or antimicrobial therapy increases the likelihood of C. difficile infection or antibiotic-associated diarrhea. Other medications may cause diarrhea or other adverse gastrointestinal effects.Patients presenting with diarrhea after international travel often are infected with bacteria or parasites, most frequently enterotoxigenic E. coli. Recent camping, travel to mountainous areas, or a prolonged diarrheal illness lasting more than 14 days suggests Giardia infection.
Physical ExaminationPhysical examination should concentrate on assessment of volume status with particular attention to heart rate, blood pressure, and mental status, especially in the very young and elderly. A directed examination of the abdomen may qualify the illness, but sensitivity and specificity for agents of infectious diarrhea is extremely low. A rectal examination may reveal hemoccult or grossly positive blood or mucus and may elicit tenderness, indicating proctitis.*72/348/5*