# Someone's toe nail ripped off



## Limes (Feb 16, 2016)

First time poster here, so I'm not sure if this goes here.

I'm a lifeguard at the Waterpark about to go to school for EMR. A couple weeks ago, a lifeguard was administering FA on a patron who had his whole big toe nail ripped off. 

In this situation, what I would have done was get some sterile gauze, wipe around the wound and lightly dab on the wound to wipe off the blood. I would then bandage, fill out a FA report, recommend him to see a doctor (since it can be prome to infection with such a severe wound), and let him be on his way. I wouldn't use an antiseptic wipe because that would sting A LOT.

Is there anything else I could do in this situation?


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## Ewok Jerky (Feb 16, 2016)

Any nailbed injury? Those need to be repaired in the ED.

If the entire nail is gone, it should be replaced or somehow the nuchal fold needs to be splinted so the matrix can generate a new nail. Dont throw it in thr trash, we typically push it back under the fold and suture it in place until a new nail starts to generate. This can all be done at the ED urgently. Doesn't need a 911 call or ambulance, but should definitely go the ED after this type of injury.


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## Limes (Feb 16, 2016)

Unfortunately the whole nail was lost. I was debating on whether to seek medical attention or not, but it seems it would be a wise choice.

I'm curious though, what happens now that the whole nailbed is exposed and the ripped off nail cannot serve to be a placeholder? Anything to be concerned about?


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## OnceAnEMT (Feb 16, 2016)

Very sensitive and very vulnerable area when the nail is no longer present. Nastiest injuries too.

Hydrogen peroxide and anything alcohol-based has its time and place, and this situation isn't one of them. A nice commercial wound cleaner or antibiotic ointment is your better bet. It's easy to keep covered and clean over time, but as mentioned, it is extremely sensitive. I'd never suggest a "replacement" hard shell directly on the nail bed, but I've seen creative uses of occlusive dressings or thin non-adherent pads followed by something harder (or harder), be it a big fake nail, thumb DIP joint splint, or something home made, which is then wrapped with coban or roller gauze.


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## Ewok Jerky (Feb 16, 2016)

Limes said:


> Unfortunately the whole nail was lost. I was debating on whether to seek medical attention or not, but it seems it would be a wise choice.
> 
> I'm curious though, what happens now that the whole nailbed is exposed and the ripped off nail cannot serve to be a placeholder? Anything to be concerned about?


The risk is that the nuchal fold will scar down and a new nail cannot grow out.


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## Ewok Jerky (Feb 16, 2016)

Excuse me, I've been meaning to say eponychial fold, not nuchal fold.


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## gotbeerz001 (Feb 16, 2016)

Got finger caught in the action of a sawzall...
Whole nail punched out in .35 seconds...
Wrapped it up and then went on a pub crawl...
Everything ended up fine.


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## OnceAnEMT (Feb 16, 2016)




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