Major crush injuries occur most often with falls and car accidents. Many occur with natural disasters such as earthquakes or when a building collapses. Minor crush injuries happen all the time right now, like when a heavy object is dropped on a foot or fingers get smashed in doors or by a hammer, or as my husband did to me, rolling a car window up.
Painful as they are, most of these minor crush injuries do not cause lasting damage. There may be some bruising; however, the pain usually subsides within an hour or two. Oral pain relief in the form of ibuprofen or acetaminophen and perhaps an ice pack should suffice.
With injuries to finger- and toenails, occasionally a blood blister, or hematoma, will develop beneath the nail. While not generally cause for concern, it can be quite painful. The pain will gradually subside. However, if the patient is in substantial discomfort, a simple procedure called trephination may be considered. As explained in the excerpt below from The Ship’s Medicine Chest, a tiny hole made in the nail to release the pressure built up underneath provides instant relief.
Blood Blisters (Hematomas)
Blood blisters that occur under fingernails and toenails as a result of a blow are very painful. If a hole is made in the nail to allow the blood to escape, the patient will obtain some relief.
Treatment
The patient’s hand should be cleansed with soap and water, and povidone-iodine solution applied. The head of a straight pin should be heated until it glows—then carefully pressed through the nail into the center of the blood blister. If this is done carefully, a tiny opening will be made in the nail, and the hot pin will not penetrate into underlying tissues. The hole releases pressure, drains the blood blister, and gives the patient prompt relief from pain. A sterile dressing should be applied over the area.[1]
If you cannot find a straight pin (with a metal head that can be heated in a flame), a paper clip, drill bit or 18 gauge needle may be used. Something dull is preferable to a sharp object. Heating the head of the straight pin will sterilize it, and as the heat will burn through the nail, you don’t need a sharp object to poke through. You definitely do not want to penetrate into underlying tissues. After the procedure, keep the finger dry, splinted, and bandaged with sterile dressings for at least 48 hours.
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