Hand Infections

Acute paronychia    
Usually staph. aureus
- Ask advice
- Pus confined to nail fold; I & D under ring block.    
- Pus under nail; remove wedge of nail or whole nail under ring block.  
- Antibiotics are rarely needed. 
Chronic paronychia    
Usually candida infection.  
- Treat with antifungal cream rubbed into nail fold tds and every time patient gets hands wet. 
Pulp space abscess    
Usually staph. aureus
- If severe, X-ray to exclude osteomyelitis
- I & D over most tender spot, (mark before injecting L.A.)
- Antibiotics rarely needed 
Severe infections eg tendon sheath infections, palmar space infections, severe cellulitis  
-  Refer to Hand Surgery service for iv antibiotics +/- exploration