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How to deal with subungual hematoma

DR BOIMA

HEALTH ISSUES

Subungual hematoma is a phenomenon in which there is bleeding under the nail, be it fingernail or toenail. It is mostly caused by a crush injury to the concerned digit usually by slamming a car door over the finger, using certain tools like a hammer, or something heavy falling over the digit. Subungual hematoma can cause severe throbbing pain especially immediately after the injury happens, and worsening gradually as the blood collects under the nail (pressure effect). Most people get into a panic mode from this heart-wrecking pain and do all sorts of unimaginable things.


What to do?
Ice compressions – placing ice wrapped in a towel over the affected finger/toe can help arrest the bleeding and prevent further consequences. It can help with the pain a lot!

Elevate the limb – placing the hand or foot above the level of the heart (rather than letting it hang) can help in decreasing the swelling and the pain as it limits the amount of circulation to that area
Take a very strong painkiller – preferably NSAID like diclofenac or ibuprofen
Keep the injured finger or toe as dry as possible and away from closed shoes or moisture
Seek medical help immediately – if unsure seek medical help for advice or active intervention
Trephination/Decompression – if experienced enough and there is clean equipment available, one can make a small hole on the nail bed to drain the blood, depending on the size of the hematoma. But this is better left off to medical personnel as there is slight risk of infection and further damage associated with this procedure

What not to do?

There is absolutely no role medically for any of the following home remedies in changing the course or the progression of the subungual hematoma apart from acting as a ‘placebo’ and making the patient feel like they have done something. In other cases the actions will even cause more harm than good;
Soaking in warm salty water
Applying vinegar
Applying charcoal
Applying toothpaste, or any kind of paste found at home
Shaking of the finger
Sucking on the finger
Try to remove the nail

Care at the health facility

Subungual hematomas differ in size.
If the pain is very mild and the hematoma is less than 25% of the nail area,  home remedies can be enough
For larger ones (>50%), medical attention is needed. The Doctor may numb the affected nail or toe with a nerve block (depending on the decision between the doctor and the patient) and use either cautery wire or a small needle to puncture the nail to let the blood out. 

After the hematoma is drained the pressure beneath the nail is relieved and the pain decreases significantly. The main complication associated with decompression is infection as the hole might act as a portal for bugs that may infect the residual hematoma. Antibiotics may be prescribed but this is not done routinely


X-ray – Very large hematomas might be associated with injuries like broken bones or severe damage to other supporting structures so the injury need be examined properly by a medical professional. There is likelihood of an X-ray in severe cases


Nail removal – if subungual hematoma affects almost the whole nail, the nail bed underneath is likely to have had significant injury. There is also a high chance that the trapped blood will be infected in due course. The most sensible management will be removing the nail altogether, and inspecting and cleaning the nail bed underneath (suturing may also be needed in severe cases).

After – care

If one has had their nail removed (either by the injury or the doctor) these are the steps to follow to ensure healthy recovery;
Daily soaks in warm salty water  or with antiseptic for 10-15 minutes
Daily dressings with dry sterile plaster /band-aid
Turning up for doctors follow-up appointments as scheduled
A new nail can re-grow fully in as little as eight weeks.
NB – Even with the best repair, there is still that possibility that the new nail may grow back with an abnormal appearance.

For comments or questions please email agboima@yahoo.com

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Export Processing Zones: How to Get SEZA to Sizzle

23rd September 2020
Export Processing Zone (EPZ) factory in Kenya

In 2005, the Business & Economic Advisory Council (BEAC) pitched the idea of the establishment of Special Economic Zones (SEZs) to the Mogae Administration.

It took five years before the SEZ policy was formulated, another five years before the relevant law was enacted, and a full three years before the Special Economic Zones Authority (SEZA) became operational.

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Egypt Bagged Again

23rd September 2020
Samson

… courtesy of infiltration stratagem by Jehovah-Enlil’s clan

With the passing of Joshua’s generation, General Atiku, the promised peace and prosperity of a land flowing with milk and honey disappeared, giving way to chaos and confusion.

Maybe Joshua himself was to blame for this shambolic state of affairs. He had failed to mentor a successor in the manner Moses had mentored him. He had left the nation without a central government or a human head of state but as a confederacy of twelve independent tribes without any unifying force except their Anunnaki gods.

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‘RO, ‘RO ‘RO YOUR ‘BOT

23rd September 2020

If I say the word ‘robot’ to you,  I can guess what would immediately spring to mind –  a cute little Android or animal-like creature with human or pet animal characteristics and a ‘heart’, that is to say to say a battery, of gold, the sort we’ve all seen in various movies and  tv shows.  Think R2D2 or 3CPO in Star Wars, Wall-E in the movie of the same name,  Sonny in I Robot, loveable rogue Bender in Futurama,  Johnny 5 in Short Circuit…

Of course there are the evil ones too, the sort that want to rise up and eliminate us  inferior humans – Roy Batty in Blade Runner, Schwarzenegger’s T-800 in The Terminator,  Box in Logan’s Run,  Police robots in Elysium and  Otomo in Robocop.

And that’s to name but a few.  As a general rule of thumb, the closer the robot is to human form, the more dangerous it is and of course the ultimate threat in any Sci-Fi movie is that the robots will turn the tables and become the masters, not the mechanical slaves.  And whilst we are in reality a long way from robotic domination, there are an increasing number of examples of  robotics in the workplace.

ROBOT BLOODHOUNDS Sometimes by the time that one of us smells something the damage has already begun – the smell of burning rubber or even worse, the smell of deadly gas. Thank goodness for a robot capable of quickly detecting and analyzing a smell from our very own footprint.

A*Library Bot The A*Star (Singapore) developed library bot which when books are equipped with RFID location chips, can scan shelves quickly seeking out-of-place titles.  It manoeuvres with ease around corners, enhances the sorting and searching of books, and can self-navigate the library facility during non-open hours.

DRUG-COMPOUNDING ROBOT Automated medicine distribution system, connected to the hospital prescription system. It’s goal? To manipulate a large variety of objects (i.e.: drug vials, syringes, and IV bags) normally used in the manual process of drugs compounding to facilitate stronger standardisation, create higher levels of patient safety, and lower the risk of hospital staff exposed to toxic substances.

AUTOMOTIVE INDUSTRY ROBOTS Applications include screw-driving, assembling, painting, trimming/cutting, pouring hazardous substances, labelling, welding, handling, quality control applications as well as tasks that require extreme precision,

AGRICULTURAL ROBOTS Ecrobotix, a Swiss technology firm has a solar-controlled ‘bot that not only can identify weeds but thereafter can treat them. Naio Technologies based in southwestern France has developed a robot with the ability to weed, hoe, and assist during harvesting. Energid Technologies has developed a citrus picking system that retrieves one piece of fruit every 2-3 seconds and Spain-based Agrobot has taken the treachery out of strawberry picking. Meanwhile, Blue River Technology has developed the LettuceBot2 that attaches itself to a tractor to thin out lettuce fields as well as prevent herbicide-resistant weeds. And that’s only scratching the finely-tilled soil.

INDUSTRIAL FLOOR SCRUBBERS The Global Automatic Floor Scrubber Machine boasts a 1.6HP motor that offers 113″ water lift, 180 RPM and a coverage rate of 17,000 sq. ft. per hour

These examples all come from the aptly-named site www.willrobotstakemyjob.com    because while these functions are labour-saving and ripe for automation, the increasing use of artificial intelligence in the workplace will undoubtedly lead to increasing reliance on machines and a resulting swathe of human redundancies in a broad spectrum of industries and services.

This process has been greatly boosted by the global pandemic due to a combination of a workforce on furlough, whether by decree or by choice, and the obvious advantages of using virus-free machines – I don’t think computer viruses count!  For example, it was suggested recently that their use might have a beneficial effect in care homes for the elderly, solving short staffing issues and cheering up the old folks with the novelty of having their tea, coffee and medicines delivered by glorified model cars.  It’s a theory, at any rate.

Already, customers at the South-Korean  fast-food chain No Brand Burger can avoid any interaction with a human server during the pandemic.  The chain is using robots to take orders, prepare food and bring meals out to diners.  Customers order and pay via touchscreen, then their request is sent to the kitchen where a cooking machine heats up the buns and patties. When it’s ready, a robot ‘waiter’ brings out their takeout bag.   

‘This is the first time I’ve actually seen such robots, so they are really amazing and fun,’ Shin Hyun Soo, an office worker at No Brand in Seoul for the first time, told the AP. 

Human workers add toppings to the burgers and wrap them up in takeout bags before passing them over to yellow-and-black serving robots, which have been compared to Minions. 

Also in Korea, the Italian restaurant chain Mad for Garlic is using serving robots even for sit-down customers. Using 3D space mapping and other technology, the electronic ‘waiter,’ known as Aglio Kim, navigates between tables with up to five orders.  Mad for Garlic manager Lee Young-ho said kids especially like the robots, which can carry up to 66lbs in their trays.

These catering robots look nothing like their human counterparts – in fact they are nothing more than glorified food trolleys so using our thumb rule from the movies, mankind is safe from imminent takeover but clearly  Korean hospitality sector workers’ jobs are not.

And right there is the dichotomy – replacement by stealth.  Remote-controlled robotic waiters and waitresses don’t need to be paid, they don’t go on strike and they don’t spread disease so it’s a sure bet their army is already on the march.

But there may be more redundancies on the way as well.  Have you noticed how AI designers have an inability to use words of more than one syllable?  So ‘robot’ has become ‘bot’ and ‘android’ simply ‘droid?  Well, guys, if you continue to build machines ultimately smarter than yourselves you ‘rons  may find yourself surplus to requirements too – that’s ‘moron’ to us polysyllabic humans”!

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