Tuesday, July 24, 2007


I treated a 20-year-old guy in clinic for finger pain. His index fingernail was split, and there was a lot of swelling and tenderness at the tip and at the nail cuticle.
The previous night he was lobster hunting from Lau Lau Beach by his family's house. The keys to lobster hunting, he replied to my insistence, are to go out after a light rain and to act quickly. He dives in at the reef and hopes to snatch the animals as they peer out from the rocks. If he can surprise them, the lobsters don't have time to grab onto the rocks. On the right night, he and his cousins can bring back 5-10 big lobsters. His uncle throws them into the pot and the family has a handsome boil.
That night, my patient was diving when he saw from his periphery a puffer fish angling for him. It bit his index finger.
Blood and pus can accumulate under a nail and cause problems. The nail needs to be removed to create a vent. One could argue that the split in this guy's nail acted like a vent, but I wanted to give him the VIP treatment. So I numbed the finger and pulled the nail off. With the nail removed, I saw that the split in the nail actually extended through the fleshy "nail bed" down to the bone. Three stitches approximated the edges.
Teeth--and thus bites--of different animals carry different bacteria. I have a guide that lists these and suggests appropriate antibiotics. I've used this guide before for dog, cat, human, and even horse bites. It was no help, though, for puffer fish.


Krafty said...

Might I refer you to some interested reading young Dr. Hutchison. I think you are referring to the bite of a Tetraodontiformes, the group of fishes to which the puffer belongs. One might find the how water treatment of marine envenomation a hot topic.


Ryan said...

Thanks for tearing away the scars of my PTSD from being the dumbest medical student on rounds. By the way, I often think of you while referencing the Sanford Guide. SLC's own Merle Sande MD is one of the authors.
Maybe we could fly you here for a morning report (and several weeks of scuba diving).

Krafty said...

Dr. Sande was our program director, and I know him well. He has moved on to bigger and better things than us SLC people. Wow... 12 wks of diving. I might need hot water immersion after that.