#1. Finger Flambé
Like many of you from the Einstein and Rowan DO Emergency Medicine Residency Programs, I had the privilege of training under Tony Dipasquale DO . During a short visit to the hand surgeon’s office this week, I was transported right back to one of the funniest Tony D moments that I could remember. I first met Tony during my residency in emergency medicine at the Osteopathic Medical Center of Philadelphia. That program morphed into the combined residency program at Einstein Medical Center Philadelphia. We rotated through a busy community ED at Northeastern Hospital in the Port Richmond section of Philadelphia. Tony was one of a small group of attending physicians who trained students and residents rotating through the ED.
Before the hand surgeon injected an area of my hand, he sprayed liberally with a bottle of ethylene chloride. It looked just like this:
I was a first-year emergency medicine resident and my patient was a lady who presented with a traumatic subungual hematoma that had a lot of blood trapped under her fingernail.
Pressure generated by pooled blood under the nail can be extremely painful. To relieve the pain, we can perform decompression, also called trephination, which allows the underlying blood to drain, relieving pressure and pain in the area. Tony came to the bedside with me to perform this procedure.
The patient had her hand on a blue chux pad and we sprayed her finger liberally with the ethylene chloride spray. We then activated a hand-held cautery device to burn through her nail to release the blood trapped beneath her fingernail. The whole area burst into flames!
Tony very swiftly doused the flames with a towel and assured the patient, “This happens all the time!” I somehow managed not to soil myself.
Fast forward years later to the last time I saw Tony, at the American College of Osteopathic Emergency Physicians 2019 meeting in Austin, TX. Of course, he never let on that he was ill and failing. We shared a good laugh as I reminded him of that episode from many years gone by. He quipped, “Just a flambé.”
