This is a surgical emergency. Definitive management is surgical incision & drainage. A hand specialist must be consulted. Start IV antibiotics with broad empiric coverage, narrowing as culture sensitivities dictate. Antibiotics should cover GPCs and GNRs. For example, start ceftriaxone 1g IV and broaden with coverage for MRSA and/or anaerobic pathogens as the clinical situation dictates. Cover for Pseudomonas if the patient is diabetic and for Pasteurella multocida if the patient was bitten by an animal5.