Foreign Body Removal: Ticks, Rings, and Fish Hooks

imagesIndicated only if location of foreign body (FB) is certain

imagesRemoval may be done in 30 minutes or less


imagesInvolvement of joint—orthopedic consultation may be required

imagesCoagulopathies or bleeding diathesis

imagesAllergy to anesthetic

imagesChronic medical problems that delay healing, such as diabetes, uremia, or immunocompromised state

imagesInvolvement of abdomen/pelvis/thorax

imagesNear major vascular structures that are difficult to visualize

imagesUncooperative, difficult, or intoxicated patient

imagesFB not localized


imagesProcedure can cause pain (local anesthesia will be given)

imagesLocal bleeding

imagesThere is potential for introducing infection (sterile technique will be utilized)

imagesRisk of injuring local neurovascular structures

imagesScar at site of FB removal

imagesPatient must be informed that all FBs may not be removed

imagesRetained wood FBs always develop an inflammatory response, but retained bullets rarely produce inflammation

imagesGeneral Basic Steps

   imagesLocalize the FB

   imagesPatient preparation

   imagesDecide on method of removal


imagesLocalize the FB

   imagesGet multiple projections of plain x-ray using a soft-tissue technique (e.g., underpenetrated film); to locate radiopaque FBs, place a marker (i.e., needle) on the skin surface at the wound entrance before the x-ray procedure

   imagesAlthough glass and metal are easily located with plain films, ultrasonographic localization may be required for wood and thorns

   imagesAll intraorbital and intracranial FBs must be imaged by computed tomography (CT)

   imagesIf a patient has a previously explored wound demonstrating signs of infection, poor wound healing, or persistent pain, consider doing a CT

imagesPatient Preparation

   imagesSterilize and drape the area from where FB will be removed

   imagesAnesthetize area either via local infiltration or appropriate nerve block

imagesGeneral Removal Techniques

   imagesEnlarge the entrance to wound with an adequate skin incision

   imagesSpread the soft tissue with hemostats, avoiding use of fingers

      imagesHemostats can help find glass in a wound by creating a clicking sound when tapped against glass

   imagesIf visualization is inadequate, consider excision of small block of tissue, only if no significant neurovascular structures are involved

   imagesWhen searching for a thorn or needle, consider an elliptical incision, undermine the skin in all directions, and then compress the sides, expelling the FB

   imagesClosure of the wound after thorough irrigation is indicated unless exploring a contaminated wound


imagesNonmechanical means of tick removal is not recommended (i.e., drowning the tick in petroleum jelly), because it may cause the tick to regurgitate, increasing infection risk (FIGURE 84.1)

imagesMechanical removal

   imagesUsing the tip of forceps, grab the tick as close as possible to the patient’s skin, and apply steady traction

   imagesEnsure that all mouth parts are removed. Use an 18-gauge needle to remove retained pieces.

   imagesThoroughly cleanse the area with soap and water

imagesIn patients at high risk of Lyme disease, consider administration of 200 mg of doxycycline in a single dose (or amoxicillin in pediatrics) (Figure 84.1)


FIGURE 84.1 Tick removal. (From Bond GR. Envenomation management and tick removal. In: Henretig FM, King C, eds. Textbook of Pediatric Emergency Procedures. Philadelphia, PA: Williams & Wilkins; 1997:1328, with permission.)

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Aug 9, 2016 | Posted by in EMERGENCY MEDICINE | Comments Off on Foreign Body Removal: Ticks, Rings, and Fish Hooks
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