When things are stuck inside the body,
we got to get it out.
Tony just has a ball of jelly mucus
that’s just stuck there.
This is never going to come out on its own.
This mucus was literally stuck there,
probably months to years.
Wow. Well, look at that.
These nails, they actually have some
wire looped around there,
and they can tear up tissues as they go in,
and it definitely makes pulling them out harder.
She has a bead in her ear.
When you’re looking at kids,
it’s what your persona puts off.
I try to speak very softly, tell them it’s gonna be okay.
- Okay, baby doll. - Okay.
You’re doing so good.
From the looks of it, it’s been in there for a while.
Ah, there goes the nail.
A five-second accident
can turn into a five-hour surgery.
There’s this pleasant lady,
she’s got a huge stiletto heel
stuck smack into her face.
My name is George Crawford.
I am a board-certified general surgeon,
I practice in Anniston, Alabama,
and I work at the Crawford Clinic.
When I get a call from the emergency room and they say,
"Hey, we have this guy that got shot with a nail gun in his arm."
The real questions that need to be answered,
you know, is it in a vessel,
is it a big nail, or is it a screw?
Is it something that’s gonna rip a nerve?
Does he have neurological damage?
So a lot of those things are going through my mind
when I get that phone call.
But we know that once we see the patient,
we can start answering those questions.
- Dude, what’s up? - Well...
My name is Brian Chaney,
I do residential construction work
in Gadsden, Alabama.
So exactly what happened now?
Nail gun, somehow trigger was...
- was obviously pressed on it. - Okay.
I put my arm down and I was on a steep pitched roof...
- Okay. - ...so the nail gun was laying right beside me
- and it was turned up... - Right.
- ...towards the sky. - Okay.
But I was on such a steep pitched roof,
I kept sliding off... Right.
...so I kept pulling it back up
and I didn’t pay attention when I pulled it back up. Got you.
Then it was pointing up.
- And then-- - ...so I just
put, put my arm down gently,
- because normally stuff like this don’t happen... - Right.
...because that it’s a, it’s a two way. You got to do two things.
The trigger has got to be locked in, you actually have to--
- And you have to push the head. - Right, right.
So when I did that,
you know, ah, there goes the nail.
I’ve seen a few nail gun injuries like this.
The worst one was a guy that actually did the same thing,
slipped and he actually shot himself in the neck.
So a five-second accident
can turn into a five-hour surgery.
So, the ER physician tried to pull it out,
and you can see it’s actually in there pretty good.
A hemostat is an instrument that we use
in the operating room to grasp stuff.
We use it pretty much in every surgery.
When I walked in to see Brian,
there was one hanging off the nail and I was kind of like,
"Uh, guys, can we just take that off?" You know?
They kind of made a mess.
So it looks like the ER was fiddling with it,
trying to get it out and couldn’t get it out.
- And you said it’s got ridges on it, so it stays in. - Yeah.
- It’s a rim shank, so. - All right.
The nurse came over and was holding my arm
and he couldn’t get a grip to pull it out.
You know, I couldn’t feel it when he was taking the pliers and,
uh, trying to get the head of the nail.
You know, it wasn’t hurting me until he started trying to pull it out.
It felt like he had some lopping shears that you cut
tree branches with and you’re cutting the muscle in my arm in half,
so I start screaming,
I’m like, "No. Uh-uh, uh-uh." I almost pass out.
It’s hurting so bad.
It was excruciating at that point, and I said, uh,
"No, um, you’re gonna have to knock me out.
You’re gonna have to put me under and, uh, pull it out."
So we’ll pull it out.
- I think it’s really just stuck in the muscle. - Mmm-hmm.
So once we do that,
- we’ll kind of twist it out... - Mmm-hmm.
- ...since you’ll be asleep... - Right.
...and then I’ll loosen it up and hopefully
- pull everything out and then you won’t... - Mmm-hmm.
- ...hurt as much... - All right.
- and we won’t damage anything, so. - All right. Okay.
- Sounds good? - Thank you. Yeah.
All right, dude. So we’re gonna take you to the operating room.
Some roofing nails have barbs on them,
so it’s almost like a fish hook.
And that’s why everybody was having
a real hard time trying to remove it.
- See, there’s the head. - Yeah, that’s the head.
And then it’s something in here, some kind of tissue
that’s got it in pretty good.
Looking at Brian’s x-ray, what I’m thinking in my head is,
"Is this stuck in the bone?
Is it stuck in a tendon?
Is it an artery?
Is it something that I can make worse by pulling on it?
Or do I need to cut down to it to take it out?"
Okay, great. Why did they...
Why did they leave the hemostat on there?
- I feel like a-- - We’ll take the hemostat off.
- You ready? - Yeah.
All right.
So, the plan of action,
take Brian to the operating room,
put him to sleep and get set up
for what’s called a major vascular procedure.
So we have all the clamps necessary to reconstruct
the arteries or veins if we need to,
and once we have everything set up,
the first thing I’mma do is actually pull the nail out.
The one complication we worry about in this situation
is the nail being stuck in a nerve.
If it’s stuck in the nerve, we remove it,
he could lose complete function of his arm.
If we can’t repair that nerve or even if we can repair it,
he may never regain function,
so he may end up eventually losing that arm.
Okay. So you can see it’s actually stuck pretty good.
Can I have a hemostat, please?
Brian’s asleep, the easiest way to get this thing out is to pull it.
So the first thing I do is grab a hemostat,
kind of wiggle it a little bit,
see if it’ll come out on its own,
if I just kind of push it in and pull it out.
It gives a little bit, but doesn’t come all the way.
I know from the x-rays, it doesn’t appear to be stuck in a nerve,
so you could hear it rip
through a little bit of tendon or tissue.
It kind of has this flexing thing
that it does right before you pull it out because again,
you’re stimulating the muscle,
so it almost pulls back a little bit.
Oh, a little crunch.
Oh, I see why.
So that’s why.
You see the barb?
When we get it out, there’s no blood coming out,
so I’m like, "Whew! Good."
That’s the problem right there.
That was stuck in tissues,
and there’s a little tissue stuck on that.
That barb is why we couldn’t just pull it out.
And it was holding on to something.
I’ll irrigate it out a little bit.
It’s critical to irrigate the wound because
the one thing that we don’t want to do is
do a great operation
and then it get infected.
So we irrigate it as much as we can
to get any residual metal out,
to get any bacteria out.
And now that that’s out, he should fine,
we’ll watch him for a couple of hours.
As long as it doesn’t bleed, he’ll be okay.
40% of carpenters have had an injury
because of a nail gun, they are very powerful machines.
I’ve seen people get nails in their hands,
nails in their arm,
and the biggest thing is you could lose that extremity,
and I can guarantee you, nobody wants to hire
a one-handed carpenter.
- All right, man, so we got it out. - I like you, dude.
Dude, I appreciate it.
You made me feel comfortable, you know, you’re a good dude.
Dr. Crawford’s a really cool guy.
He came in, cutting up, made the mood,
you know, lightened the mood a little bit.
Uh, I liked him right off the bat.
It’s all gone.
We got the barbs out and everything, it’s not bleeding.
You just put Neosporin on it and, uh, you’ll feel a lot better.
- That’s good. - All right.
- Get some rest and we’ll, uh... - I love you.
Love you too, man.
I’m extremely safe with nail guns now.
I always make sure the nail gun is never
pointed towards me.
I always make sure it’s pointed away from me.
I want to be as safe as possible with it
because I don’t want to shoot myself in the arm again.
He actually kind of felt something
flopping around in his nose.
You hear that, you automatically think
he’s got some nasal polyps, which he did.
This is the main one.
There’s basically a little vacuum that pulls the polyps out.
Uh, here it is.
Wow.
That is just cool. Look at that.
It just keeps coming.
You know, the valium kind of hits
and you feel a little bit tired,
that’s kind of the point of it, you know?
I’m Dr. Dan Carothers.
I’m an ear, nose and throat physician
at, uh, ENT Institute.
So my next patient is Tony,
he’s had a long history of problems
breathing through his nose, and just recently
it’s gotten a lot worse.
He’s lost his ability to smell
and he’s getting a lot of sinus infections,
and he actually kind of felt something
flopping around in his nose.
Prior to the plan for any procedure coming together,
you need to get a CAT scan of the sinuses.
And what we’re looking at here
are views of the face, kind of front to back,
like your head’s a loaf of bread,
and these are called coronal views.
Coming further back in, you can see the beginning
of where the polyp is,
which is right here and sort of starts up in this area,
near what’s called the uncinate process.
This polyp is going all the way from his eye,
all the way down to the bottom of his nose,
and actually is hanging sort of back into the nose.
There’s almost sort of like a glacial growth
where it’s just very gradually they’ll start heading down
into the nose and will just keep going forever.
The polyps will literally come out of your nose.
I saw a patient one time
that the polyps had gotten so large
it looked like he had two little hot dogs coming down
on either side of his nose,
uh, and he had never had them removed.
So getting those out is critical.
All right, let’s, uh, just take a look in here.
So, you know, when you look inside the nose on the left side,
you’ve got what’s called the septum, that’s the dividing wall.
The structure there is called a turbinate,
it’s a little bit enlarged.
And as you can see here,
there’s a polyp here, sort of hanging down,
that’s extending way back in,
and that was just flopping back and forth,
and, you know, you can feel that there’s another little polyp right there.
So he’s got, kind of, a couple little polyps here.
We’ll sort of get all those out.
Okay.
We start out with just a little bit of, um,
numbing decongestant.
This has just a little bit of epinephrine and some lidocaine, okay?
In addition to numbing his nose,
we’ve also applied a powerful decongestant
that prevents it from bleeding during the procedure
as well as afterward, and, uh, he won’t feel anything
as we take the polyps out.
All right, sir. We’re gonna just sort of get started here.
We also cover the eyes because we have
metal instruments in front of the face,
so it’s sort of protection,
and it’s also relaxing for patients
when you’re coming at them with, uh, instruments
that are metal and graspers and things like that.
It’s a little bit scary.
- I am going to get this one polyp out first. - Okay.
And that’s attached just right there in that little stalk,
and we’ll just sort of... remove this guy right from here.
So there’s a... There’s one of the polyps right there.
And maybe just get this one other one here.
And this is the main one
that he could feel flopping back and forth.
It’s not a growth, it’s just inflammatory swelling.
That is something you can get throughout your sinuses.
Nasal polyps are a genetic condition,
and it involves exposure to things in the air.
When we breathe in, we’re breathing in mold spores,
uh, pollen and things that are irritating to the sinus lining.
And polyps really just begin
as just a puffiness of the membranes inside the nose.
You’re gonna hear, sort of, like a dentist instrument
to get out the rest of the polyps.
There’s basically a little vacuum that pulls the polyps out.
Okay.
You all right?
And it sort of just vacuums it right up
through this attachment.
All right, let’s see the, uh, balloon.
We get those polyps out, that’s gonna open up his passages,
but the next part of the procedure,
we’re gonna use a little balloon
to permanently open those sinuses.
You can kind of slide it where it needs to be.
You fill it with water and it cracks the bones open,
healing them in a new position to allow,
uh, that constant mucus that’s being produced
to drain out appropriately.
All right, go ahead and inflate.
All right. Looking good.
Here you go.
So, what we’re going to do next is, we’re gonna, um,
irrigate the left cheek sinus.
- There was some fluid that had built up in here, okay? - Oh, okay.
Tony has several problems,
one of which is the polyps.
The other is that his sinus on the left cheek side,
uh, has failed to drain.
He just has a ball of sort of jelly mucus
that’s just stuck there, and it’s just never gonna come out
unless we remove it.
This device we use is, uh, called a cyclone,
it basically has a irrigation and a suction.
Oh, here it is.
So there’s that liq... liquid we were trying to get out,
uh, it’s beside of mucus.
This cyclone device is fantastic.
In years past, we would literally take
a metal tube that was hollow and a hammer
and just hammer it into the sidewall of the nose.
You would attach a little irrigation device
and then you would just ram some saline in there,
and it would come rushing out of the sinus into their mouth
and they would have to spit it into a bowl.
Yeah, I can hear it.
That just stuck in your sinuses.
Yeah, we’re gonna... And it’s not infection,
it’s just, it’s just thickened and it’s just really tenuous and...
Hmm.
This is never gonna come out on its own.
Wait, let’s...
Here we go. Wow, that is just...
That is just cool, look at that.
It just keeps coming.
So what he had going on was this mucus
was literally stuck there who knows how long.
I’m thinking, you know, probably months to years.
And man, when that started to come out,
it was too thick for even the suction.
It, it was just like the slime
that kids, uh, will make at home.
I was able to get that out in sort of one, big, gooey ball.
And, you know, just getting that out was incredibly satisfying.
And, you know, it’s no longer stuck,
so he’s going to feel great.
Wow.
And that’s the end of it.
- It usually is all attached in one glob. - Hmm.
So I don’t think there’s any more,
and that’s all she wrote.
Oh, my goodness.
- Nice job. - Thank you.
- You did great. - You did great.
Any time you have obstruction,
you can’t just assume it’s a polyp,
you need to get it checked out.
There are certain types of masses
that are called papillomas.
This type of polyp has a chance
of turning into cancer at some point in your life.
Inverted papillomas can be quite serious
and have to be surgically removed.
This dressing is just in case, uh, things drip a little bit.
Let me get you out of here, okay?
Like all polyp patients,
Tony is at risk of polyp recurrence,
but as long as he keeps coming back
and he does his topical nasal steroid sprays,
I think he’ll be just great.
Yeah.
- It’s not so bad, is it? - No.
From a breathing perspective and just generally
feeling better, his sense of smell,
I think he’s going to be super happy and, uh,
and we’ll see how things go over the next few weeks.
And what are we seeing you guys for today?
She has a bead in her ear.
How long has it been in there?
The child usually doesn’t want to acknowledge it
’cause they don’t want to talk about
how that object got there.
- Okay. - You’re doing so good.
From the looks of it, it’s been in there for a while.
- Hey! Good evening. - Hi.
I’m Taliyah and I’m six years old.
- Hey, Taliyah. - Yes.
She has a bead stuck in her ear.
A bead.
We’ll get you all set, okay, and they’ll come right up for you.
- Okay, thank you. - Thank you.
A bead of a beanbag for my sister,
it went in my ear, so I tried to get it out.
- Taliyah? - Yes.
- You’re ready? - Yes, we’re ready. You ready?
- You’re ready? - Right this way.
Thank you.
Gonna go right this way. Okay.
Have a seat in the big chair for me, Taliyah.
Big girl chair.
And what are we seeing you guys for today?
She has a bead in her ear.
Which ear?
It’s the right ear.
- Does it hurt? - Uh-huh.
Okay, good.
How long has it been in there?
From the looks of it, it’s been in there for a while,
because we haven’t had a beanbag in months.
Mmm-hmm?
All right. Well, I’m gonna go get Dr. Livermore. Okay?
- Okay. - He’ll be right in.
Thank you.
All right, Dr. Livermore.
It’s in her right ear.
Is your heart beating fast?
Mine is too.
Mom said she just found out about this
- three days ago. - Okay.
I’m George Livermore, ear, nose and throat doctor.
I’ve been doing this for 32 years.
- Hey! I’m Doctor Livermore. - Hi. How are you doing?
In terms of kids and foreign objects,
it’s very common for those objects to be there for quite a while.
The child usually doesn’t wanna acknowledge it
’cause they don’t want to talk about how that object got there.
Oh, okay, let’s see. Oh, yeah.
- It’s right there. - Yeah.
Now I’m gonna look over on this side, okay?
Two ears, two looks.
When you’re looking at kids and trying to reassure them,
it’s what your persona puts off.
I try to speak very softly,
I tell them it’s gonna be okay.
Okay, baby doll.
- You’re gonna stay real still for Dr. Livermore. - Um, really still.
- Real still, okay? - Guess what?
You just yell at me if it hurts.
If it hurts you say, "Ouch."
The strangest thing I ever got out of a child’s orifice though,
was the arm of, like, a little doll
and it was stuck up in her nose.
You know what this looks like?
What does it look like?
This looks like popcorn.
- Could it be popcorn? - Popcorn in her ear?
Did you put popcorn in your ear?
- No. It’s a bead. - No?
- It’s a bead-- - From a beanbag.
- Yeah, from a beanbag. - There’s a piece of bead.
It’s coming out.
You just got to hold real still, okay?
- You’re doing so good. - Okay.
The length of time that
a foreign body is in a, a cavity,
especially in the ear,
wax will accumulate around it and over time,
you will eventually get a wax impaction or,
you know, you won’t be able to hear very well at all.
Can you hear it?
Yeah.
I need a little suction just to get all that liquid out of there.
You just have to look at me in the eyes.
We’re almost done.
Okay, I think it’s coming.
Oh, my God.
I think I want to cry now.
He did a good job.
Great.
- Thank you, Dr. Livermore. - Come here.
Thank you.
Okay.
Don’t put anything else in your ears.
Sometimes they’re not that easy to get out.
Just don’t do it. Just say no.
Just say no.
When you’re successful at removing a foreign body
from a child and the child is happy
and you haven’t hurt them,
I felt like I’ve done my thing that day.
I mean, it’s my thing, you know.
Never, ever do that again.
So that’s why we’re throwing all the beads away.
Yes, we are.
Hello, Miss Cochran. Okay, we’re ready?
- Yes, ma’am. - Yeah.
So I’ll get some gloves on here.
My name is Susan Cochran
and I’m here for the earwax in my left ear.
So we’ll show you the normal ear first
so you can see what that looks like,
and then we’ll pop over to the other side.
Susan’s coming in because she hasn’t been able to hear
out of her left ear for the last several weeks.
She saw her primary care doctor,
who told her that she had a lot of wax built up inside her ears.
She’s tried various different home remedies
and hasn’t been able to get any relief.
Now, so you can see your eardrum,
it looks nice and healthy inside,
so that’s a perfect looking ear.
Now we’ll move over to the other side.
Every day at the ENT Institute,
I see something that’s stuck in patients’ ears.
Most of the time it’s wax,
but sometimes we see something else in the ear
that’s not supposed to be there.
My name is Brandon Elias.
I lodged a cotton swab in my left ear this morning,
uh, as I was cleaning my ears out.
Our next patient today is Mrs. Stokes,
and she has a dome of a hearing aid
that is wedged in her ear.
All right, let’s take a look here first.
My name is Josephine,
and I basically got something stuck in my ear.
I felt a bug go into my ear,
and I was trying to get it out,
- but I just couldn’t. - Yeah.
Sometimes patients know that they have something stuck in their ear,
but other times they have no idea.
Every time I put my hearing aid in my right ear,
it would fall out
and it would hurt a little bit when I push it in there.
I didn’t know it was stuck in my ear until today.
I could hear the cotton just kind of stick,
and I immediately looked and saw that the stick
had no cotton swab on it at all.
I could feel something against my ear
and I went to swat it away
and it just went in my ear.
It’s been weird ’cause I haven’t been able to hear.
It’s been real muffled.
But when I go to sleep, I can’t hear nothing,
it goes totally silent.
I could feel it in my ear. I could hear a noise.
It was just not the best feeling.
To best describe it would be,
if you’re going down the road and the vehicle
has the windows open and you hear the noise of the wind,
it was like windy inside of my ear.
It’s very important to listen to my patients’ symptoms
before I start any sort of procedure.
So specifically, I want to know what their symptoms are,
so whether it’s pain, it’s pressure,
it’s muffled hearing, because that tells me what to look for,
what to watch out for while I’m doing the procedure.
We have this little camera here and that’ll show us
what your cotton swab looks like.
You can see there’s some blood
from the attempt that you and your wife made.
- There is the cotton swab. - Oh, wow.
It’s blocking pretty much the whole canal,
so that’s why you have some muffled hearing
and some clogged feeling.
So this is the right external meatus or canal,
and you can see this dome is wedged sideways pretty far in.
It is relatively close to the eardrums now,
and so it’ll, it’ll be a little bit loud.
So this is what’s in this side.
That’s nasty.
So it looks like some wax.
Hold on, looks like there’s something else
further back in here.
Looks like the head of a cotton swab.
This is what cotton swabs look like
after they’ve been stuck in the ear for a while,
and it’s had time to mix with some earwax as well.
So once we pull it out, we’ll be able to see
exactly what that is inside.
No matter what it is or how it got there,
either way, we have to get it out.
We always try to do that without causing too much pain.
Okay, you might feel a little bit of a pinch here.
- Ouch. Ooh. - Sorry.
It’s really, it’s really stuck in there.
Ooh.
- So this should not hurt at all. - Oh.
And that’s coming out, right here.
So this is our cotton ball.
Oh, it’s so much better.
- And there’s the cotton swab. - Wow.
I feel much better, I can hear better with no hearing aid.
All right. Do you wanna take a look at it?
No. What was it though?
It definitely is a bug.
I think it’s probably a small cockroach.
Okay. So let me take a look,
make sure it’s all clear.
Once the procedure is over, I take one final look
in the ear just to make sure that the ear canal looks healthy
and that we have everything.
- All righty, and you can hear now, huh? - I can hear.
Just like that, the patient’s good to go,
it doesn’t need any further follow up,
and it’s always a good story to tell friends and family.
I can hear again and less pressure.
It feels a lot better.
So this is why in the ENT world we always say,
"Never clean your ears with anything bigger than your elbow."
Smaller than your elbow.
Never clean your ears with anything smaller than your elbow.
There’s this pleasant lady,
she’s got a huge stiletto heel
stuck smack into her face.
My 40 years of working in emergency departments,
I’ve just seen a slew of different kind of bizarre things
that people had stuck in them.
Bows and arrows stuck in the extremity,
stuck earrings, little kids will come in
with hair tourniquets
where their mother’s hair gets wrapped around the finger.
Fishhooks are another nemesis for patients.
I had a young lady one time with a pencil sticking out of her neck.
Not crying, not upset, but with this large pencil
just sticking out from her neck.
And it’s not uncommon for little boys that are,
uh, zipping up their pants that they’ll catch
the foreskin of the penis in the zipper.
That’s a challenge when it happens.
One of the injuries that we see intermittently are, are nail gun injuries.
Many times they’re just pulling these nails out
and putting a little Bacitracin ointment
and some gauze and some duct tape and going back to work.
Then there are times, though, where that’s not gonna work.
Can you straighten your finger?
- Okay, okay. And you can feel me touching here? - Yes, sir.
So one patient I had,
a fairly large nail just go straight through the bone,
and so our challenge was then,
did it fracture the bone, is he going to get an infection?
- We’re going to do a digital block on this... - Mmm-hmm. Yep.
...and then we’ll get an x-ray after that.
These nails are not just the everyday nails,
they actually have some wire looped around there
and they can tear up tissues as they go in,
and it definitely makes pulling them out harder.
It’s out.
What was most dramatic about it?
You put the saline bottle right on the wound
and you could see saline just squirting out the other side.
And that means that was one heck of a hole.
One of the more dramatic images that I have
of things that were stuck in people,
so I walked into the trauma room
and there’s this pleasant lady
laying on the gurney,
she’s got a huge stiletto heel stuck,
smack into her face.
She had been out with friends,
there was an altercation between her and another lady,
and unfortunately, as we found out,
the stiletto heel can be a significant potential weapon.
And so a lot of times you have to do
procedural sedation to get that out.
Before it became loose. So you really had to...
You had to put a lot of tension
on that to pull that out.
She was so lucky, though,
in that there was minimal damage.
In the ER, I get to see it all and get to do it all.
You even get to remove bullets, in this case, a BB.
Our patient who just arrived is a 17-year-old,
who got shot in the face with a BB gun.
Looks like it was more than just one shot.
It looks like it was four,
one very close to the eye right there, so yeah.
We’re gonna have to extract them.
I think there’s one BB still buried in the skin,
it’s the one that’s closest to his eye.
BB’s can potentially actually go through bone
and go into the brain.
I’m not 100 % sure how many BB’s are still in there,
but I’m going to go ahead and get an x-ray,
we’ll get a better idea after that, so.
My name is Jeremiah.
I’m 17, and I live in Mobile, Alabama.
Me and my friend, we were just playing around,
shooting a gun, we were having fun
until they just started coming back at me.
Shots hit my face and I hit the ground,
blood was pouring down on my face.
There was a BB stuck, like, right by my eye,
and my mom was like, "Take him to the ER right now."
So basically, the BB’s outside,
right up near the orbit, very close to the eye,
and we have one lucky patient here.
A lot of times if the BB is buried deep in the skin,
you just leave it, you don’t go fishing for it,
but the BB is sitting there relatively close to the surface.
I’m basically going to get a magnet.
I think that the BB’s are magnetic and we’ll see.
One of the things that I have discovered relatively recently
is that I can use these rare-earth magnets
to actually pull the BB up and out of the skin.
What I have here is a rare-earth magnet,
and I’ve got it in a sterile glove.
- Yes, sir. - All right?
He wanted to use like a little magnet.
It was weird to me.
I’m gonna just touch these, uh,
different wounds here to see if I can find
where the BB may be hiding.
Uh.
Ah, there we go.
Yeah, that’s it.
So what I’m gonna do
is see if we can actually pull it out with this
without doing any additional incisions.
When you’re working with embedded foreign bodies,
your goal is to remove it as safely as possible.
All right. It just pulls the BB
- right up to the surface. - Okay.
We’re just gonna get some tweezers
and we’re gonna try and pull it out, so.
Okay, there. See if you can pull up on that just a little bit.
Go ahead and pull that.
- This doesn’t hurt, does it? - No.
Go ahead and pull that.
I’m, I’m gonna get it.
All right. Okay.
So I’m gonna give up on the tweezers here.
That only pushed it back in deeper.
I had to go to plan B.
- Let’s just see... - Just the magnet.
- ...just using the magnet alone... - Okay.
- ...whether we can pull that out. Okay? - Okay.
All right. Now go ahead and get it caught up there.
Okay. And I’m gonna see and try
and stretch it as much as you can.
It was just pressure nonstop.
- You’re okay. - I’ve, I’ve got, I’ve got it, I’ve got it right here, guy.
Ahh!
It’s right here.
It’s pushed back down now.
It will come out.
We get it to the surface and then any manipulation we do,
it tends to go deeper again.
- We are so close, you just need to pull it back up... - Okay.
...to the surface. So, so that’s where we’re at.
It’s sitting right there.
- There we go. There it is. - Got that out.
That worked.
That time, the BB actually came out attached to the magnet,
and so, you know, we’re victorious, we did high fives.
The pressure was gone off my face
and I was happy that nothing bad happened.
- You feeling okay? - Yeah, I’m feeling all right.
- All right. - Okay. Do not play with BB guns.
And so I’m going to tell Jeremiah is
realize how close that was to your eye.
As you’re playing with your friends,
you’re goofing off and you’re a little bit careless
and that’s when accidents happen.
I kept the BB as a souvenir
just to know not to play with BBs again.
I got a hook stuck in my hand.
So you want to tell me, "Oh, look, that’s a nice lure."
That bothers you a little bit, correct?
Just a little bit. Yeah.
Mom was taking this really hard.
This was more than she could handle.
Here, I’m going to let you hold both of those.
There was multiple attempts,
especially around where the barb would be sitting.
- Hey. - Hi.
So what are you here for?
I got a hook stuck in my hand.
All right, let’s take a look at it.
Oh, look, that’s a nice lure.
Looks like it’s stuck only in the thumb. Correct?
- Yes, sir. - Okay.
Today, our patient is Giovanni,
who came to the emergency department
with a fishhook stuck in his thumb.
We work in Mobile, Alabama,
and so we’re on the Gulf Coast, and so it’s not uncommon,
um, in this part of the country
to have patients walk in with a very fancy,
pretty fishing lure sticking out of a part of their body.
What were you doing when it happened?
If you look up here,
there was excess line up here and he melted it.
- Yeah. - So when he went to try
to break it off after it cooled,
- he... - He got it...
Okay, so what we’re gonna do is we’re gonna numb your thumb up
- and try and work that fishhook out of your thumb. - Yes, sir.
I don’t think it’ll be too bad,
but we’ll... uh, we’ll tell you each step of the way
- what we’re gonna be doing. - Yes, sir.
Mom was taking this really hard.
This was more than she could handle.
- How old are you? - 13.
- 13. Okay, good. You’re a big fisherman? - Yes, sir.
- That bothers you a little bit. Correct? - Just a little bit.
Parental stress reactions.
Some parents are stressed to the point
where you find them falling out
and hitting the ground.
They become an emergency themselves.
This is my target area right here,
and then you’re gonna start injecting that. Okay?
On the thumb, traditionally, you have to do four injections
to numb up the two nerves that travel
on the pad side and then on the, on the dorsal.
And the tumescent block, though basically is putting
so much numbing medicine in there that it, it just encircles
the whole thumb or the whole finger.
And so it was just two sticks but it was still two less than four,
that’s why I elected to do this.
We’re gonna, we’re gonna grab this like this.
And what I can do is, um, I can put the tension on this...
- Okay. - ...and then you can go in there and break up...
- Okay. - ...around where the barb is being held down.
The barb release technique, I actually invented.
- Here, I’m gonna let you hold both of those. - Okay.
I just take an 18-gauge needle
and work on releasing the tissues around it.
The barb makes it so much more complicated because
if you stepped on a sewing needle,
grandma could pull that out and you’re done, you know?
But a fish hook, that barb is just buried in there.
I mean, it’s made like that to hold on to fish
so your fish can’t escape.
Humans can’t escape when that happens too, unfortunately.
It is...
I think, a lot less traumatic. Yeah, there is some s...
um, spicules of skin you’re breaking up there.
But it doesn’t mean a second one like poking the needle
through and then cutting off the barb.
- All right. - You got it?
Mmm-hmm.
Okay. All right. So let’s take a look at this.
Your barb is intact.
- You happy about that? - Mmm-hmm.
So you’re okay with it?
Yeah, I am okay. Oh, no, not--
It’s done, it’s done, it’s done. Oh, the blood.
We’ll, we’ll put a Band-Aid on there.
I think it’s an element of pride
for you fishermen out there like,
"I pulled out so many fishhooks and I don’t need
no stinking ER doctors to help me here."
And if you wanna spend the rest of your life walking around with fishhook barbs
in different parts of your body, that’s up to you,
but it wouldn’t be my preference.
Well, thanks. I appreciate all your help on this case.
You’re welcome.
My name is Edward J Starkey.
I’m from Anniston, Alabama.
I’ma touch it.
- Hey, Mr. Starkey, you ready? - Yeah.
Mr. Starkey is a gentleman
that I’ve known for six years.
He called me about a month ago and said,
"I got something in my arm."
I was kind of mad at him.
I’m like, "Dude, I’ve known you for six years
and you’re just now telling me about it."
- Mr. Starkey. - What’s up, doc?
- How are you doing? - You doing okay?
- Good, good. - Hop up here for me, man.
Let’s take a look, see what’s going on.
Dude, what happened?
That’s the scar when I went to the hospital and had nine stitches here.
Oh, yeah, right there.
- Mmm-hmm. - Cash-money. Okay.
It’s kind of interesting that small piece of glass
will cause him a significant amount of pain
’cause it’s hitting a nerve.
It looks very small to us,
but you can kind of think of it as like,
if you’ve ever had like a pin stuck in your arm
or you had a needle stuck somewhere,
that little small prick causes a lot of pain.
For him, it’s a little different because every time he moves, he can feel it,
every time he hits it on something,
he just gets this shooting pain.
All right, big fellow, let’s get this taken care of here.
All right, little stick and a burn.
The main reason we always put a little target
on foreign bodies like this, as you can see,
once the lidocaine gets in there,
the whole thing swells up.
So, before you could feel it, right now, you can’t.
That, dude, is a little tiny piece of glass.
You weren’t making that junk up. I thought you were.
It feels real good to help one of my friends out.
- All right, dude, so you’re good. - Oh, okay.
Now I’ll close it up.
The other nice part of body
is when we make that incision to open the dermis up,
if there are more pieces of it in there,
it now has a route to come out quick.
The body will get rid of it on its own
the majority of the time.
The problem is when it gets to the surface,
that’s when it starts to cause pain.
I had a nurse that was in a car accident 20 years
prior to when I was working with her.
She was actually taking care of a kid
and the glass came out of her scalp
and started bleeding all over the place.
Everybody started freaking out
’cause they thought something had happened to her,
but it was just, a glass came out at the time she was taking care of a little kid,
so it can kind of do whatever it wants to do.
So if there’s any other little fragments of glass in there,
they’ll come out over the next couple of weeks.
You got any questions?
- That’d be all right? - Yeah.
Okay.
- Bye. - Bye-bye.
About four hours from now,
he will start to feel pain from the incision,
but tomorrow he’ll be able to notice that
that nerve pain that he has is gone.