1 00:00:23,667 --> 00:00:27,037 [George Crawford] When things are stuck inside the body, 2 00:00:27,070 --> 00:00:28,200 we got to get it out. 3 00:00:29,806 --> 00:00:32,176 Tony just has a ball of jelly mucus 4 00:00:32,208 --> 00:00:33,508 that’s just stuck there. 5 00:00:33,543 --> 00:00:35,683 This is never going to come out on its own. 6 00:00:35,712 --> 00:00:38,142 This mucus was literally stuck there, 7 00:00:38,181 --> 00:00:40,011 probably months to years. 8 00:00:40,050 --> 00:00:42,850 Wow. Well, look at that. [chuckles] 9 00:00:43,520 --> 00:00:45,250 [man 1 speaking] 10 00:00:48,058 --> 00:00:50,068 [Larry] These nails, they actually have some 11 00:00:50,093 --> 00:00:51,293 wire looped around there, 12 00:00:51,328 --> 00:00:54,298 and they can tear up tissues as they go in, 13 00:00:54,331 --> 00:00:56,601 and it definitely makes pulling them out harder. 14 00:00:59,769 --> 00:01:01,969 She has a bead in her ear. 15 00:01:02,005 --> 00:01:03,805 When you’re looking at kids, 16 00:01:03,840 --> 00:01:06,870 it’s what your persona puts off. 17 00:01:06,910 --> 00:01:10,140 I try to speak very softly, tell them it’s gonna be okay. 18 00:01:10,180 --> 00:01:12,050 - [George Livermore] Okay, baby doll. - Okay. 19 00:01:12,082 --> 00:01:13,252 You’re doing so good. 20 00:01:13,283 --> 00:01:15,853 From the looks of it, it’s been in there for a while. 21 00:01:17,287 --> 00:01:19,427 Ah, there goes the nail. 22 00:01:19,456 --> 00:01:21,896 A five-second accident 23 00:01:21,925 --> 00:01:25,025 can turn into a five-hour surgery. 24 00:01:26,296 --> 00:01:27,766 [grunts] 25 00:01:27,797 --> 00:01:29,507 There’s this pleasant lady, 26 00:01:29,532 --> 00:01:32,532 she’s got a huge stiletto heel 27 00:01:32,569 --> 00:01:35,029 stuck smack into her face. 28 00:01:35,071 --> 00:01:36,801 [indistinct chatter] 29 00:01:49,886 --> 00:01:51,456 My name is George Crawford. 30 00:01:51,488 --> 00:01:54,228 I am a board-certified general surgeon, 31 00:01:54,257 --> 00:01:56,627 I practice in Anniston, Alabama, 32 00:01:56,660 --> 00:01:58,630 and I work at the Crawford Clinic. 33 00:01:58,662 --> 00:02:00,962 When I get a call from the emergency room and they say, 34 00:02:00,997 --> 00:02:04,467 "Hey, we have this guy that got shot with a nail gun in his arm." 35 00:02:04,501 --> 00:02:07,131 The real questions that need to be answered, 36 00:02:07,170 --> 00:02:08,740 you know, is it in a vessel, 37 00:02:08,772 --> 00:02:11,772 is it a big nail, or is it a screw? 38 00:02:11,808 --> 00:02:13,878 Is it something that’s gonna rip a nerve? 39 00:02:13,910 --> 00:02:16,080 Does he have neurological damage? 40 00:02:16,112 --> 00:02:18,752 So a lot of those things are going through my mind 41 00:02:18,782 --> 00:02:20,712 when I get that phone call. 42 00:02:20,750 --> 00:02:22,580 But we know that once we see the patient, 43 00:02:22,619 --> 00:02:24,179 we can start answering those questions. 44 00:02:27,991 --> 00:02:30,161 - [George Crawford] Dude, what’s up? - Well... 45 00:02:30,193 --> 00:02:31,423 [Brian] My name is Brian Chaney, 46 00:02:31,461 --> 00:02:33,831 I do residential construction work 47 00:02:33,863 --> 00:02:36,133 in Gadsden, Alabama. 48 00:02:36,166 --> 00:02:37,806 [George Crawford] So exactly what happened now? 49 00:02:37,834 --> 00:02:40,334 Nail gun, somehow trigger was... 50 00:02:40,370 --> 00:02:43,000 - was obviously pressed on it. - [George Crawford] Okay. 51 00:02:43,039 --> 00:02:45,909 I put my arm down and I was on a steep pitched roof... 52 00:02:45,942 --> 00:02:48,682 - [George Crawford] Okay. - ...so the nail gun was laying right beside me 53 00:02:48,712 --> 00:02:51,312 - and it was turned up... - [George Crawford] Right. 54 00:02:51,347 --> 00:02:52,957 - ...towards the sky. - [George Crawford] Okay. 55 00:02:52,982 --> 00:02:54,312 - [Brian speaking] - [George chuckles] 56 00:02:54,350 --> 00:02:56,120 But I was on such a steep pitched roof, 57 00:02:56,152 --> 00:02:57,752 I kept sliding off... -[George Crawford] Right. 58 00:02:57,787 --> 00:02:59,527 [Brian] ...so I kept pulling it back up 59 00:02:59,556 --> 00:03:01,826 and I didn’t pay attention when I pulled it back up. -[George Crawford] Got you. 60 00:03:01,858 --> 00:03:03,028 [Brian] Then it was pointing up. 61 00:03:03,059 --> 00:03:04,489 - [George Crawford] And then-- - ...so I just 62 00:03:04,527 --> 00:03:06,037 put, put my arm down gently, 63 00:03:06,062 --> 00:03:08,532 - because normally stuff like this don’t happen... - [George Crawford] Right. 64 00:03:08,565 --> 00:03:11,265 ...because that it’s a, it’s a two way. You got to do two things. 65 00:03:11,301 --> 00:03:13,171 The trigger has got to be locked in, you actually have to-- 66 00:03:13,203 --> 00:03:15,103 - And you have to push the head. - [George] Right, right. 67 00:03:15,138 --> 00:03:16,878 So when I did that, 68 00:03:16,906 --> 00:03:20,176 you know, ah, there goes the nail. 69 00:03:20,210 --> 00:03:23,540 [George Crawford] I’ve seen a few nail gun injuries like this. 70 00:03:23,580 --> 00:03:26,950 The worst one was a guy that actually did the same thing, 71 00:03:26,983 --> 00:03:29,823 slipped and he actually shot himself in the neck. 72 00:03:29,853 --> 00:03:33,123 So a five-second accident 73 00:03:33,156 --> 00:03:37,466 can turn into a five-hour surgery. 74 00:03:37,494 --> 00:03:39,994 So, the ER physician tried to pull it out, 75 00:03:40,029 --> 00:03:42,899 and you can see it’s actually in there pretty good. 76 00:03:42,932 --> 00:03:44,962 A hemostat is an instrument that we use 77 00:03:45,001 --> 00:03:47,001 in the operating room to grasp stuff. 78 00:03:47,036 --> 00:03:48,746 We use it pretty much in every surgery. 79 00:03:48,772 --> 00:03:50,372 When I walked in to see Brian, 80 00:03:50,406 --> 00:03:53,016 there was one hanging off the nail and I was kind of like, 81 00:03:54,511 --> 00:03:58,181 "Uh, guys, can we just take that off?" You know? 82 00:03:58,214 --> 00:04:00,154 They kind of made a mess. [chuckles] 83 00:04:00,183 --> 00:04:02,353 So it looks like the ER was fiddling with it, 84 00:04:02,385 --> 00:04:04,085 trying to get it out and couldn’t get it out. 85 00:04:04,120 --> 00:04:06,890 - And you said it’s got ridges on it, so it stays in. - Yeah. 86 00:04:06,923 --> 00:04:08,723 - It’s a rim shank, so. - [George Crawford] All right. 87 00:04:08,758 --> 00:04:11,558 The nurse came over and was holding my arm 88 00:04:11,594 --> 00:04:14,034 and he couldn’t get a grip to pull it out. 89 00:04:14,063 --> 00:04:16,903 You know, I couldn’t feel it when he was taking the pliers and, 90 00:04:16,933 --> 00:04:18,873 uh, trying to get the head of the nail. 91 00:04:18,902 --> 00:04:22,102 You know, it wasn’t hurting me until he started trying to pull it out. 92 00:04:22,138 --> 00:04:24,498 It felt like he had some lopping shears that you cut 93 00:04:24,541 --> 00:04:27,841 tree branches with and you’re cutting the muscle in my arm in half, 94 00:04:27,877 --> 00:04:29,917 so I start screaming, 95 00:04:29,946 --> 00:04:32,286 I’m like, "No. Uh-uh, uh-uh." I almost pass out. 96 00:04:32,315 --> 00:04:33,415 It’s hurting so bad. 97 00:04:33,449 --> 00:04:35,179 It was excruciating at that point, and I said, uh, 98 00:04:35,218 --> 00:04:36,688 "No, um, you’re gonna have to knock me out. 99 00:04:36,719 --> 00:04:38,579 You’re gonna have to put me under and, uh, pull it out." 100 00:04:38,621 --> 00:04:39,791 [George] So we’ll pull it out. 101 00:04:39,823 --> 00:04:41,593 - I think it’s really just stuck in the muscle. - Mmm-hmm. 102 00:04:41,624 --> 00:04:42,894 [George Crawford] So once we do that, 103 00:04:42,926 --> 00:04:44,296 - we’ll kind of twist it out... - Mmm-hmm. 104 00:04:44,327 --> 00:04:45,937 - [George] ...since you’ll be asleep... - Right. 105 00:04:45,962 --> 00:04:48,362 [George] ...and then I’ll loosen it up and hopefully 106 00:04:48,398 --> 00:04:50,108 - pull everything out and then you won’t... - Mmm-hmm. 107 00:04:50,133 --> 00:04:51,763 - [George Crawford] ...hurt as much... - All right. 108 00:04:51,801 --> 00:04:53,531 - and we won’t damage anything, so. - All right. Okay. 109 00:04:53,570 --> 00:04:55,030 - [George] Sounds good? - Thank you. Yeah. 110 00:04:55,071 --> 00:04:57,301 [George] All right, dude. So we’re gonna take you to the operating room. 111 00:04:57,340 --> 00:04:58,640 Some roofing nails have barbs on them, 112 00:04:58,675 --> 00:05:00,075 so it’s almost like a fish hook. 113 00:05:00,109 --> 00:05:02,079 And that’s why everybody was having 114 00:05:02,111 --> 00:05:04,441 a real hard time trying to remove it. 115 00:05:04,480 --> 00:05:06,580 - See, there’s the head. - Yeah, that’s the head. 116 00:05:06,616 --> 00:05:09,556 [George Crawford] And then it’s something in here, some kind of tissue 117 00:05:09,586 --> 00:05:11,826 that’s got it in pretty good. 118 00:05:11,855 --> 00:05:15,125 Looking at Brian’s x-ray, what I’m thinking in my head is, 119 00:05:15,158 --> 00:05:16,428 "Is this stuck in the bone? 120 00:05:16,459 --> 00:05:17,989 Is it stuck in a tendon? 121 00:05:18,027 --> 00:05:19,237 Is it an artery? 122 00:05:19,262 --> 00:05:22,062 Is it something that I can make worse by pulling on it? 123 00:05:22,098 --> 00:05:25,428 Or do I need to cut down to it to take it out?" 124 00:05:25,468 --> 00:05:27,398 Okay, great. Why did they... 125 00:05:27,437 --> 00:05:29,947 Why did they leave the hemostat on there? 126 00:05:29,973 --> 00:05:34,613 [Brian speaking] 127 00:05:34,644 --> 00:05:36,744 - I feel like a-- - [George Crawford] We’ll take the hemostat off. 128 00:05:36,779 --> 00:05:37,939 - You ready? - Yeah. 129 00:05:38,781 --> 00:05:40,011 [George Crawford] All right. 130 00:05:40,950 --> 00:05:42,250 So, the plan of action, 131 00:05:42,285 --> 00:05:44,125 take Brian to the operating room, 132 00:05:44,153 --> 00:05:46,593 put him to sleep and get set up 133 00:05:46,623 --> 00:05:49,293 for what’s called a major vascular procedure. 134 00:05:49,325 --> 00:05:51,425 So we have all the clamps necessary to reconstruct 135 00:05:51,461 --> 00:05:53,191 the arteries or veins if we need to, 136 00:05:53,229 --> 00:05:55,999 and once we have everything set up, 137 00:05:56,032 --> 00:05:58,362 the first thing I’mma do is actually pull the nail out. 138 00:06:00,303 --> 00:06:02,803 [George Crawford] The one complication we worry about in this situation 139 00:06:02,839 --> 00:06:05,769 is the nail being stuck in a nerve. 140 00:06:05,808 --> 00:06:08,268 If it’s stuck in the nerve, we remove it, 141 00:06:08,311 --> 00:06:10,781 he could lose complete function of his arm. 142 00:06:10,813 --> 00:06:14,313 If we can’t repair that nerve or even if we can repair it, 143 00:06:14,350 --> 00:06:16,780 he may never regain function, 144 00:06:16,819 --> 00:06:19,049 so he may end up eventually losing that arm. 145 00:06:19,088 --> 00:06:21,718 [indistinct chatter] 146 00:06:21,758 --> 00:06:24,498 [George Crawford] Okay. So you can see it’s actually stuck pretty good. 147 00:06:25,828 --> 00:06:27,988 Can I have a hemostat, please? 148 00:06:28,031 --> 00:06:31,561 Brian’s asleep, the easiest way to get this thing out is to pull it. 149 00:06:31,601 --> 00:06:33,571 So the first thing I do is grab a hemostat, 150 00:06:33,603 --> 00:06:35,033 kind of wiggle it a little bit, 151 00:06:35,071 --> 00:06:37,041 see if it’ll come out on its own, 152 00:06:37,073 --> 00:06:39,373 if I just kind of push it in and pull it out. 153 00:06:39,409 --> 00:06:42,239 It gives a little bit, but doesn’t come all the way. 154 00:06:42,278 --> 00:06:45,748 I know from the x-rays, it doesn’t appear to be stuck in a nerve, 155 00:06:45,782 --> 00:06:48,312 so you could hear it rip 156 00:06:48,351 --> 00:06:50,581 through a little bit of tendon or tissue. 157 00:06:50,620 --> 00:06:53,250 It kind of has this flexing thing 158 00:06:53,289 --> 00:06:56,059 that it does right before you pull it out because again, 159 00:06:56,092 --> 00:06:57,492 you’re stimulating the muscle, 160 00:06:57,527 --> 00:06:59,367 so it almost pulls back a little bit. 161 00:07:01,297 --> 00:07:03,007 [George Crawford grunts] 162 00:07:03,032 --> 00:07:04,362 Oh, a little crunch. 163 00:07:04,400 --> 00:07:06,700 Oh, I see why. 164 00:07:12,308 --> 00:07:13,708 So that’s why. 165 00:07:13,743 --> 00:07:15,273 You see the barb? 166 00:07:15,311 --> 00:07:17,341 When we get it out, there’s no blood coming out, 167 00:07:17,380 --> 00:07:19,780 so I’m like, "Whew! Good." 168 00:07:19,816 --> 00:07:22,286 That’s the problem right there. 169 00:07:23,086 --> 00:07:24,926 That was stuck in tissues, 170 00:07:24,954 --> 00:07:26,924 and there’s a little tissue stuck on that. 171 00:07:26,956 --> 00:07:30,126 That barb is why we couldn’t just pull it out. 172 00:07:30,159 --> 00:07:32,629 And it was holding on to something. 173 00:07:32,662 --> 00:07:35,032 I’ll irrigate it out a little bit. 174 00:07:35,064 --> 00:07:38,104 It’s critical to irrigate the wound because 175 00:07:38,134 --> 00:07:39,804 the one thing that we don’t want to do is 176 00:07:39,836 --> 00:07:41,606 do a great operation 177 00:07:41,637 --> 00:07:43,207 and then it get infected. 178 00:07:43,239 --> 00:07:46,139 So we irrigate it as much as we can 179 00:07:46,175 --> 00:07:48,375 to get any residual metal out, 180 00:07:48,411 --> 00:07:50,041 to get any bacteria out. 181 00:07:50,079 --> 00:07:52,309 And now that that’s out, he should fine, 182 00:07:52,348 --> 00:07:53,578 we’ll watch him for a couple of hours. 183 00:07:53,616 --> 00:07:56,086 As long as it doesn’t bleed, he’ll be okay. 184 00:07:57,787 --> 00:08:00,727 40% of carpenters have had an injury 185 00:08:00,757 --> 00:08:04,327 because of a nail gun, they are very powerful machines. 186 00:08:04,360 --> 00:08:07,430 I’ve seen people get nails in their hands, 187 00:08:07,463 --> 00:08:08,933 nails in their arm, 188 00:08:08,965 --> 00:08:12,735 and the biggest thing is you could lose that extremity, 189 00:08:12,769 --> 00:08:15,599 and I can guarantee you, nobody wants to hire 190 00:08:15,638 --> 00:08:17,938 a one-handed carpenter. 191 00:08:17,974 --> 00:08:20,514 - All right, man, so we got it out. - [Brian] I like you, dude. 192 00:08:20,543 --> 00:08:22,113 [George Crawford] Dude, I appreciate it. 193 00:08:22,145 --> 00:08:25,015 You made me feel comfortable, you know, you’re a good dude. 194 00:08:25,048 --> 00:08:26,858 Dr. Crawford’s a really cool guy. 195 00:08:26,883 --> 00:08:29,453 He came in, cutting up, made the mood, 196 00:08:29,485 --> 00:08:31,525 you know, lightened the mood a little bit. 197 00:08:31,554 --> 00:08:33,654 Uh, I liked him right off the bat. 198 00:08:33,689 --> 00:08:34,889 [George Crawford] It’s all gone. 199 00:08:34,924 --> 00:08:37,294 We got the barbs out and everything, it’s not bleeding. 200 00:08:37,326 --> 00:08:40,266 You just put Neosporin on it and, uh, you’ll feel a lot better. 201 00:08:40,296 --> 00:08:41,766 - That’s good. - [George Crawford] All right. 202 00:08:41,798 --> 00:08:43,438 - Get some rest and we’ll, uh... - I love you. 203 00:08:43,466 --> 00:08:44,666 [George Crawford] Love you too, man. 204 00:08:44,700 --> 00:08:47,170 I’m extremely safe with nail guns now. 205 00:08:47,203 --> 00:08:49,273 I always make sure the nail gun is never 206 00:08:49,305 --> 00:08:50,475 pointed towards me. 207 00:08:50,506 --> 00:08:53,476 I always make sure it’s pointed away from me. 208 00:08:53,509 --> 00:08:55,439 I want to be as safe as possible with it 209 00:08:55,478 --> 00:08:57,318 because I don’t want to shoot myself in the arm again. 210 00:08:57,346 --> 00:08:58,516 [chuckles] 211 00:09:02,085 --> 00:09:03,625 [Daniel] He actually kind of felt something 212 00:09:03,653 --> 00:09:04,883 flopping around in his nose. 213 00:09:04,921 --> 00:09:06,351 You hear that, you automatically think 214 00:09:06,389 --> 00:09:07,889 he’s got some nasal polyps, which he did. 215 00:09:07,924 --> 00:09:09,294 This is the main one. 216 00:09:09,325 --> 00:09:12,165 There’s basically a little vacuum that pulls the polyps out. 217 00:09:12,195 --> 00:09:13,495 Uh, here it is. 218 00:09:13,896 --> 00:09:15,336 Wow. 219 00:09:15,364 --> 00:09:17,334 That is just cool. Look at that. [chuckles] 220 00:09:18,868 --> 00:09:20,208 It just keeps coming. 221 00:09:32,181 --> 00:09:33,581 You know, the valium kind of hits 222 00:09:33,616 --> 00:09:34,816 and you feel a little bit tired, 223 00:09:34,851 --> 00:09:36,721 that’s kind of the point of it, you know? 224 00:09:37,253 --> 00:09:38,683 I’m Dr. Dan Carothers. 225 00:09:38,721 --> 00:09:41,191 I’m an ear, nose and throat physician 226 00:09:41,224 --> 00:09:43,024 at, uh, ENT Institute. 227 00:09:43,059 --> 00:09:44,689 So my next patient is Tony, 228 00:09:44,727 --> 00:09:46,997 he’s had a long history of problems 229 00:09:47,029 --> 00:09:48,589 breathing through his nose, and just recently 230 00:09:48,631 --> 00:09:49,701 it’s gotten a lot worse. 231 00:09:49,732 --> 00:09:51,202 He’s lost his ability to smell 232 00:09:51,234 --> 00:09:53,374 and he’s getting a lot of sinus infections, 233 00:09:53,402 --> 00:09:54,832 and he actually kind of felt something 234 00:09:54,871 --> 00:09:56,671 flopping around in his nose. 235 00:09:56,706 --> 00:09:59,176 Prior to the plan for any procedure coming together, 236 00:09:59,208 --> 00:10:00,908 you need to get a CAT scan of the sinuses. 237 00:10:00,943 --> 00:10:02,273 And what we’re looking at here 238 00:10:02,311 --> 00:10:05,211 are views of the face, kind of front to back, 239 00:10:05,248 --> 00:10:06,758 like your head’s a loaf of bread, 240 00:10:06,782 --> 00:10:08,612 and these are called coronal views. 241 00:10:08,651 --> 00:10:11,021 Coming further back in, you can see the beginning 242 00:10:11,053 --> 00:10:12,283 of where the polyp is, 243 00:10:12,321 --> 00:10:15,121 which is right here and sort of starts up in this area, 244 00:10:15,158 --> 00:10:17,198 near what’s called the uncinate process. 245 00:10:17,226 --> 00:10:19,366 This polyp is going all the way from his eye, 246 00:10:19,395 --> 00:10:20,935 all the way down to the bottom of his nose, 247 00:10:20,963 --> 00:10:23,933 and actually is hanging sort of back into the nose. 248 00:10:23,966 --> 00:10:26,436 There’s almost sort of like a glacial growth 249 00:10:26,469 --> 00:10:29,569 where it’s just very gradually they’ll start heading down 250 00:10:29,605 --> 00:10:32,945 into the nose and will just keep going forever. 251 00:10:32,975 --> 00:10:35,945 The polyps will literally come out of your nose. 252 00:10:35,978 --> 00:10:37,778 I saw a patient one time 253 00:10:37,813 --> 00:10:39,813 that the polyps had gotten so large 254 00:10:39,849 --> 00:10:42,549 it looked like he had two little hot dogs coming down 255 00:10:42,585 --> 00:10:44,225 on either side of his nose, 256 00:10:44,253 --> 00:10:46,393 uh, and he had never had them removed. 257 00:10:46,422 --> 00:10:48,122 So getting those out is critical. 258 00:10:49,258 --> 00:10:51,658 All right, let’s, uh, just take a look in here. 259 00:10:53,596 --> 00:10:56,066 So, you know, when you look inside the nose on the left side, 260 00:10:56,098 --> 00:10:58,328 you’ve got what’s called the septum, that’s the dividing wall. 261 00:10:58,367 --> 00:10:59,807 The structure there is called a turbinate, 262 00:10:59,835 --> 00:11:01,075 it’s a little bit enlarged. 263 00:11:01,103 --> 00:11:02,503 And as you can see here, 264 00:11:02,538 --> 00:11:04,498 there’s a polyp here, sort of hanging down, 265 00:11:05,541 --> 00:11:06,971 that’s extending way back in, 266 00:11:07,009 --> 00:11:09,109 and that was just flopping back and forth, 267 00:11:09,145 --> 00:11:12,345 and, you know, you can feel that there’s another little polyp right there. 268 00:11:12,381 --> 00:11:15,951 So he’s got, kind of, a couple little polyps here. 269 00:11:15,985 --> 00:11:17,555 We’ll sort of get all those out. 270 00:11:18,554 --> 00:11:19,924 Okay. 271 00:11:19,956 --> 00:11:21,926 We start out with just a little bit of, um, 272 00:11:21,958 --> 00:11:23,328 numbing decongestant. 273 00:11:23,359 --> 00:11:26,529 This has just a little bit of epinephrine and some lidocaine, okay? 274 00:11:26,562 --> 00:11:28,262 In addition to numbing his nose, 275 00:11:28,297 --> 00:11:30,837 we’ve also applied a powerful decongestant 276 00:11:30,866 --> 00:11:33,106 that prevents it from bleeding during the procedure 277 00:11:33,135 --> 00:11:35,805 as well as afterward, and, uh, he won’t feel anything 278 00:11:35,838 --> 00:11:37,168 as we take the polyps out. 279 00:11:37,206 --> 00:11:39,976 All right, sir. [sighs] We’re gonna just sort of get started here. 280 00:11:40,009 --> 00:11:42,169 We also cover the eyes because we have 281 00:11:42,211 --> 00:11:43,711 metal instruments in front of the face, 282 00:11:43,746 --> 00:11:44,946 so it’s sort of protection, 283 00:11:44,981 --> 00:11:46,711 and it’s also relaxing for patients 284 00:11:46,749 --> 00:11:49,009 when you’re coming at them with, uh, instruments 285 00:11:49,051 --> 00:11:51,181 that are metal and graspers and things like that. 286 00:11:51,220 --> 00:11:52,450 It’s a little bit scary. 287 00:11:52,488 --> 00:11:55,018 - I am going to get this one polyp out first. - [Tony] Okay. 288 00:11:58,694 --> 00:12:01,164 And that’s attached just right there in that little stalk, 289 00:12:01,197 --> 00:12:04,367 and we’ll just sort of... remove this guy right from here. 290 00:12:14,877 --> 00:12:17,447 So there’s a... There’s one of the polyps right there. 291 00:12:18,447 --> 00:12:20,517 And maybe just get this one other one here. 292 00:12:25,955 --> 00:12:27,925 And this is the main one 293 00:12:27,957 --> 00:12:30,427 that he could feel flopping back and forth. 294 00:12:30,459 --> 00:12:33,729 It’s not a growth, it’s just inflammatory swelling. 295 00:12:33,763 --> 00:12:35,933 That is something you can get throughout your sinuses. 296 00:12:35,965 --> 00:12:38,535 Nasal polyps are a genetic condition, 297 00:12:38,567 --> 00:12:41,277 and it involves exposure to things in the air. 298 00:12:41,304 --> 00:12:45,074 When we breathe in, we’re breathing in mold spores, 299 00:12:45,107 --> 00:12:48,277 uh, pollen and things that are irritating to the sinus lining. 300 00:12:48,311 --> 00:12:50,281 And polyps really just begin 301 00:12:50,313 --> 00:12:53,283 as just a puffiness of the membranes inside the nose. 302 00:12:53,316 --> 00:12:55,386 You’re gonna hear, sort of, like a dentist instrument 303 00:12:55,418 --> 00:12:57,388 to get out the rest of the polyps. 304 00:12:57,420 --> 00:13:00,720 There’s basically a little vacuum that pulls the polyps out. 305 00:13:06,262 --> 00:13:07,292 Okay. 306 00:13:12,768 --> 00:13:14,128 You all right? 307 00:13:17,973 --> 00:13:20,143 And it sort of just vacuums it right up 308 00:13:20,810 --> 00:13:22,540 through this attachment. 309 00:13:22,578 --> 00:13:24,638 All right, let’s see the, uh, balloon. 310 00:13:27,116 --> 00:13:30,226 We get those polyps out, that’s gonna open up his passages, 311 00:13:30,252 --> 00:13:31,952 but the next part of the procedure, 312 00:13:31,987 --> 00:13:33,497 we’re gonna use a little balloon 313 00:13:33,522 --> 00:13:35,392 to permanently open those sinuses. 314 00:13:35,424 --> 00:13:38,124 You can kind of slide it where it needs to be. 315 00:13:38,160 --> 00:13:41,160 You fill it with water and it cracks the bones open, 316 00:13:41,197 --> 00:13:43,567 healing them in a new position to allow, 317 00:13:43,599 --> 00:13:46,099 uh, that constant mucus that’s being produced 318 00:13:46,135 --> 00:13:48,235 to drain out appropriately. 319 00:13:48,270 --> 00:13:50,370 All right, go ahead and inflate. 320 00:13:57,346 --> 00:13:59,256 All right. Looking good. 321 00:13:59,281 --> 00:14:00,451 Here you go. 322 00:14:00,483 --> 00:14:02,983 So, what we’re going to do next is, we’re gonna, um, 323 00:14:03,018 --> 00:14:04,948 irrigate the left cheek sinus. 324 00:14:04,987 --> 00:14:07,527 - There was some fluid that had built up in here, okay? - [Tony] Oh, okay. 325 00:14:07,556 --> 00:14:09,026 [Daniel] Tony has several problems, 326 00:14:09,058 --> 00:14:10,468 one of which is the polyps. 327 00:14:10,493 --> 00:14:13,763 The other is that his sinus on the left cheek side, 328 00:14:13,796 --> 00:14:15,136 uh, has failed to drain. 329 00:14:15,164 --> 00:14:17,604 He just has a ball of sort of jelly mucus 330 00:14:17,633 --> 00:14:20,033 that’s just stuck there, and it’s just never gonna come out 331 00:14:20,069 --> 00:14:21,869 unless we remove it. 332 00:14:21,904 --> 00:14:24,274 This device we use is, uh, called a cyclone, 333 00:14:24,306 --> 00:14:26,816 it basically has a irrigation and a suction. 334 00:14:29,478 --> 00:14:30,738 Oh, here it is. 335 00:14:32,047 --> 00:14:34,687 So there’s that liq... liquid we were trying to get out, 336 00:14:34,717 --> 00:14:36,157 uh, it’s beside of mucus. 337 00:14:36,185 --> 00:14:38,355 This cyclone device is fantastic. 338 00:14:38,387 --> 00:14:41,027 In years past, we would literally take 339 00:14:41,056 --> 00:14:44,566 a metal tube that was hollow and a hammer 340 00:14:44,593 --> 00:14:47,233 and just hammer it into the sidewall of the nose. 341 00:14:47,263 --> 00:14:49,403 You would attach a little irrigation device 342 00:14:49,432 --> 00:14:51,362 and then you would just ram some saline in there, 343 00:14:51,400 --> 00:14:54,330 and it would come rushing out of the sinus into their mouth 344 00:14:54,370 --> 00:14:56,670 and they would have to spit it into a bowl. 345 00:14:56,705 --> 00:14:57,905 [Tony] Yeah, I can hear it. 346 00:14:57,940 --> 00:14:59,540 [Daniel] That just stuck in your sinuses. 347 00:14:59,575 --> 00:15:01,675 Yeah, we’re gonna... And it’s not infection, 348 00:15:01,710 --> 00:15:05,510 it’s just, it’s just thickened and it’s just really tenuous and... 349 00:15:05,548 --> 00:15:06,618 [Tony] Hmm. 350 00:15:08,017 --> 00:15:10,327 This is never gonna come out on its own. 351 00:15:10,352 --> 00:15:11,452 Wait, let’s... 352 00:15:12,521 --> 00:15:14,751 Here we go. Wow, that is just... 353 00:15:16,892 --> 00:15:18,762 That is just cool, look at that. 354 00:15:19,261 --> 00:15:20,891 [chuckles] 355 00:15:20,930 --> 00:15:22,360 It just keeps coming. 356 00:15:23,632 --> 00:15:25,902 So what he had going on was this mucus 357 00:15:25,935 --> 00:15:28,405 was literally stuck there who knows how long. 358 00:15:28,437 --> 00:15:30,777 I’m thinking, you know, probably months to years. 359 00:15:30,806 --> 00:15:32,606 And man, when that started to come out, 360 00:15:32,641 --> 00:15:34,771 it was too thick for even the suction. 361 00:15:34,810 --> 00:15:36,610 It, it was just like the slime 362 00:15:36,645 --> 00:15:38,745 that kids, uh, will make at home. 363 00:15:38,781 --> 00:15:42,381 I was able to get that out in sort of one, big, gooey ball. 364 00:15:42,418 --> 00:15:45,588 And, you know, just getting that out was incredibly satisfying. 365 00:15:45,621 --> 00:15:47,551 And, you know, it’s no longer stuck, 366 00:15:47,590 --> 00:15:48,620 so he’s going to feel great. 367 00:15:48,891 --> 00:15:50,421 Wow. 368 00:15:50,459 --> 00:15:51,619 And that’s the end of it. 369 00:15:51,660 --> 00:15:54,490 - It usually is all attached in one glob. - [Tony] Hmm. 370 00:15:55,798 --> 00:15:57,368 So I don’t think there’s any more, 371 00:15:57,399 --> 00:15:58,899 and that’s all she wrote. 372 00:15:58,934 --> 00:16:00,204 [Tony] Oh, my goodness. 373 00:16:00,236 --> 00:16:02,206 - Nice job. - Thank you. 374 00:16:02,238 --> 00:16:04,748 - [Daniel] You did great. - You did great. 375 00:16:04,773 --> 00:16:06,373 Any time you have obstruction, 376 00:16:06,408 --> 00:16:07,708 you can’t just assume it’s a polyp, 377 00:16:07,743 --> 00:16:08,873 you need to get it checked out. 378 00:16:08,911 --> 00:16:10,711 There are certain types of masses 379 00:16:10,746 --> 00:16:12,286 that are called papillomas. 380 00:16:12,314 --> 00:16:14,714 This type of polyp has a chance 381 00:16:14,750 --> 00:16:17,280 of turning into cancer at some point in your life. 382 00:16:17,319 --> 00:16:19,489 Inverted papillomas can be quite serious 383 00:16:19,522 --> 00:16:21,892 and have to be surgically removed. 384 00:16:21,924 --> 00:16:25,224 This dressing is just in case, uh, things drip a little bit. 385 00:16:25,261 --> 00:16:26,731 Let me get you out of here, okay? 386 00:16:26,762 --> 00:16:28,462 Like all polyp patients, 387 00:16:28,497 --> 00:16:30,667 Tony is at risk of polyp recurrence, 388 00:16:30,699 --> 00:16:32,799 but as long as he keeps coming back 389 00:16:32,835 --> 00:16:35,475 and he does his topical nasal steroid sprays, 390 00:16:35,504 --> 00:16:36,844 I think he’ll be just great. 391 00:16:36,872 --> 00:16:40,112 [Tony speaking] 392 00:16:41,610 --> 00:16:42,840 - Yeah. - [Tony speaking] 393 00:16:42,878 --> 00:16:44,608 - It’s not so bad, is it? - [Tony] No. 394 00:16:44,647 --> 00:16:46,687 From a breathing perspective and just generally 395 00:16:46,715 --> 00:16:48,355 feeling better, his sense of smell, 396 00:16:48,384 --> 00:16:50,854 I think he’s going to be super happy and, uh, 397 00:16:50,886 --> 00:16:52,856 and we’ll see how things go over the next few weeks. 398 00:17:00,863 --> 00:17:03,033 [nurse 2] And what are we seeing you guys for today? 399 00:17:03,065 --> 00:17:05,365 [Leneetha] She has a bead in her ear. 400 00:17:05,401 --> 00:17:07,001 [nurse 2] How long has it been in there? 401 00:17:07,036 --> 00:17:09,476 The child usually doesn’t want to acknowledge it 402 00:17:09,505 --> 00:17:10,945 ’cause they don’t want to talk about 403 00:17:10,973 --> 00:17:12,343 how that object got there. 404 00:17:12,374 --> 00:17:14,044 - [nurse 2] Okay. - [Leneetha] You’re doing so good. 405 00:17:14,076 --> 00:17:16,646 From the looks of it, it’s been in there for a while. 406 00:17:39,501 --> 00:17:41,401 - Hey! Good evening. - Hi. 407 00:17:41,437 --> 00:17:45,807 I’m Taliyah and I’m six years old. 408 00:17:45,841 --> 00:17:48,311 - [nurse 2] Hey, Taliyah. - [Leneetha] Yes. 409 00:17:48,344 --> 00:17:50,184 She has a bead stuck in her ear. 410 00:17:51,013 --> 00:17:52,413 [producer speaking] 411 00:17:52,848 --> 00:17:53,848 A bead. 412 00:17:56,185 --> 00:17:59,025 We’ll get you all set, okay, and they’ll come right up for you. 413 00:17:59,054 --> 00:18:00,824 - Okay, thank you. - Thank you. 414 00:18:00,856 --> 00:18:03,666 A bead of a beanbag for my sister, 415 00:18:03,692 --> 00:18:06,792 it went in my ear, so I tried to get it out. 416 00:18:08,063 --> 00:18:09,503 - Taliyah? - [Leneetha] Yes. 417 00:18:09,531 --> 00:18:11,331 - You’re ready? - [Leneethat] Yes, we’re ready. You ready? 418 00:18:11,367 --> 00:18:13,077 - You’re ready? - [nurse 2] Right this way. 419 00:18:13,102 --> 00:18:14,502 [Leneetha] Thank you. 420 00:18:14,536 --> 00:18:16,606 Gonna go right this way. Okay. 421 00:18:17,806 --> 00:18:19,946 [nurse 2] Have a seat in the big chair for me, Taliyah. 422 00:18:19,975 --> 00:18:21,475 [Leneetha] Big girl chair. 423 00:18:23,445 --> 00:18:25,615 [nurse 2] And what are we seeing you guys for today? 424 00:18:25,648 --> 00:18:27,858 [Leneetha] She has a bead in her ear. 425 00:18:27,883 --> 00:18:29,113 [nurse 2] Which ear? 426 00:18:29,151 --> 00:18:30,621 It’s the right ear. 427 00:18:30,653 --> 00:18:32,853 - [nurse 2] Does it hurt? - Uh-huh. 428 00:18:32,888 --> 00:18:34,048 [nurse 2] Okay, good. 429 00:18:34,089 --> 00:18:35,819 How long has it been in there? 430 00:18:39,962 --> 00:18:41,862 [chuckles] 431 00:18:41,897 --> 00:18:45,037 From the looks of it, it’s been in there for a while, 432 00:18:45,067 --> 00:18:49,077 because we haven’t had a beanbag in months. 433 00:18:51,974 --> 00:18:53,614 Mmm-hmm? 434 00:18:53,642 --> 00:18:56,912 All right. Well, I’m gonna go get Dr. Livermore. Okay? 435 00:18:56,945 --> 00:18:58,615 - [Taliyah] Okay. - [nurse 2] He’ll be right in. 436 00:18:58,647 --> 00:19:00,217 [Leneetha] Thank you. 437 00:19:00,249 --> 00:19:01,709 [nurse 2] All right, Dr. Livermore. 438 00:19:01,750 --> 00:19:03,820 It’s in her right ear. 439 00:19:03,852 --> 00:19:05,652 Is your heart beating fast? 440 00:19:05,688 --> 00:19:06,998 Mine is too. 441 00:19:07,022 --> 00:19:08,822 Mom said she just found out about this 442 00:19:08,857 --> 00:19:10,367 - three days ago. - [George Livermore] Okay. 443 00:19:10,392 --> 00:19:13,332 [George Livermore] I’m George Livermore, ear, nose and throat doctor. 444 00:19:13,362 --> 00:19:16,332 I’ve been doing this for 32 years. 445 00:19:16,365 --> 00:19:18,665 - [George Livermore] Hey! I’m Doctor Livermore. - Hi. How are you doing? 446 00:19:18,701 --> 00:19:21,731 In terms of kids and foreign objects, 447 00:19:21,770 --> 00:19:25,240 it’s very common for those objects to be there for quite a while. 448 00:19:25,274 --> 00:19:27,844 The child usually doesn’t wanna acknowledge it 449 00:19:27,876 --> 00:19:30,746 ’cause they don’t want to talk about how that object got there. 450 00:19:30,779 --> 00:19:33,279 Oh, okay, let’s see. Oh, yeah. 451 00:19:33,315 --> 00:19:35,155 - [Leneetha] It’s right there. - [George Livermore] Yeah. 452 00:19:36,218 --> 00:19:38,118 Now I’m gonna look over on this side, okay? 453 00:19:38,153 --> 00:19:39,423 Two ears, two looks. 454 00:19:39,455 --> 00:19:42,925 When you’re looking at kids and trying to reassure them, 455 00:19:42,958 --> 00:19:45,988 it’s what your persona puts off. 456 00:19:46,028 --> 00:19:48,038 I try to speak very softly, 457 00:19:48,063 --> 00:19:49,263 I tell them it’s gonna be okay. 458 00:19:49,298 --> 00:19:50,868 [George Livermore] Okay, baby doll. 459 00:19:50,899 --> 00:19:53,269 - You’re gonna stay real still for Dr. Livermore. - [Leneetha] Um, really still. 460 00:19:53,302 --> 00:19:55,302 - [nurse 2] Real still, okay? - [George Livermore] Guess what? 461 00:19:55,337 --> 00:19:56,847 You just yell at me if it hurts. 462 00:19:56,872 --> 00:19:58,872 [Leneetha] If it hurts you say, "Ouch." 463 00:19:58,907 --> 00:20:02,177 The strangest thing I ever got out of a child’s orifice though, 464 00:20:02,211 --> 00:20:05,181 was the arm of, like, a little doll 465 00:20:05,214 --> 00:20:06,714 and it was stuck up in her nose. 466 00:20:06,749 --> 00:20:08,449 [George Livermore] You know what this looks like? 467 00:20:08,484 --> 00:20:09,954 [Leneetha] What does it look like? 468 00:20:09,985 --> 00:20:11,455 [George Livermore] This looks like popcorn. 469 00:20:11,487 --> 00:20:13,857 - Could it be popcorn? - [Leneetha] Popcorn in her ear? 470 00:20:13,889 --> 00:20:15,389 [nurse 2] Did you put popcorn in your ear? 471 00:20:15,424 --> 00:20:16,964 - [Taliyah] No. It’s a bead. - [George Livermore] No? 472 00:20:16,992 --> 00:20:18,462 - It’s a bead-- - From a beanbag. 473 00:20:18,494 --> 00:20:20,794 - Yeah, from a beanbag. - [George Livermore] There’s a piece of bead. 474 00:20:20,829 --> 00:20:21,689 It’s coming out. 475 00:20:21,730 --> 00:20:23,060 You just got to hold real still, okay? 476 00:20:23,098 --> 00:20:24,558 - You’re doing so good. - [Taliyah] Okay. 477 00:20:24,600 --> 00:20:25,900 The length of time that 478 00:20:25,934 --> 00:20:28,974 a foreign body is in a, a cavity, 479 00:20:29,004 --> 00:20:30,404 especially in the ear, 480 00:20:30,439 --> 00:20:32,969 wax will accumulate around it and over time, 481 00:20:33,008 --> 00:20:35,408 you will eventually get a wax impaction or, 482 00:20:35,444 --> 00:20:38,044 you know, you won’t be able to hear very well at all. 483 00:20:39,014 --> 00:20:41,354 - [Taliyah groans] - [nurse 2] Can you hear it? 484 00:20:41,383 --> 00:20:42,983 [Taliyah] Yeah. 485 00:20:43,018 --> 00:20:46,818 [Livermore] I need a little suction just to get all that liquid out of there. 486 00:20:46,855 --> 00:20:48,695 You just have to look at me in the eyes. 487 00:20:48,724 --> 00:20:51,064 We’re almost done. 488 00:20:51,093 --> 00:20:53,663 [George Livermore] Okay, I think it’s coming. 489 00:20:53,695 --> 00:20:55,835 - [Leneetha] Here we go. Look at that. - [Taliyah laughing] 490 00:20:55,864 --> 00:20:58,234 - [Leneetha] Oh, my God. Oh, my God. - [Taliyah continues laughing] 491 00:20:58,867 --> 00:21:00,077 [Leneetha] Oh, my God. 492 00:21:01,537 --> 00:21:03,207 I think I want to cry now. 493 00:21:03,238 --> 00:21:04,698 He did a good job. 494 00:21:04,740 --> 00:21:05,900 Great. 495 00:21:05,941 --> 00:21:07,541 - Thank you, Dr. Livermore. - [George Livermore] Come here. 496 00:21:07,576 --> 00:21:08,716 [Taliyah] Thank you. 497 00:21:08,744 --> 00:21:10,284 [Leneetha chuckles] 498 00:21:10,312 --> 00:21:11,482 Okay. 499 00:21:11,513 --> 00:21:13,513 [George Livermore] Don’t put anything else in your ears. 500 00:21:13,549 --> 00:21:15,079 Sometimes they’re not that easy to get out. 501 00:21:15,117 --> 00:21:17,587 [Taliyah speaking] 502 00:21:17,619 --> 00:21:18,779 [George Livermore laughs] 503 00:21:18,821 --> 00:21:21,421 Just don’t do it. Just say no. 504 00:21:21,456 --> 00:21:22,596 [George Livermore] Just say no. 505 00:21:22,624 --> 00:21:24,364 [laughs] 506 00:21:24,393 --> 00:21:27,733 When you’re successful at removing a foreign body 507 00:21:27,763 --> 00:21:29,593 from a child and the child is happy 508 00:21:29,631 --> 00:21:30,931 and you haven’t hurt them, 509 00:21:30,966 --> 00:21:33,206 I felt like I’ve done my thing that day. 510 00:21:33,235 --> 00:21:34,935 I mean, it’s my thing, you know. 511 00:21:34,970 --> 00:21:37,270 [Taliyah] Never, ever do that again. 512 00:21:37,306 --> 00:21:40,146 So that’s why we’re throwing all the beads away. 513 00:21:40,175 --> 00:21:41,415 [Leneetha] Yes, we are. 514 00:21:47,249 --> 00:21:49,209 [knocks on door] 515 00:21:49,251 --> 00:21:52,251 [Lynn] Hello, Miss Cochran. Okay, we’re ready? 516 00:21:52,287 --> 00:21:53,597 - Yes, ma’am. - [Lynn] Yeah. 517 00:21:53,622 --> 00:21:56,052 So I’ll get some gloves on here. 518 00:21:56,091 --> 00:21:57,461 My name is Susan Cochran 519 00:21:57,492 --> 00:22:00,032 and I’m here for the earwax in my left ear. 520 00:22:00,996 --> 00:22:02,966 [Lynn] So we’ll show you the normal ear first 521 00:22:02,998 --> 00:22:04,068 so you can see what that looks like, 522 00:22:04,099 --> 00:22:05,999 and then we’ll pop over to the other side. 523 00:22:06,034 --> 00:22:08,634 Susan’s coming in because she hasn’t been able to hear 524 00:22:08,670 --> 00:22:10,640 out of her left ear for the last several weeks. 525 00:22:10,672 --> 00:22:12,502 She saw her primary care doctor, 526 00:22:12,541 --> 00:22:15,941 who told her that she had a lot of wax built up inside her ears. 527 00:22:15,978 --> 00:22:18,288 She’s tried various different home remedies 528 00:22:18,313 --> 00:22:20,583 and hasn’t been able to get any relief. 529 00:22:20,616 --> 00:22:21,986 Now, so you can see your eardrum, 530 00:22:22,017 --> 00:22:23,987 it looks nice and healthy inside, 531 00:22:24,019 --> 00:22:25,519 so that’s a perfect looking ear. 532 00:22:25,554 --> 00:22:27,954 Now we’ll move over to the other side. 533 00:22:27,990 --> 00:22:29,920 Every day at the ENT Institute, 534 00:22:29,958 --> 00:22:32,588 I see something that’s stuck in patients’ ears. 535 00:22:32,628 --> 00:22:34,468 Most of the time it’s wax, 536 00:22:34,496 --> 00:22:37,036 but sometimes we see something else in the ear 537 00:22:37,065 --> 00:22:38,605 that’s not supposed to be there. 538 00:22:38,634 --> 00:22:40,104 My name is Brandon Elias. 539 00:22:40,135 --> 00:22:42,875 I lodged a cotton swab in my left ear this morning, 540 00:22:42,905 --> 00:22:44,475 uh, as I was cleaning my ears out. 541 00:22:44,506 --> 00:22:46,776 [Daniel] Our next patient today is Mrs. Stokes, 542 00:22:46,808 --> 00:22:49,138 and she has a dome of a hearing aid 543 00:22:49,177 --> 00:22:50,517 that is wedged in her ear. 544 00:22:50,545 --> 00:22:52,685 All right, let’s take a look here first. 545 00:22:52,714 --> 00:22:54,214 My name is Josephine, 546 00:22:54,249 --> 00:22:56,619 and I basically got something stuck in my ear. 547 00:22:56,652 --> 00:22:58,352 I felt a bug go into my ear, 548 00:22:58,387 --> 00:23:00,157 and I was trying to get it out, 549 00:23:00,188 --> 00:23:01,648 - but I just couldn’t. - Yeah. 550 00:23:01,690 --> 00:23:05,160 Sometimes patients know that they have something stuck in their ear, 551 00:23:05,193 --> 00:23:07,363 but other times they have no idea. 552 00:23:07,396 --> 00:23:10,836 [Mrs. Stokes] Every time I put my hearing aid in my right ear, 553 00:23:10,866 --> 00:23:12,206 it would fall out 554 00:23:12,234 --> 00:23:14,804 and it would hurt a little bit when I push it in there. 555 00:23:14,836 --> 00:23:17,806 I didn’t know it was stuck in my ear until today. 556 00:23:17,839 --> 00:23:20,169 I could hear the cotton just kind of stick, 557 00:23:20,208 --> 00:23:22,538 and I immediately looked and saw that the stick 558 00:23:22,577 --> 00:23:24,417 had no cotton swab on it at all. 559 00:23:24,446 --> 00:23:27,156 I could feel something against my ear 560 00:23:27,182 --> 00:23:29,312 and I went to swat it away 561 00:23:29,351 --> 00:23:30,851 and it just went in my ear. 562 00:23:30,886 --> 00:23:34,356 It’s been weird ’cause I haven’t been able to hear. 563 00:23:34,389 --> 00:23:35,819 It’s been real muffled. 564 00:23:35,857 --> 00:23:38,227 But when I go to sleep, I can’t hear nothing, 565 00:23:38,260 --> 00:23:40,060 it goes totally silent. 566 00:23:40,095 --> 00:23:42,895 I could feel it in my ear. I could hear a noise. 567 00:23:42,931 --> 00:23:45,161 It was just not the best feeling. 568 00:23:45,200 --> 00:23:47,570 To best describe it would be, 569 00:23:47,602 --> 00:23:49,942 if you’re going down the road and the vehicle 570 00:23:49,972 --> 00:23:53,242 has the windows open and you hear the noise of the wind, 571 00:23:53,275 --> 00:23:55,875 it was like windy inside of my ear. 572 00:23:55,911 --> 00:23:58,341 It’s very important to listen to my patients’ symptoms 573 00:23:58,380 --> 00:24:00,750 before I start any sort of procedure. 574 00:24:00,782 --> 00:24:03,552 So specifically, I want to know what their symptoms are, 575 00:24:03,585 --> 00:24:05,925 so whether it’s pain, it’s pressure, 576 00:24:05,954 --> 00:24:08,754 it’s muffled hearing, because that tells me what to look for, 577 00:24:08,790 --> 00:24:11,220 what to watch out for while I’m doing the procedure. 578 00:24:11,259 --> 00:24:13,959 [doctor] We have this little camera here and that’ll show us 579 00:24:13,996 --> 00:24:15,896 what your cotton swab looks like. 580 00:24:15,931 --> 00:24:17,961 You can see there’s some blood 581 00:24:18,000 --> 00:24:20,770 - from the attempt that you and your wife made. - [Brandon chuckles] 582 00:24:20,802 --> 00:24:22,872 - There is the cotton swab. - [Brandon] Oh, wow. 583 00:24:22,904 --> 00:24:24,774 [docor] It’s blocking pretty much the whole canal, 584 00:24:24,806 --> 00:24:26,406 so that’s why you have some muffled hearing 585 00:24:26,441 --> 00:24:27,771 and some clogged feeling. 586 00:24:27,809 --> 00:24:31,309 [Daniel] So this is the right external meatus or canal, 587 00:24:31,346 --> 00:24:35,516 and you can see this dome is wedged sideways pretty far in. 588 00:24:36,651 --> 00:24:39,891 It is relatively close to the eardrums now, 589 00:24:39,921 --> 00:24:41,921 and so it’ll, it’ll be a little bit loud. 590 00:24:41,957 --> 00:24:44,467 [Lynn] So this is what’s in this side. 591 00:24:44,493 --> 00:24:45,593 That’s nasty. 592 00:24:45,627 --> 00:24:47,437 [Lynn] So it looks like some wax. 593 00:24:47,462 --> 00:24:49,392 Hold on, looks like there’s something else 594 00:24:49,431 --> 00:24:50,731 further back in here. 595 00:24:50,766 --> 00:24:52,836 Looks like the head of a cotton swab. 596 00:24:52,868 --> 00:24:54,608 This is what cotton swabs look like 597 00:24:54,636 --> 00:24:56,776 after they’ve been stuck in the ear for a while, 598 00:24:56,805 --> 00:24:59,645 and it’s had time to mix with some earwax as well. 599 00:24:59,674 --> 00:25:02,074 So once we pull it out, we’ll be able to see 600 00:25:02,110 --> 00:25:03,910 exactly what that is inside. 601 00:25:03,945 --> 00:25:06,015 No matter what it is or how it got there, 602 00:25:06,048 --> 00:25:07,788 either way, we have to get it out. 603 00:25:07,816 --> 00:25:10,356 We always try to do that without causing too much pain. 604 00:25:12,788 --> 00:25:15,358 [Daniel] Okay, you might feel a little bit of a pinch here. 605 00:25:15,390 --> 00:25:17,990 - [Mrs. Stokes] Ouch. Ooh. - [Daniel] Sorry. 606 00:25:18,026 --> 00:25:20,296 It’s really, it’s really stuck in there. 607 00:25:20,328 --> 00:25:21,658 [Mrs. Stokes] Ooh. 608 00:25:21,696 --> 00:25:25,366 - [Lynn] So this should not hurt at all. - Oh. 609 00:25:25,400 --> 00:25:27,130 And that’s coming out, right here. 610 00:25:27,169 --> 00:25:29,169 So this is our cotton ball. 611 00:25:29,204 --> 00:25:31,104 - [Susan] Ew! - [Lynn chuckles] 612 00:25:31,139 --> 00:25:33,869 [Susan] Oh, it’s so much better. 613 00:25:33,909 --> 00:25:35,909 - And there’s the cotton swab. - [Brandon] Wow. 614 00:25:38,647 --> 00:25:40,417 - [Daniel] And there we go. - [sighs] 615 00:25:41,716 --> 00:25:45,886 I feel much better, I can hear better with no hearing aid. 616 00:25:48,256 --> 00:25:50,396 [Eric] All right. Do you wanna take a look at it? 617 00:25:50,425 --> 00:25:52,495 No. What was it though? 618 00:25:52,527 --> 00:25:54,197 [Eric] It definitely is a bug. 619 00:25:54,229 --> 00:25:56,289 I think it’s probably a small cockroach. 620 00:25:56,331 --> 00:25:57,831 [Lynn] Okay. So let me take a look, 621 00:25:57,866 --> 00:25:59,206 make sure it’s all clear. 622 00:25:59,234 --> 00:26:01,374 Once the procedure is over, I take one final look 623 00:26:01,403 --> 00:26:04,073 in the ear just to make sure that the ear canal looks healthy 624 00:26:04,106 --> 00:26:05,306 and that we have everything. 625 00:26:05,340 --> 00:26:08,540 - All righty, and you can hear now, huh? - I can hear. 626 00:26:08,577 --> 00:26:10,317 Just like that, the patient’s good to go, 627 00:26:10,345 --> 00:26:12,245 it doesn’t need any further follow up, 628 00:26:12,280 --> 00:26:14,980 and it’s always a good story to tell friends and family. 629 00:26:15,016 --> 00:26:17,826 I can hear again and less pressure. 630 00:26:17,853 --> 00:26:19,183 It feels a lot better. 631 00:26:19,221 --> 00:26:21,721 [Lynn] So this is why in the ENT world we always say, 632 00:26:21,756 --> 00:26:24,896 "Never clean your ears with anything bigger than your elbow." 633 00:26:26,361 --> 00:26:27,631 Smaller than your elbow. 634 00:26:27,662 --> 00:26:30,362 Never clean your ears with anything smaller than your elbow. 635 00:26:30,398 --> 00:26:31,528 [chuckles] 636 00:26:34,136 --> 00:26:35,936 There’s this pleasant lady, 637 00:26:35,971 --> 00:26:39,041 she’s got a huge stiletto heel 638 00:26:39,074 --> 00:26:41,744 stuck smack into her face. 639 00:26:41,776 --> 00:26:43,546 [indistinct chatter] 640 00:26:57,993 --> 00:27:01,133 My 40 years of working in emergency departments, 641 00:27:01,163 --> 00:27:04,403 I’ve just seen a slew of different kind of bizarre things 642 00:27:04,432 --> 00:27:06,402 that people had stuck in them. 643 00:27:06,434 --> 00:27:08,704 Bows and arrows stuck in the extremity, 644 00:27:08,737 --> 00:27:11,307 stuck earrings, little kids will come in 645 00:27:11,339 --> 00:27:13,039 with hair tourniquets 646 00:27:13,074 --> 00:27:16,544 where their mother’s hair gets wrapped around the finger. 647 00:27:16,578 --> 00:27:20,158 Fishhooks are another nemesis for patients. 648 00:27:21,983 --> 00:27:26,453 I had a young lady one time with a pencil sticking out of her neck. 649 00:27:26,488 --> 00:27:29,958 Not crying, not upset, but with this large pencil 650 00:27:29,991 --> 00:27:31,791 just sticking out from her neck. 651 00:27:31,826 --> 00:27:34,496 And it’s not uncommon for little boys that are, 652 00:27:34,529 --> 00:27:37,099 uh, zipping up their pants that they’ll catch 653 00:27:37,132 --> 00:27:39,232 the foreskin of the penis in the zipper. 654 00:27:39,267 --> 00:27:42,307 That’s a challenge when it happens. 655 00:27:42,337 --> 00:27:46,917 One of the injuries that we see intermittently are, are nail gun injuries. 656 00:27:46,942 --> 00:27:49,112 Many times they’re just pulling these nails out 657 00:27:49,144 --> 00:27:51,114 and putting a little Bacitracin ointment 658 00:27:51,146 --> 00:27:54,316 and some gauze and some duct tape and going back to work. 659 00:27:54,349 --> 00:27:56,819 Then there are times, though, where that’s not gonna work. 660 00:27:56,851 --> 00:27:58,451 [man 1 speaking] 661 00:28:00,488 --> 00:28:02,518 [doctor] Can you straighten your finger? 662 00:28:02,557 --> 00:28:05,467 - Okay, okay. And you can feel me touching here? - [man 1] Yes, sir. 663 00:28:05,493 --> 00:28:06,993 [Larry] So one patient I had, 664 00:28:07,028 --> 00:28:09,488 a fairly large nail just go straight through the bone, 665 00:28:09,531 --> 00:28:11,601 and so our challenge was then, 666 00:28:11,633 --> 00:28:14,473 did it fracture the bone, is he going to get an infection? 667 00:28:14,502 --> 00:28:16,942 - [doctor] We’re going to do a digital block on this... - [Larry] Mmm-hmm. Yep. 668 00:28:16,972 --> 00:28:19,302 [Larry] ...and then we’ll get an x-ray after that. 669 00:28:19,341 --> 00:28:22,441 [Larry] These nails are not just the everyday nails, 670 00:28:22,477 --> 00:28:24,717 they actually have some wire looped around there 671 00:28:24,746 --> 00:28:27,686 and they can tear up tissues as they go in, 672 00:28:27,716 --> 00:28:30,056 and it definitely makes pulling them out harder. 673 00:28:45,900 --> 00:28:47,130 It’s out. 674 00:28:47,168 --> 00:28:48,728 What was most dramatic about it? 675 00:28:48,770 --> 00:28:51,470 You put the saline bottle right on the wound 676 00:28:51,506 --> 00:28:55,816 and you could see saline just squirting out the other side. 677 00:28:55,844 --> 00:28:59,014 And that means that was one heck of a hole. 678 00:29:02,417 --> 00:29:04,757 One of the more dramatic images that I have 679 00:29:04,786 --> 00:29:06,426 of things that were stuck in people, 680 00:29:06,454 --> 00:29:08,094 so I walked into the trauma room 681 00:29:08,123 --> 00:29:10,293 and there’s this pleasant lady 682 00:29:10,925 --> 00:29:12,395 laying on the gurney, 683 00:29:12,427 --> 00:29:16,197 she’s got a huge stiletto heel stuck, 684 00:29:16,231 --> 00:29:18,061 smack into her face. 685 00:29:18,099 --> 00:29:19,759 [indistinct chatter] 686 00:29:19,801 --> 00:29:22,131 [Michael speaking] 687 00:29:24,072 --> 00:29:25,742 She had been out with friends, 688 00:29:25,774 --> 00:29:28,614 there was an altercation between her and another lady, 689 00:29:28,643 --> 00:29:30,713 and unfortunately, as we found out, 690 00:29:30,745 --> 00:29:34,955 the stiletto heel can be a significant potential weapon. 691 00:29:34,983 --> 00:29:36,413 And so a lot of times you have to do 692 00:29:36,451 --> 00:29:38,481 procedural sedation to get that out. 693 00:29:41,790 --> 00:29:44,620 [Michael speaking] 694 00:29:46,828 --> 00:29:49,188 - Before it became loose. So you really had to... - [Michael speaking] 695 00:29:49,230 --> 00:29:50,760 You had to put a lot of tension 696 00:29:50,799 --> 00:29:52,729 - on that to pull that out. - [Michael speaking] 697 00:29:53,968 --> 00:29:55,528 [Larry] She was so lucky, though, 698 00:29:55,570 --> 00:29:57,340 in that there was minimal damage. 699 00:30:02,610 --> 00:30:05,640 In the ER, I get to see it all and get to do it all. 700 00:30:05,680 --> 00:30:09,250 You even get to remove bullets, in this case, a BB. 701 00:30:09,284 --> 00:30:12,654 Our patient who just arrived is a 17-year-old, 702 00:30:12,687 --> 00:30:15,497 who got shot in the face with a BB gun. 703 00:30:15,523 --> 00:30:18,063 Looks like it was more than just one shot. 704 00:30:18,093 --> 00:30:19,493 It looks like it was four, 705 00:30:19,527 --> 00:30:22,837 one very close to the eye right there, so yeah. 706 00:30:22,864 --> 00:30:24,334 We’re gonna have to extract them. 707 00:30:24,366 --> 00:30:27,506 I think there’s one BB still buried in the skin, 708 00:30:27,535 --> 00:30:29,935 it’s the one that’s closest to his eye. 709 00:30:29,971 --> 00:30:33,271 BB’s can potentially actually go through bone 710 00:30:33,308 --> 00:30:34,948 and go into the brain. 711 00:30:34,976 --> 00:30:38,986 I’m not 100 % sure how many BB’s are still in there, 712 00:30:39,013 --> 00:30:40,913 but I’m going to go ahead and get an x-ray, 713 00:30:40,949 --> 00:30:43,649 we’ll get a better idea after that, so. 714 00:30:48,456 --> 00:30:49,756 My name is Jeremiah. 715 00:30:49,791 --> 00:30:53,261 I’m 17, and I live in Mobile, Alabama. 716 00:30:53,294 --> 00:30:55,764 Me and my friend, we were just playing around, 717 00:30:55,797 --> 00:30:57,837 shooting a gun, we were having fun 718 00:30:57,866 --> 00:31:01,676 until they just started coming back at me. 719 00:31:01,703 --> 00:31:04,773 Shots hit my face and I hit the ground, 720 00:31:04,806 --> 00:31:06,946 blood was pouring down on my face. 721 00:31:06,975 --> 00:31:09,475 There was a BB stuck, like, right by my eye, 722 00:31:09,511 --> 00:31:11,841 and my mom was like, "Take him to the ER right now." 723 00:31:17,585 --> 00:31:19,885 [Larry] So basically, the BB’s outside, 724 00:31:19,921 --> 00:31:22,551 right up near the orbit, very close to the eye, 725 00:31:22,590 --> 00:31:24,690 and we have one lucky patient here. 726 00:31:24,726 --> 00:31:27,636 A lot of times if the BB is buried deep in the skin, 727 00:31:27,662 --> 00:31:29,662 you just leave it, you don’t go fishing for it, 728 00:31:29,697 --> 00:31:32,707 but the BB is sitting there relatively close to the surface. 729 00:31:32,734 --> 00:31:35,234 I’m basically going to get a magnet. 730 00:31:35,270 --> 00:31:39,070 I think that the BB’s are magnetic and we’ll see. 731 00:31:39,107 --> 00:31:41,417 One of the things that I have discovered relatively recently 732 00:31:41,443 --> 00:31:43,343 is that I can use these rare-earth magnets 733 00:31:43,378 --> 00:31:46,548 to actually pull the BB up and out of the skin. 734 00:31:46,581 --> 00:31:49,311 What I have here is a rare-earth magnet, 735 00:31:49,350 --> 00:31:50,580 and I’ve got it in a sterile glove. 736 00:31:50,618 --> 00:31:52,018 - [Jeremiah] Yes, sir. - [Larry] All right? 737 00:31:52,053 --> 00:31:55,053 [Jeremiah] He wanted to use like a little magnet. 738 00:31:55,089 --> 00:31:56,249 It was weird to me. 739 00:31:56,291 --> 00:31:58,021 I’m gonna just touch these, uh, 740 00:31:58,059 --> 00:31:59,859 different wounds here to see if I can find 741 00:31:59,894 --> 00:32:01,364 where the BB may be hiding. 742 00:32:01,396 --> 00:32:02,396 Uh. 743 00:32:04,098 --> 00:32:05,198 Uh. 744 00:32:06,701 --> 00:32:08,271 Ah, there we go. 745 00:32:08,303 --> 00:32:09,673 Yeah, that’s it. 746 00:32:09,704 --> 00:32:11,204 So what I’m gonna do 747 00:32:11,239 --> 00:32:13,669 is see if we can actually pull it out with this 748 00:32:13,708 --> 00:32:16,268 without doing any additional incisions. 749 00:32:16,311 --> 00:32:19,611 When you’re working with embedded foreign bodies, 750 00:32:19,647 --> 00:32:22,687 your goal is to remove it as safely as possible. 751 00:32:22,717 --> 00:32:24,427 All right. It just pulls the BB 752 00:32:24,452 --> 00:32:26,422 - right up to the surface. - Okay. 753 00:32:26,454 --> 00:32:27,924 [Larry] We’re just gonna get some tweezers 754 00:32:27,956 --> 00:32:29,856 and we’re gonna try and pull it out, so. 755 00:32:29,891 --> 00:32:32,921 Okay, there. See if you can pull up on that just a little bit. 756 00:32:32,961 --> 00:32:34,091 Go ahead and pull that. 757 00:32:34,128 --> 00:32:36,358 - This doesn’t hurt, does it? - [Jeremiah] No. 758 00:32:36,397 --> 00:32:37,567 [Larry] Go ahead and pull that. 759 00:32:37,599 --> 00:32:39,899 I’m, I’m gonna get it. 760 00:32:39,934 --> 00:32:41,074 All right. Okay. 761 00:32:41,102 --> 00:32:43,602 So I’m gonna give up on the tweezers here. 762 00:32:43,638 --> 00:32:46,208 That only pushed it back in deeper. 763 00:32:46,241 --> 00:32:48,141 I had to go to plan B. 764 00:32:48,176 --> 00:32:49,476 - Let’s just see... - Just the magnet. 765 00:32:49,511 --> 00:32:50,881 - ...just using the magnet alone... - Okay. 766 00:32:50,912 --> 00:32:52,412 - ...whether we can pull that out. Okay? - Okay. 767 00:32:52,447 --> 00:32:55,957 All right. Now go ahead and get it caught up there. 768 00:32:55,984 --> 00:32:58,954 Okay. And I’m gonna see and try 769 00:32:58,987 --> 00:33:00,827 and stretch it as much as you can. 770 00:33:00,855 --> 00:33:02,955 It was just pressure nonstop. 771 00:33:02,991 --> 00:33:04,391 [Jeremiah groans] 772 00:33:04,425 --> 00:33:06,095 - [Larry] I see it. - [Jeremiah groans] 773 00:33:06,127 --> 00:33:08,737 - [nurse 3] You’re okay. - I’ve, I’ve got, I’ve got it, I’ve got it right here, guy. 774 00:33:08,763 --> 00:33:09,833 [Jeremiah] Ahh! 775 00:33:09,864 --> 00:33:11,264 [Larry] It’s right here. 776 00:33:11,299 --> 00:33:12,659 [nurse 3] It’s pushed back down now. 777 00:33:12,700 --> 00:33:13,900 [Larry] It will come out. 778 00:33:13,935 --> 00:33:16,805 We get it to the surface and then any manipulation we do, 779 00:33:16,838 --> 00:33:18,478 it tends to go deeper again. 780 00:33:18,506 --> 00:33:21,276 - We are so close, you just need to pull it back up... - Okay. 781 00:33:21,309 --> 00:33:23,309 ...to the surface. So, so that’s where we’re at. 782 00:33:23,344 --> 00:33:25,144 It’s sitting right there. 783 00:33:25,179 --> 00:33:27,009 - There we go. There it is. - Got that out. 784 00:33:27,048 --> 00:33:28,508 That worked. 785 00:33:28,550 --> 00:33:31,620 [Larry] That time, the BB actually came out attached to the magnet, 786 00:33:31,653 --> 00:33:34,623 and so, you know, we’re victorious, we did high fives. 787 00:33:38,626 --> 00:33:40,266 [Jeremiah] The pressure was gone off my face 788 00:33:40,295 --> 00:33:42,765 and I was happy that nothing bad happened. 789 00:33:42,797 --> 00:33:44,967 - You feeling okay? - Yeah, I’m feeling all right. 790 00:33:44,999 --> 00:33:47,669 - All right. - [Larry] Okay. Do not play with BB guns. 791 00:33:47,702 --> 00:33:49,832 And so I’m going to tell Jeremiah is 792 00:33:49,871 --> 00:33:52,341 realize how close that was to your eye. 793 00:33:52,373 --> 00:33:53,943 As you’re playing with your friends, 794 00:33:53,975 --> 00:33:56,175 you’re goofing off and you’re a little bit careless 795 00:33:56,210 --> 00:33:57,440 and that’s when accidents happen. 796 00:33:57,478 --> 00:33:59,308 [Jeremiah] I kept the BB as a souvenir 797 00:33:59,347 --> 00:34:01,717 just to know not to play with BBs again. 798 00:34:07,155 --> 00:34:09,055 I got a hook stuck in my hand. 799 00:34:09,090 --> 00:34:11,860 [Larry] So you want to tell me, "Oh, look, that’s a nice lure." 800 00:34:11,893 --> 00:34:13,223 That bothers you a little bit, correct? 801 00:34:13,261 --> 00:34:14,391 [Nancy] Just a little bit. Yeah. 802 00:34:14,429 --> 00:34:16,629 Mom was taking this really hard. 803 00:34:16,664 --> 00:34:18,334 This was more than she could handle. 804 00:34:18,366 --> 00:34:20,306 Here, I’m going to let you hold both of those. 805 00:34:20,335 --> 00:34:22,535 There was multiple attempts, 806 00:34:22,570 --> 00:34:25,540 especially around where the barb would be sitting. 807 00:34:36,584 --> 00:34:39,024 [indistinct chatter] 808 00:34:40,288 --> 00:34:41,898 - [Larry] Hey. - [Nancy] Hi. 809 00:34:41,923 --> 00:34:43,593 [Larry] So what are you here for? 810 00:34:43,625 --> 00:34:45,925 I got a hook stuck in my hand. 811 00:34:45,960 --> 00:34:47,930 [Larry] All right, let’s take a look at it. 812 00:34:47,962 --> 00:34:50,032 Oh, look, that’s a nice lure. 813 00:34:50,064 --> 00:34:52,204 Looks like it’s stuck only in the thumb. Correct? 814 00:34:52,233 --> 00:34:53,733 - [Giovanni] Yes, sir. - [Larry] Okay. 815 00:34:53,768 --> 00:34:55,578 Today, our patient is Giovanni, 816 00:34:55,603 --> 00:34:57,243 who came to the emergency department 817 00:34:57,271 --> 00:34:59,841 with a fishhook stuck in his thumb. 818 00:34:59,874 --> 00:35:01,674 We work in Mobile, Alabama, 819 00:35:01,709 --> 00:35:04,839 and so we’re on the Gulf Coast, and so it’s not uncommon, 820 00:35:04,879 --> 00:35:06,879 um, in this part of the country 821 00:35:06,914 --> 00:35:10,214 to have patients walk in with a very fancy, 822 00:35:10,251 --> 00:35:13,251 pretty fishing lure sticking out of a part of their body. 823 00:35:15,456 --> 00:35:17,466 What were you doing when it happened? 824 00:35:17,492 --> 00:35:19,022 If you look up here, 825 00:35:19,060 --> 00:35:21,860 there was excess line up here and he melted it. 826 00:35:21,896 --> 00:35:23,396 - [Larry] Yeah. - [Nancy] So when he went to try 827 00:35:23,431 --> 00:35:25,431 to break it off after it cooled, 828 00:35:25,466 --> 00:35:26,636 - he... - [Larry] He got it... 829 00:35:26,668 --> 00:35:28,938 [Nancy speaking] 830 00:35:28,970 --> 00:35:32,200 [Larry] Okay, so what we’re gonna do is we’re gonna numb your thumb up 831 00:35:32,240 --> 00:35:35,640 - and try and work that fishhook out of your thumb. - [Giovanni] Yes, sir. 832 00:35:35,677 --> 00:35:37,077 [Larry] I don’t think it’ll be too bad, 833 00:35:37,111 --> 00:35:40,281 but we’ll... uh, we’ll tell you each step of the way 834 00:35:40,314 --> 00:35:42,284 - what we’re gonna be doing. - [Giovanni] Yes, sir. 835 00:35:42,316 --> 00:35:44,556 [Larry] Mom was taking this really hard. 836 00:35:44,585 --> 00:35:46,255 This was more than she could handle. 837 00:35:46,287 --> 00:35:47,757 - How old are you? - [Giovanni] 13. 838 00:35:47,789 --> 00:35:50,559 - [Larry] 13. Okay, good. You’re a big fisherman? - [Giovanni] Yes, sir. 839 00:35:50,591 --> 00:35:53,121 - [Larry] That bothers you a little bit. Correct? - [Nancy] Just a little bit. 840 00:35:53,161 --> 00:35:55,331 [Larry laughs] 841 00:35:55,363 --> 00:35:57,133 [Larry] Parental stress reactions. 842 00:35:57,165 --> 00:36:00,265 Some parents are stressed to the point 843 00:36:00,301 --> 00:36:02,571 where you find them falling out 844 00:36:02,603 --> 00:36:04,103 and hitting the ground. 845 00:36:04,138 --> 00:36:05,968 They become an emergency themselves. 846 00:36:06,007 --> 00:36:07,777 This is my target area right here, 847 00:36:07,809 --> 00:36:10,409 and then you’re gonna start injecting that. Okay? 848 00:36:10,445 --> 00:36:13,515 On the thumb, traditionally, you have to do four injections 849 00:36:13,548 --> 00:36:17,258 to numb up the two nerves that travel 850 00:36:17,285 --> 00:36:20,225 on the pad side and then on the, on the dorsal. 851 00:36:21,656 --> 00:36:24,296 And the tumescent block, though basically is putting 852 00:36:24,325 --> 00:36:28,295 so much numbing medicine in there that it, it just encircles 853 00:36:28,329 --> 00:36:30,529 the whole thumb or the whole finger. 854 00:36:30,565 --> 00:36:33,705 And so it was just two sticks but it was still two less than four, 855 00:36:33,735 --> 00:36:35,835 that’s why I elected to do this. 856 00:36:35,870 --> 00:36:38,800 We’re gonna, we’re gonna grab this like this. 857 00:36:42,643 --> 00:36:47,113 And what I can do is, um, I can put the tension on this... 858 00:36:47,148 --> 00:36:49,688 - [Taylor] Okay. - [Larry] ...and then you can go in there and break up... 859 00:36:49,717 --> 00:36:52,487 - [Taylor] Okay. - [Larry] ...around where the barb is being held down. 860 00:36:55,323 --> 00:36:59,023 The barb release technique, I actually invented. 861 00:36:59,060 --> 00:37:01,590 - Here, I’m gonna let you hold both of those. - [Taylor] Okay. 862 00:37:03,030 --> 00:37:05,200 I just take an 18-gauge needle 863 00:37:05,233 --> 00:37:08,573 and work on releasing the tissues around it. 864 00:37:09,670 --> 00:37:12,340 [Larry speaking] 865 00:37:13,708 --> 00:37:16,878 The barb makes it so much more complicated because 866 00:37:16,911 --> 00:37:19,141 if you stepped on a sewing needle, 867 00:37:19,180 --> 00:37:21,810 grandma could pull that out and you’re done, you know? 868 00:37:21,849 --> 00:37:25,149 But a fish hook, that barb is just buried in there. 869 00:37:25,186 --> 00:37:27,896 I mean, it’s made like that to hold on to fish 870 00:37:27,922 --> 00:37:29,392 so your fish can’t escape. 871 00:37:29,423 --> 00:37:31,893 Humans can’t escape when that happens too, unfortunately. 872 00:37:32,293 --> 00:37:34,093 [Larry] It is... 873 00:37:34,128 --> 00:37:37,028 I think, a lot less traumatic. Yeah, there is some s... 874 00:37:37,064 --> 00:37:40,064 um, spicules of skin you’re breaking up there. 875 00:37:44,038 --> 00:37:48,608 But it doesn’t mean a second one like poking the needle 876 00:37:48,643 --> 00:37:51,383 through and then cutting off the barb. 877 00:37:51,412 --> 00:37:52,842 - [Taylor] All right. - [Larry] You got it? 878 00:37:52,880 --> 00:37:54,280 [Taylor] Mmm-hmm. 879 00:37:54,315 --> 00:37:57,825 [Larry] Okay. All right. So let’s take a look at this. 880 00:37:58,553 --> 00:38:00,423 Your barb is intact. 881 00:38:00,454 --> 00:38:01,924 - You happy about that? - [Giovanni] Mmm-hmm. 882 00:38:01,956 --> 00:38:03,596 [Larry and Nancy laughing] 883 00:38:04,625 --> 00:38:06,195 So you’re okay with it? 884 00:38:06,227 --> 00:38:07,467 [Nancy] Yeah, I am okay. Oh, no, not-- 885 00:38:07,495 --> 00:38:09,465 [Larry] It’s done, it’s done, it’s done. Oh, the blood. 886 00:38:09,497 --> 00:38:10,807 We’ll, we’ll put a Band-Aid on there. 887 00:38:13,401 --> 00:38:15,271 - [Giovanni] Yeah, Mom. Yo, listen up. - [Taylor laughs] 888 00:38:16,771 --> 00:38:19,041 [Larry] I think it’s an element of pride 889 00:38:19,073 --> 00:38:21,043 for you fishermen out there like, 890 00:38:21,075 --> 00:38:23,745 "I pulled out so many fishhooks and I don’t need 891 00:38:23,778 --> 00:38:26,618 no stinking ER doctors to help me here." 892 00:38:26,647 --> 00:38:29,787 And if you wanna spend the rest of your life walking around with fishhook barbs 893 00:38:29,817 --> 00:38:31,757 in different parts of your body, that’s up to you, 894 00:38:31,786 --> 00:38:34,096 but it wouldn’t be my preference. 895 00:38:34,121 --> 00:38:36,821 [Larry] Well, thanks. I appreciate all your help on this case. 896 00:38:36,858 --> 00:38:38,998 - [Nancy] Thank you so much. [chuckles] - [Larry] You’re welcome. 897 00:38:53,441 --> 00:38:55,311 My name is Edward J Starkey. 898 00:38:55,343 --> 00:38:57,173 I’m from Anniston, Alabama. 899 00:38:57,211 --> 00:39:00,881 [Edward speaking] 900 00:39:05,019 --> 00:39:06,019 I’ma touch it. 901 00:39:11,993 --> 00:39:15,293 - [nurse 4] Hey, Mr. Starkey, you ready? - [Edward] Yeah. 902 00:39:15,329 --> 00:39:16,829 [George Crawford] Mr. Starkey is a gentleman 903 00:39:16,864 --> 00:39:18,964 that I’ve known for six years. 904 00:39:19,000 --> 00:39:20,700 He called me about a month ago and said, 905 00:39:20,735 --> 00:39:22,135 "I got something in my arm." 906 00:39:22,169 --> 00:39:23,299 I was kind of mad at him. 907 00:39:23,337 --> 00:39:24,877 I’m like, "Dude, I’ve known you for six years 908 00:39:24,906 --> 00:39:26,306 and you’re just now telling me about it." 909 00:39:26,340 --> 00:39:28,210 - [George Crawford] Mr. Starkey. - [Edward] What’s up, doc? 910 00:39:28,242 --> 00:39:29,942 - How are you doing? - [Crawford] You doing okay? 911 00:39:29,977 --> 00:39:31,887 - [Edward] Good, good. - [Crawford] Hop up here for me, man. 912 00:39:31,913 --> 00:39:33,343 Let’s take a look, see what’s going on. 913 00:39:33,381 --> 00:39:34,981 Dude, what happened? 914 00:39:35,016 --> 00:39:38,886 [Edward] That’s the scar when I went to the hospital and had nine stitches here. 915 00:39:39,754 --> 00:39:41,324 [George Crawford] Oh, yeah, right there. 916 00:39:41,355 --> 00:39:43,125 - [Edward] Mmm-hmm. - Cash-money. Okay. 917 00:39:43,157 --> 00:39:45,967 It’s kind of interesting that small piece of glass 918 00:39:45,993 --> 00:39:47,863 will cause him a significant amount of pain 919 00:39:47,895 --> 00:39:49,195 ’cause it’s hitting a nerve. 920 00:39:49,230 --> 00:39:50,960 It looks very small to us, 921 00:39:50,998 --> 00:39:52,528 but you can kind of think of it as like, 922 00:39:52,566 --> 00:39:55,176 if you’ve ever had like a pin stuck in your arm 923 00:39:55,202 --> 00:39:57,332 or you had a needle stuck somewhere, 924 00:39:57,371 --> 00:39:59,841 that little small prick causes a lot of pain. 925 00:39:59,874 --> 00:40:02,844 For him, it’s a little different because every time he moves, he can feel it, 926 00:40:02,877 --> 00:40:05,087 every time he hits it on something, 927 00:40:05,112 --> 00:40:07,012 he just gets this shooting pain. 928 00:40:07,048 --> 00:40:10,188 All right, big fellow, let’s get this taken care of here. 929 00:40:10,217 --> 00:40:11,527 All right, little stick and a burn. 930 00:40:13,688 --> 00:40:15,898 The main reason we always put a little target 931 00:40:15,923 --> 00:40:18,093 on foreign bodies like this, as you can see, 932 00:40:18,125 --> 00:40:19,695 once the lidocaine gets in there, 933 00:40:19,727 --> 00:40:20,937 the whole thing swells up. 934 00:40:20,962 --> 00:40:23,792 So, before you could feel it, right now, you can’t. 935 00:40:52,393 --> 00:40:54,693 That, dude, is a little tiny piece of glass. 936 00:40:54,729 --> 00:40:57,059 You weren’t making that junk up. I thought you were. 937 00:40:57,098 --> 00:40:59,768 It feels real good to help one of my friends out. 938 00:40:59,800 --> 00:41:02,470 - All right, dude, so you’re good. - [Edward] Oh, okay. 939 00:41:02,503 --> 00:41:04,473 Now I’ll close it up. 940 00:41:04,505 --> 00:41:06,145 [George Crawford] The other nice part of body 941 00:41:06,173 --> 00:41:10,543 is when we make that incision to open the dermis up, 942 00:41:10,578 --> 00:41:13,388 if there are more pieces of it in there, 943 00:41:13,414 --> 00:41:15,784 it now has a route to come out quick. 944 00:41:15,816 --> 00:41:18,456 The body will get rid of it on its own 945 00:41:18,486 --> 00:41:20,456 the majority of the time. 946 00:41:20,488 --> 00:41:22,958 The problem is when it gets to the surface, 947 00:41:22,990 --> 00:41:24,720 that’s when it starts to cause pain. 948 00:41:24,759 --> 00:41:27,629 I had a nurse that was in a car accident 20 years 949 00:41:27,661 --> 00:41:30,131 prior to when I was working with her. 950 00:41:30,164 --> 00:41:32,064 She was actually taking care of a kid 951 00:41:32,099 --> 00:41:33,759 and the glass came out of her scalp 952 00:41:33,801 --> 00:41:35,601 and started bleeding all over the place. 953 00:41:35,636 --> 00:41:37,306 Everybody started freaking out 954 00:41:37,338 --> 00:41:39,248 ’cause they thought something had happened to her, 955 00:41:39,273 --> 00:41:42,513 but it was just, a glass came out at the time she was taking care of a little kid, 956 00:41:42,543 --> 00:41:45,613 so it can kind of do whatever it wants to do. 957 00:41:45,646 --> 00:41:48,356 So if there’s any other little fragments of glass in there, 958 00:41:48,382 --> 00:41:50,282 they’ll come out over the next couple of weeks. 959 00:41:50,317 --> 00:41:51,657 You got any questions? 960 00:41:51,685 --> 00:41:53,425 - [Edward] That’d be all right? - [George Crawford] Yeah. 961 00:41:53,454 --> 00:41:54,494 [Edward] Okay. 962 00:41:54,522 --> 00:41:55,892 [Edward speaking] 963 00:42:07,501 --> 00:42:08,871 [Edward chuckles] 964 00:42:08,903 --> 00:42:11,443 [Edward speaking] 965 00:42:11,472 --> 00:42:13,472 - [George Crawford] All right, get out. - [Edward speaking] 966 00:42:15,076 --> 00:42:16,416 - [nurse 4] Bye. - [Edward] Bye-bye. 967 00:42:17,211 --> 00:42:19,211 About four hours from now, 968 00:42:19,246 --> 00:42:21,886 he will start to feel pain from the incision, 969 00:42:21,916 --> 00:42:24,526 but tomorrow he’ll be able to notice that 970 00:42:24,552 --> 00:42:27,552 that nerve pain that he has is gone.