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00:00:23,667 --> 00:00:27,037
[George Crawford] When things
are stuck inside the body,
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00:00:27,070 --> 00:00:28,200
we got to get it out.
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00:00:29,806 --> 00:00:32,176
Tony just has
a ball of jelly mucus
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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.
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00:00:35,712 --> 00:00:38,142
This mucus was
literally stuck there,
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00:00:38,181 --> 00:00:40,011
probably months to years.
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00:00:40,050 --> 00:00:42,850
Wow. Well, look at that.
[chuckles]
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00:00:43,520 --> 00:00:45,250
[man 1 speaking]
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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,
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00:00:51,328 --> 00:00:54,298
and they can tear up tissues
as they go in,
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00:00:54,331 --> 00:00:56,601
and it definitely makes
pulling them out harder.
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00:00:59,769 --> 00:01:01,969
She has a bead in her ear.
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00:01:02,005 --> 00:01:03,805
When you’re looking at kids,
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00:01:03,840 --> 00:01:06,870
it’s what your
persona puts off.
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00:01:06,910 --> 00:01:10,140
I try to speak very softly,
tell them it’s gonna be okay.
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00:01:10,180 --> 00:01:12,050
- [George Livermore] Okay, baby doll.
- Okay.
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00:01:12,082 --> 00:01:13,252
You’re doing so good.
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00:01:13,283 --> 00:01:15,853
From the looks of it,
it’s been in there
for a while.
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00:01:17,287 --> 00:01:19,427
Ah, there goes the nail.
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00:01:19,456 --> 00:01:21,896
A five-second accident
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00:01:21,925 --> 00:01:25,025
can turn into
a five-hour surgery.
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00:01:26,296 --> 00:01:27,766
[grunts]
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00:01:27,797 --> 00:01:29,507
There’s this pleasant lady,
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00:01:29,532 --> 00:01:32,532
she’s got a huge
stiletto heel
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00:01:32,569 --> 00:01:35,029
stuck smack into her face.
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00:01:35,071 --> 00:01:36,801
[indistinct chatter]
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00:01:49,886 --> 00:01:51,456
My name is George Crawford.
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00:01:51,488 --> 00:01:54,228
I am a board-certified
general surgeon,
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00:01:54,257 --> 00:01:56,627
I practice
in Anniston, Alabama,
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00:01:56,660 --> 00:01:58,630
and I work at
the Crawford Clinic.
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00:01:58,662 --> 00:02:00,962
When I get a call
from the emergency
room and they say,
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00:02:00,997 --> 00:02:04,467
"Hey, we have this guy
that got shot with a nail gun
in his arm."
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00:02:04,501 --> 00:02:07,131
The real questions that
need to be answered,
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00:02:07,170 --> 00:02:08,740
you know, is it in a vessel,
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00:02:08,772 --> 00:02:11,772
is it a big nail,
or is it a screw?
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00:02:11,808 --> 00:02:13,878
Is it something that’s
gonna rip a nerve?
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00:02:13,910 --> 00:02:16,080
Does he have
neurological damage?
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00:02:16,112 --> 00:02:18,752
So a lot of those things
are going through my mind
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00:02:18,782 --> 00:02:20,712
when I get that phone call.
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00:02:20,750 --> 00:02:22,580
But we know that
once we see the patient,
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00:02:22,619 --> 00:02:24,179
we can start answering
those questions.
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00:02:27,991 --> 00:02:30,161
- [George Crawford] Dude, what’s up?
- Well...
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00:02:30,193 --> 00:02:31,423
[Brian] My name
is Brian Chaney,
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00:02:31,461 --> 00:02:33,831
I do residential
construction work
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00:02:33,863 --> 00:02:36,133
in Gadsden, Alabama.
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[George Crawford] So exactly
what happened now?
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00:02:37,834 --> 00:02:40,334
Nail gun, somehow
trigger was...
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00:02:40,370 --> 00:02:43,000
- was obviously pressed on it.
- [George Crawford] Okay.
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00:02:43,039 --> 00:02:45,909
I put my arm down and I was
on a steep pitched roof...
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00:02:45,942 --> 00:02:48,682
- [George Crawford] Okay.
- ...so the nail gun was laying right beside me
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00:02:48,712 --> 00:02:51,312
- and it was turned up...
- [George Crawford] Right.
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00:02:51,347 --> 00:02:52,957
- ...towards the sky.
- [George Crawford] Okay.
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00:02:52,982 --> 00:02:54,312
- [Brian speaking]
- [George chuckles]
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00:02:54,350 --> 00:02:56,120
But I was on such
a steep pitched roof,
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00:02:56,152 --> 00:02:57,752
I kept sliding off...
-[George Crawford] Right.
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00:02:57,787 --> 00:02:59,527
[Brian] ...so I kept
pulling it back up
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00:02:59,556 --> 00:03:01,826
and I didn’t pay attention
when I pulled it back up.
-[George Crawford] Got you.
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00:03:01,858 --> 00:03:03,028
[Brian] Then it
was pointing up.
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00:03:03,059 --> 00:03:04,489
- [George Crawford] And then--
- ...so I just
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00:03:04,527 --> 00:03:06,037
put, put my arm down gently,
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00:03:06,062 --> 00:03:08,532
- because normally stuff like this don’t happen...
- [George Crawford] Right.
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00:03:08,565 --> 00:03:11,265
...because that it’s a,
it’s a two way.
You got to do two things.
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00:03:11,301 --> 00:03:13,171
The trigger
has got to be locked in,
you actually have to--
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00:03:13,203 --> 00:03:15,103
- And you have to push the head.
- [George] Right, right.
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00:03:15,138 --> 00:03:16,878
So when I did that,
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00:03:16,906 --> 00:03:20,176
you know, ah,
there goes the nail.
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00:03:20,210 --> 00:03:23,540
[George Crawford]
I’ve seen a few nail gun
injuries like this.
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00:03:23,580 --> 00:03:26,950
The worst one was a guy that
actually did the same thing,
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00:03:26,983 --> 00:03:29,823
slipped and he actually
shot himself in the neck.
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00:03:29,853 --> 00:03:33,123
So a five-second accident
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00:03:33,156 --> 00:03:37,466
can turn into
a five-hour surgery.
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00:03:37,494 --> 00:03:39,994
So, the ER physician
tried to pull it out,
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00:03:40,029 --> 00:03:42,899
and you can see it’s actually
in there pretty good.
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00:03:42,932 --> 00:03:44,962
A hemostat is
an instrument that we use
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00:03:45,001 --> 00:03:47,001
in the operating
room to grasp stuff.
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00:03:47,036 --> 00:03:48,746
We use it pretty much
in every surgery.
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00:03:48,772 --> 00:03:50,372
When I walked in to see Brian,
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00:03:50,406 --> 00:03:53,016
there was one hanging off
the nail and I was
kind of like,
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00:03:54,511 --> 00:03:58,181
"Uh, guys, can we just
take that off?" You know?
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00:03:58,214 --> 00:04:00,154
They kind of made a mess.
[chuckles]
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00:04:00,183 --> 00:04:02,353
So it looks like the ER
was fiddling with it,
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00:04:02,385 --> 00:04:04,085
trying to get it out
and couldn’t get it out.
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00:04:04,120 --> 00:04:06,890
- And you said it’s got ridges on it, so it stays in.
- Yeah.
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00:04:06,923 --> 00:04:08,723
- It’s a rim shank, so.
- [George Crawford] All right.
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00:04:08,758 --> 00:04:11,558
The nurse came over
and was holding my arm
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00:04:11,594 --> 00:04:14,034
and he couldn’t get
a grip to pull it out.
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00:04:14,063 --> 00:04:16,903
You know, I couldn’t
feel it when he was
taking the pliers and,
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00:04:16,933 --> 00:04:18,873
uh, trying to get
the head of the nail.
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00:04:18,902 --> 00:04:22,102
You know, it wasn’t
hurting me until he started
trying to pull it out.
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00:04:22,138 --> 00:04:24,498
It felt like he had some
lopping shears that you cut
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00:04:24,541 --> 00:04:27,841
tree branches with and you’re
cutting the muscle in my arm
in half,
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00:04:27,877 --> 00:04:29,917
so I start screaming,
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00:04:29,946 --> 00:04:32,286
I’m like, "No. Uh-uh, uh-uh."
I almost pass out.
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00:04:32,315 --> 00:04:33,415
It’s hurting so bad.
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00:04:33,449 --> 00:04:35,179
It was excruciating at
that point, and I said, uh,
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00:04:35,218 --> 00:04:36,688
"No, um, you’re gonna
have to knock me out.
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00:04:36,719 --> 00:04:38,579
You’re gonna have to put me
under and, uh, pull it out."
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00:04:38,621 --> 00:04:39,791
[George]
So we’ll pull it out.
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00:04:39,823 --> 00:04:41,593
- I think it’s really just stuck in the muscle.
- Mmm-hmm.
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00:04:41,624 --> 00:04:42,894
[George Crawford]
So once we do that,
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00:04:42,926 --> 00:04:44,296
- we’ll kind of twist it out...
- Mmm-hmm.
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00:04:44,327 --> 00:04:45,937
- [George] ...since you’ll be asleep...
- Right.
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00:04:45,962 --> 00:04:48,362
[George] ...and then
I’ll loosen it up
and hopefully
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00:04:48,398 --> 00:04:50,108
- pull everything out and then you won’t...
- Mmm-hmm.
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00:04:50,133 --> 00:04:51,763
- [George Crawford] ...hurt as much...
- All right.
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00:04:51,801 --> 00:04:53,531
- and we won’t damage anything, so.
- All right. Okay.
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00:04:53,570 --> 00:04:55,030
- [George] Sounds good?
- Thank you. Yeah.
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00:04:55,071 --> 00:04:57,301
[George] All right, dude.
So we’re gonna take
you to the operating room.
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00:04:57,340 --> 00:04:58,640
Some roofing nails
have barbs on them,
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00:04:58,675 --> 00:05:00,075
so it’s almost
like a fish hook.
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00:05:00,109 --> 00:05:02,079
And that’s why
everybody was having
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00:05:02,111 --> 00:05:04,441
a real hard time
trying to remove it.
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00:05:04,480 --> 00:05:06,580
- See, there’s the head.
- Yeah, that’s the head.
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[George Crawford] And then
it’s something in here,
some kind of tissue
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00:05:09,586 --> 00:05:11,826
that’s got it in pretty good.
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00:05:11,855 --> 00:05:15,125
Looking at Brian’s x-ray,
what I’m thinking
in my head is,
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00:05:15,158 --> 00:05:16,428
"Is this stuck in the bone?
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00:05:16,459 --> 00:05:17,989
Is it stuck in a tendon?
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00:05:18,027 --> 00:05:19,237
Is it an artery?
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00:05:19,262 --> 00:05:22,062
Is it something that I can
make worse by pulling on it?
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00:05:22,098 --> 00:05:25,428
Or do I need to cut down
to it to take it out?"
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00:05:25,468 --> 00:05:27,398
Okay, great. Why did they...
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00:05:27,437 --> 00:05:29,947
Why did they leave
the hemostat on there?
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00:05:29,973 --> 00:05:34,613
[Brian speaking]
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00:05:34,644 --> 00:05:36,744
- I feel like a--
- [George Crawford] We’ll take the hemostat off.
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00:05:36,779 --> 00:05:37,939
- You ready?
- Yeah.
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00:05:38,781 --> 00:05:40,011
[George Crawford] All right.
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00:05:40,950 --> 00:05:42,250
So, the plan of action,
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take Brian to
the operating room,
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00:05:44,153 --> 00:05:46,593
put him to sleep
and get set up
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00:05:46,623 --> 00:05:49,293
for what’s called a major
vascular procedure.
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00:05:49,325 --> 00:05:51,425
So we have all the clamps
necessary to reconstruct
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00:05:51,461 --> 00:05:53,191
the arteries or
veins if we need to,
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00:05:53,229 --> 00:05:55,999
and once we have
everything set up,
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00:05:56,032 --> 00:05:58,362
the first thing I’mma do
is actually pull the nail out.
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00:06:00,303 --> 00:06:02,803
[George Crawford]
The one complication we worry
about in this situation
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00:06:02,839 --> 00:06:05,769
is the nail being
stuck in a nerve.
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00:06:05,808 --> 00:06:08,268
If it’s stuck in the nerve,
we remove it,
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00:06:08,311 --> 00:06:10,781
he could lose complete
function of his arm.
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00:06:10,813 --> 00:06:14,313
If we can’t repair that nerve
or even if we can repair it,
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00:06:14,350 --> 00:06:16,780
he may never regain function,
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00:06:16,819 --> 00:06:19,049
so he may end up
eventually losing that arm.
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00:06:19,088 --> 00:06:21,718
[indistinct chatter]
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00:06:21,758 --> 00:06:24,498
[George Crawford] Okay.
So you can see it’s actually
stuck pretty good.
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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.
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00:06:31,601 --> 00:06:33,571
So the first thing I do
is grab a hemostat,
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00:06:33,603 --> 00:06:35,033
kind of wiggle it
a little bit,
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00:06:35,071 --> 00:06:37,041
see if it’ll come out
on its own,
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00:06:37,073 --> 00:06:39,373
if I just kind of push it in
and pull it out.
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00:06:39,409 --> 00:06:42,239
It gives a little bit,
but doesn’t come all the way.
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00:06:42,278 --> 00:06:45,748
I know from the x-rays,
it doesn’t appear to be stuck
in a nerve,
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00:06:45,782 --> 00:06:48,312
so you could hear it rip
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00:06:48,351 --> 00:06:50,581
through a little bit of tendon
or tissue.
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00:06:50,620 --> 00:06:53,250
It kind of has
this flexing thing
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00:06:53,289 --> 00:06:56,059
that it does right before
you pull it out because again,
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00:06:56,092 --> 00:06:57,492
you’re stimulating the muscle,
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00:06:57,527 --> 00:06:59,367
so it almost pulls
back a little bit.
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00:07:01,297 --> 00:07:03,007
[George Crawford grunts]
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00:07:03,032 --> 00:07:04,362
Oh, a little crunch.
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00:07:04,400 --> 00:07:06,700
Oh, I see why.
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00:07:12,308 --> 00:07:13,708
So that’s why.
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00:07:13,743 --> 00:07:15,273
You see the barb?
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00:07:15,311 --> 00:07:17,341
When we get it out,
there’s no blood coming out,
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00:07:17,380 --> 00:07:19,780
so I’m like, "Whew! Good."
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00:07:19,816 --> 00:07:22,286
That’s the problem
right there.
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00:07:23,086 --> 00:07:24,926
That was stuck in tissues,
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00:07:24,954 --> 00:07:26,924
and there’s a little
tissue stuck on that.
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00:07:26,956 --> 00:07:30,126
That barb is why we
couldn’t just pull it out.
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00:07:30,159 --> 00:07:32,629
And it was
holding on to something.
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00:07:32,662 --> 00:07:35,032
I’ll irrigate it out
a little bit.
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00:07:35,064 --> 00:07:38,104
It’s critical to irrigate
the wound because
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00:07:38,134 --> 00:07:39,804
the one thing that we
don’t want to do is
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00:07:39,836 --> 00:07:41,606
do a great operation
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00:07:41,637 --> 00:07:43,207
and then it get infected.
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00:07:43,239 --> 00:07:46,139
So we irrigate it
as much as we can
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00:07:46,175 --> 00:07:48,375
to get any residual metal out,
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00:07:48,411 --> 00:07:50,041
to get any bacteria out.
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00:07:50,079 --> 00:07:52,309
And now that that’s out,
he should fine,
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00:07:52,348 --> 00:07:53,578
we’ll watch him
for a couple of hours.
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00:07:53,616 --> 00:07:56,086
As long as it doesn’t bleed,
he’ll be okay.
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00:07:57,787 --> 00:08:00,727
40% of carpenters
have had an injury
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00:08:00,757 --> 00:08:04,327
because of a nail gun,
they are
very powerful machines.
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00:08:04,360 --> 00:08:07,430
I’ve seen people get
nails in their hands,
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00:08:07,463 --> 00:08:08,933
nails in their arm,
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00:08:08,965 --> 00:08:12,735
and the biggest thing is
you could lose that extremity,
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00:08:12,769 --> 00:08:15,599
and I can guarantee you,
nobody wants to hire
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00:08:15,638 --> 00:08:17,938
a one-handed carpenter.
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00:08:17,974 --> 00:08:20,514
- All right, man, so we got it out.
- [Brian] I like you, dude.
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00:08:20,543 --> 00:08:22,113
[George Crawford]
Dude, I appreciate it.
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00:08:22,145 --> 00:08:25,015
You made me feel comfortable,
you know, you’re a good dude.
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00:08:25,048 --> 00:08:26,858
Dr. Crawford’s
a really cool guy.
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00:08:26,883 --> 00:08:29,453
He came in, cutting up,
made the mood,
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00:08:29,485 --> 00:08:31,525
you know, lightened the mood
a little bit.
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00:08:31,554 --> 00:08:33,654
Uh, I liked him
right off the bat.
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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.
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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.
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00:08:43,466 --> 00:08:44,666
[George Crawford]
Love you too, man.
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00:08:44,700 --> 00:08:47,170
I’m extremely safe
with nail guns now.
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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
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00:08:55,478 --> 00:08:57,318
because I don’t want to
shoot myself in the arm again.
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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
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00:09:51,234 --> 00:09:53,374
and he’s getting
a lot of sinus infections,
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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.