# fish hook back of the neck



## EMS Fanatic (May 30, 2015)

Hello I was curious on how you would handle a call for a 15 year old with a fish hook stuck In the back of his neck. Both barbs penetrated the skin. I'm thinking normal saline to wash injury then 4×4 then wrap with roller gauze. Any suggestions?


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## EMSComeLately (May 30, 2015)

Yup...stabilize impaled object and transport.  Of course, you wouldn't want to wrap kerlex around the kids neck just to stabilize. A pad with tape non circumferential is fine too.


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## chaz90 (May 30, 2015)

Eh, "stabilizing" something as small as a fish hook is likely overrated. You'd likely cause more movement and pain when wrapping it. Position of comfort, wash out contamination if obvious, and transport. Pain meds PRN.


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## Medic Tim (May 30, 2015)

Remove it. Clean it up, Suture if needed, and bandage. Maybe a tetanus shot and abx. Scheduled a follow up for a couple days or refer to pts doctor for a follow up.


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## EMSComeLately (May 30, 2015)

Medic Tim said:


> Remove it. Clean it up, Suture if needed, and bandage. Maybe a tetanus shot and abx. Scheduled a follow up for a couple days or refer to pts doctor for a follow up.


Wow...that's quite a scope of practice you have there.


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## Medic Tim (May 30, 2015)

EMSComeLately said:


> Wow...that's quite a scope of practice you have there.


I work in remote oilfield clinics.


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## EMSComeLately (May 30, 2015)

Medic Tim said:


> I work in remote oilfield clinics.


Very cool!


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## NomadicMedic (May 30, 2015)

It it were my kid, I'd use a pair of dykes to clip the barbs, slide the shank out, put a dab of triple antibiotic and a bandaid on it and keep fishing. 

If I was CALLED to this scene, I'd use a KED, pelvic binder, MAST trousers and call for a helicopter. 

...Or maybe I'd gently and kindly suggest that mom and dad drive their kid to the urgent care or ER and save a medic unit for people who need one.


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## EMS Fanatic (May 30, 2015)

Haha. I don't even think we are allowed to use Mast trousers anymore in franklin county VA


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## NomadicMedic (May 30, 2015)

EMS Fanatic said:


> Haha. I don't even think we are allowed to use Mast trousers anymore in franklin county VA



They're still in my fishhook protocol.


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## jgray92 (May 30, 2015)

you forgot the morphine! lol Them fishin hooks are painful.


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## jgray92 (May 30, 2015)

Would you transport though in this situation?


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## Medic Tim (May 30, 2015)

Barring any complications removing it... This would be a treat and release or a treat and refer for me. 
The typical 911 call answer is .... If they want to go you take them.

I would also prefer entonox or ketamine for the sedation... If it was needed.


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## jgray92 (May 30, 2015)

Fair enough, thank you for the answer.
as far as ketamine goes, it is good stuff. I've only ever seen it used once on a combative patient in the ER, they went out pretty quickly.


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## ERDoc (May 31, 2015)

Pretty much what Medic Tim said.  There really is nothing for EMS to do in a case like this.  You really don't need much more than some local Lido and a tetanus.


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## DrParasite (May 31, 2015)

EMS Fanatic said:


> Hello I was curious on how you would handle a call for a 15 year old with a fish hook stuck In the back of his neck. Both barbs penetrated the skin. I'm thinking normal saline to wash injury then 4×4 then wrap with roller gauze. Any suggestions?


wait, through and through (the barbs came in and back out), or are they embedded in the skin?  

if through and through, I'd cut the barb off, remove the hooks (hopefully with something I can find in my toolbox), control any bleeding (probably with a bandaid), and transport to the ER for a tetnus shot.  

If it was embedded in the skin, cover with a 4x4, maybe some tape, and have the kid walk to the ambulance, and take an nice easy ride to the ER


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## Akulahawk (May 31, 2015)

Well, a fish hook embedded in the back of a neck is a whole lot better than one embedded in a tongue...


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## EMS Fanatic (May 31, 2015)

The hook was embedded in the skin no barbs showing just the eyelet.


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## gotbeerz001 (May 31, 2015)

EMS Fanatic said:


> The hook was embedded in the skin no barbs showing just the eyelet.


The hospital will push it through, clip the barbs and remove; same as one would on the dock. It can be done with or without a local anesthetic. As mentioned, tetanus shot would be the biggest issue overall... This is a superficial/very minor injury.


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## DesertMedic66 (May 31, 2015)

Ask the kid if he caught anything. Let the parents know my treatment plan "hey mom and dad, I am not going to do anything at all for your kid. I'm just going to act like an expensive taxi and he may go directly to the lobby at the ED. So what would you like to do? We can take him by ambulance, you can drive him to an urgent care, or you can drive him to the ED."


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## COmedic17 (May 31, 2015)

If it was my child, I would push it through,cut off the barbs, and clean throughly. 


If it was someone else's kids I would inform them of what the hospital would do, in detail (wouldn't tell them to do it, I would just be very descriptive with what they would do), offer transport, but let them know that there's nothing I can do as a medic.


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## medichopeful (Jun 1, 2015)

C-collar, oxygen, position of comfort, lights and sirens to the hospital.  Consider ALS intercept as well.


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## squirrel15 (Jun 1, 2015)

medichopeful said:


> C-collar, oxygen, position of comfort, lights and sirens to the hospital.  Consider ALS intercept as well.


Was this sarcasm? I hope so... A c-collar would be awful...


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## NomadicMedic (Jun 1, 2015)

We need a sarcasm font.


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## squirrel15 (Jun 1, 2015)

DEmedic said:


> We need a sarcasm font.


We do lol. Or atleast a smiley after so people like myself dont get super confused


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## medichopeful (Jun 2, 2015)

squirrel15 said:


> Was this sarcasm? I hope so... A c-collar would be awful...



Just a little sarcasm!


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## RedAirplane (Jun 4, 2015)

I'm obviously not as experienced as others on here, but since it is the BLS forum I'll throw in my $0.02.

Ensure an open airway and adequate breathing. Is the fish hook preventing this? Seems not. So focus on circulation. 

Even though it is shallow, my training is to stabilize in place after controlling bleeding. 

If the wound is not bleeding, wipe the area with a BZK wipe or with a soapy gauze followed by a wet gauze. 

Don't wrap a bandage around the neck, but rather, alternating armpits with a figure 8. Tie a beautiful bow  like you learned in class. 

Continually reassess. 

If the pt is shocky (abnormal VS, pale, cool, not PERL, whatever) strongly consider oxygen and an ALS intercept. 

I'd argue against a C collar because it interferes against the C on ABC. 

I would not be comfortable releasing this patient but I am hopelessly cautious


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## Av8or007 (Jun 4, 2015)

Lidocaine!

Aka: prep site, infiltrate lidocaine (plain is ok), push hook through skin, cut barb, pull hook back through.

Make sure tetanus is up do date. Apply some polymixin b ointment and refer for follow up.

THIS is why BLS drives me insane. This is about as fricken basic as you can get re fixing the issue....


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## RedAirplane (Jun 4, 2015)

Av8or007 said:


> Lidocaine!
> 
> Aka: prep site, infiltrate lidocaine (plain is ok), push hook through skin, cut barb, pull hook back through.
> 
> ...



I'm confused. Why does BLS drive you insane?


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## Av8or007 (Jun 4, 2015)

Because in 90% of cases it is either not beneficial, prolongs the problem, or in some cases can be downright harmful (due to the way it is taught mostly).

Combined with the fact that even for the 'true emergencies' that are relatively rare, they can't do crap to address the problem in most cases.

Add to that the fact that pain control and non emergent symptom relief  (e.g. antiemetics) is nonexistent or horrible and yeah...

Stuff that is considered really really basic medicine is considered 'too advanced' - think IM injections as an example.

And on top of all of this, the education for BLS is downright awful..

(BLS in this case is EMT-B/EMR, not a PCP - although pcp has many of the same issues)

In this case, a 10-15 minute procedure would solve the issue once and for all - rather than taking up an ED or urgent care bed.


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## gotbeerz001 (Jun 4, 2015)

DEmedic said:


> We need a sarcasm font.


Best idea ever!!
Maybe Comic Sans.


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## gotbeerz001 (Jun 4, 2015)

gotshirtz001 said:


> Maybe Comic Sans.


Which would have naturally been written in Comic Sans. #sarcasm


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## TheLocalMedic (Jun 4, 2015)

Here's a thought:  Removing a fish hook is taught in the Boy Scouts.  Simply push the barb through the skin, snip it off, and then pull it out and apply a bandage.  

So if it's taught by the Scouts, shouldn't we be able to do the same in EMS?  #problemsolved


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## redundantbassist (Jun 4, 2015)

TheLocalMedic said:


> Here's a thought:  Removing a fish hook is taught in the Boy Scouts.  Simply push the barb through the skin, snip it off, and then pull it out and apply a bandage.
> 
> So if it's taught by the Scouts, shouldn't we be able to do the same in EMS?  #problemsolved


Agreed. If its in the scope of practice of a bunch on snot-nosed 12 year olds with zero medical training, its definitely in the BLS scope of practice.


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## Tigger (Jun 4, 2015)

Ishan said:


> I'm obviously not as experienced as others on here, but since it is the BLS forum I'll throw in my $0.02.
> 
> Ensure an open airway and adequate breathing. Is the fish hook preventing this? Seems not. So focus on circulation.
> 
> ...


We are talking a fishhook and not a boat anchor, correct?


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## RedAirplane (Jun 5, 2015)

Tigger said:


> We are talking a fishhook and not a boat anchor, correct?



Not that I would know the difference, but I imagined a sharp barbed wire kind of thing sticking in one side and out the other


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## RedAirplane (Jun 5, 2015)

redundantbassist said:


> Agreed. If its in the scope of practice of a bunch on snot-nosed 12 year olds with zero medical training, its definitely in the BLS scope of practice.



I agree we need a Better scope. 

Although I can, most EMTs can't even give out OTC Meds. 

still a bit undecided on the Boy Scouts though.


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## DrParasite (Jun 5, 2015)

TheLocalMedic said:


> Here's a thought:  Removing a fish hook is taught in the Boy Scouts.  Simply push the barb through the skin, snip it off, and then pull it out and apply a bandage.
> 
> So if it's taught by the Scouts, shouldn't we be able to do the same in EMS?  #problemsolved


shouldn't it be?  absolutely, as should many other things that are taught in the boy scouts manual (as well as many other common sense things). 

Is it?  well, show me some documentation showing where I can read it as being in the BLS scope of practice, and I will gladly agree with you


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## luke_31 (Jun 5, 2015)

A lot of the material for first aid and other stuff, typically infers that you are not in an area with quick medical access and the ability to get help involves that they are already looking for you.  Thus Boy Scouts were still being taught tourniquets when they had fallen out of favor in the prehospital environment, simply because there was no quick access to definitive care. When I was in the Boy Scouts we did lots of backpacking, and at times we were a day or more from seeing anybody else, and more than likely at least one to three days depending where we were from even getting to a road to find someone to get help. While some stuff is common sense enough to have in the EMT scope, I wouldn't say everything that is in the Boy Scout Manuel should be a part of the scope.


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## ERDoc (Jun 5, 2015)

Are there any fans of the string method for removing fish hooks?


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## TimRaven (Jun 6, 2015)

Removing fish hook was taught in both WEMT and AWLS courses as well, but it's an interesting topic if the local scope permits it...maybe I should ask next time meeting with county EMS board...


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## DesertMedic66 (Jun 6, 2015)

Heck, we aren't even supposed to remove the Tazer barbs.


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## redundantbassist (Jun 6, 2015)

ERDoc said:


> Are there any fans of the string method for removing fish hooks?


Is it like pulling a tooth, where you tie it to a door and then have someone shut it?


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## Medic Tim (Jun 6, 2015)

DesertEMT66 said:


> Heck, we aren't even supposed to remove the Tazer barbs.


Wow really... Bls skill everywhere I have worked.


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## Jim37F (Jun 6, 2015)

I had a patient once who somehow got a pair of tweezers embedded in the palm of her hand....probably would have been better for her the have just pulled it out and put a band-aid on it rather than call 911.....I still had to stabilize the impaired object and transport (local hospital had a bit of a laugh, joking we should've ALS'd Code 3 to the trauma center as they directed the lady to triage). So yeah, pushing the fish hook through to snip the barber off and pull it back out would not fly here and I'd probably be out of a job....unless I did it to a Boy Scout while on a camping trip as an Eagle Scout adult leader lol


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## TimRaven (Jun 6, 2015)

redundantbassist said:


> Is it like pulling a tooth, where you tie it to a door and then have someone shut it?



From WEMT field guideline:
- Attach a 12-inch piece of string around the curve of the hook. Simultaneously push down on the eye of the hook and pull the string along the axis of the hook.
or
- Push the point of the barb through the skin. Snip off the barb and back the hook out.


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## 24verdicts (Jun 7, 2015)

Had the hook from a wiper blade refill(was 15 at the time) jammed into my index finger and came out from underneath my nail.
Got some pliers snipped the end and pulled the rest out. No big deal i just made sure the puncture was clean.


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## ERDoc (Jun 8, 2015)

redundantbassist said:


> Is it like pulling a tooth, where you tie it to a door and then have someone shut it?


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## smorkal42 (Jun 8, 2015)

There's really no point in transporting unless the parents are really adamant about it. I'd just explain what was going to happen at the ER; they are going to remove it and give him a tetanus shot, and then tell them it would save them some money if they just drove the kid to an ER or urgent care. Works out fine for everyone.


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## EMSComeLately (Jun 8, 2015)

I don't know that directly talking someone out of transport is prudent; however they tend to get the point if you say "either we can take to the ER or you can."  They tend to recognize that you're not concerned and they shouldn't be either.


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## redundantbassist (Jun 9, 2015)

ERDoc said:


>


Yes doc, i was joking.


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## ERDoc (Jun 9, 2015)

redundantbassist said:


> Yes doc, i was joking.



I realize that you were joking but I realized that others may not be familiar with it though and figured I'd post the pic.


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