Emergency physicians are constantly challenged with fishing foreign bodies out of various orifices such as ears, as shown here in an earlier Trick of the Trade using a tissue adhesive.

What do you do when an overweight person presents with the cotton portion of a Q-tip lodged in his umbilicus? Skin retractors and direct probing were unsuccessful in removing the cotton.

Trick of the Trade: Umbilical foreign body removal

Insert a long nasal speculum (typically found in an ENT kit) to visualize the entire umbilical tract. Remove under direct visualization using forceps.

NasalSpec2

NasalSpec3

Thanks to Dr. Joseph Chong and Sari Raber (EM faculty and medical student, respectively, at University of British Columbia)

Michelle Lin, MD
ALiEM Founder and CEO
Professor and Digital Innovation Lab Director
Department of Emergency Medicine
University of California, San Francisco
Michelle Lin, MD

@M_Lin

Professor of Emerg Med at UCSF-Zuckerberg San Francisco General. Founder of ALiEM @aliemteam #PostitPearls https://t.co/7v7cgJqNEn
Michelle Lin, MD