Trick of the Trade: "Punch out" the foreign body

DoctorA patient re-presents to the Emergency Department with a foreign body sensation in his heel after stepping on a broken window. Despite a negative xray and bedside ultrasound yesterday, the patient still believes that a small foreign body is still in there.  You are unable to find a foreign body despite excising the overlying skin with a scalpel and exploring with forceps.

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By |2016-11-11T18:44:37-08:00Jun 12, 2012|Tricks of the Trade|

Trick of the Trade: Hair tourniquet release

449px-Hairtournequet

A 3 month old baby presents with distal erythema and swelling of one of her toes. A hair tourniquet is identified. Typically one can try manually unwrapping the tourniquet using forceps, but often only part of the tourniquet can be removed. The distal toe remains swollen and erythematous with delayed capillary refill.

As demonstrated by the image above, it can be difficult to identify the hair because of the edema and the thin nature of the hair (especially if the same as the patient’s skin color). In a 2006 review of hair tourniquets in the Annals of Plastic Surgery, they recommend incising down to the bone along the lateral edge of the digit to ensure tourniquet release. It seems a bit aggressive…
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By |2016-11-11T18:44:38-08:00Jun 5, 2012|Tricks of the Trade|