Remarks on foreign bodies in the ED
Many foreign bodies should be removed in the ED; for example, all foreign material within the cavities of fresh lacerations should be irrigated away, debrided, or extracted with instruments.
Occasionally, patients with subcutaneous foreign bodies should be referred to appropriate specialists for delayed removal.
These trigger the most severe inflammatory reactions
Vegetative foreign bodies, such as wood, thorns, and spines
Most common complication of retained foreign bodies
Infection,
producing local wound infection, cellulitis, abscess formation, lymphangitis, tenosynovitis, bursitis, septic arthritis, and osteomyelitis
Remarks on wounds and foreign bodies
Every wound has the potential for concealing a foreign body, but only a small percentage of lacerations and puncture wounds actually contain them.
Most are found during a deliberate and careful exploration of wounds considered to be at risk.
How to optimize exploration of wounds for foreign bodies
Adequate lighting
Good hemostasis
Appropriate anesthesia
Patient cooperation
Make effort to visually inspect recesses of a wound
Some wounds may need to have their margins extended with a scalpel to better visualize and extract a foreign body
Wounds that have a higher association with foreign bodies
Wounds deeper than 5 mm and wounds whose depth cannot be visualized.
Blind probing with a hemostat is especially dangerous in
Hands, feet, or face,
where direct visualization is the preferred method of exploration
Blind probing is time consuming and can cause further injury.
Other localization methods
Using radioopaque skin markers, such as lead circles, paper clips, or hypodermic needles
Remarks on radiography
If a foreign body is suspected based on the mechanism of injury but not found during exploration of a wound, a radiograph should be ordered first, because plain radiograph will detect as many as 80 to 90% of all foreign bodies
If the wound was caused by _______________- and no foreign body was found on plain films or wound exploration, the physician can end the search
metal, glass, or gravel
Glass in radiography
Almost all glass is visible on radiograph if it is 2 mm or larger,
and glass does not have to contain lead to be visible on plain films
Not visible on plain radiographs
Bone, fish, (some)
Wood
Plastic (most)
Spines, cactusª
ªNOTE: spines from sea urchins and stingrays are radioOPAQUE
Pitfall of CT
Wood foreign bodies may initially mimic air bubbles on CT images.
a radiograph should be ordered first, because plain radiograph will detect as many as
**80 to 90% of all foreign bodies*
For most adults, fluoroscopy is limited to the
limbs
