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... Every year, patients arrive at emergency departments with injuries caused by fishhooks [1]. More broadly, the embedment of fishhooks in the skin is a common injury incurred by people who fish recreationally and commercially across the globe [2][3][4][5][6]. While special barbless hooks exist for conservation purposes, the most common style of fishhook is barbed and is designed to be difficult to remove. ...
... While special barbless hooks exist for conservation purposes, the most common style of fishhook is barbed and is designed to be difficult to remove. Therefore, injuries involving these can become complicated if proper techniques are not used when attempting to remove an embedded fishhook [2][3][4][5][6]. There is a variety of popular and scientific literature which details the unique challenges of treating fishhook injuries and specific techniques for fishhook removal. ...
... For the purposes of this report, we chose to specifically sample physicians who practice family and emergency medicine. This was based on the literature, which suggests these physicians are most likely to encounter patients with fishhook injuries and must be competent in multiple techniques used for the removal of uncomplicated, embedded fishhooks [1,2,[4][5][6]. Furthermore, because these physicians must be competent in fishhook removal, they form a representative sample of the target population who may benefit from simulation training using the FISH-ER ...
While participation in both recreational and commercial fisheries is common, it is not risk-free. Puncture wounds caused by fishhooks are commonly incurred by people who fish recreationally and commercially. Despite literature that details the challenges of treating fishhook injuries and specific techniques for fishhook removal, only a single publication focuses on teaching fishhook removal techniques to medical trainees and staff physicians.
The aim of this technical report is to investigate the efficacy of using a 3D-printed task trainer for simulating and teaching fishhook removal techniques. To facilitate this, the 3D-printed Fishhook Emergency Removal Simulator (FISH-ER 3D) was designed by the Memorial University of Newfoundland (MUN) MED 3D Network and satellite research partner, Carbonear Institute for Rural Reach and Innovation by the Sea (CIRRIS).
A sample of 22 medical residents and staff physicians were asked to evaluate the task trainer by way of a practical session, which was then followed by an evaluation survey. The overall realism of the 3D-printed task trainer components was ranked as “realistic” or “very realistic” by 86% of the evaluators. The majority of evaluators rated acquiring and performing various fishhook removal techniques using the simulator as “easy” or “somewhat easy”. Most evaluators found that using the task trainer increased user competence and confidence with fishhook removal techniques, and 100% of the evaluators rated the task trainer as a “very valuable” or “valuable” training tool.
The results of this report demonstrate support for the FISH-ER 3D as an efficacious simulator for building competence in fishhook removal techniques.
... Fish hook related injuries have been described in various anatomical areas like hands, face, eye, lower limbs, oral cavity and back [3,5]. Management of fish hook related injuries should begin with a focused history followed by careful examination of the wound and the surrounding tissues [2,6]. A specialist opinion should be sought at the earliest in case of complex wounds involving eye and suspected injury to underlying blood vessels, nerves or tendons [6] because the external injuries can look deceivingly minimal [4]. ...
... Management of fish hook related injuries should begin with a focused history followed by careful examination of the wound and the surrounding tissues [2,6]. A specialist opinion should be sought at the earliest in case of complex wounds involving eye and suspected injury to underlying blood vessels, nerves or tendons [6] because the external injuries can look deceivingly minimal [4]. ...
... There are five techniques that can be used for removing fish hooks embedded in the tissues. These include simple retrograde technique, string-pull technique, needle cover technique, advance and cut technique (for single barb and multiple barb fish hooks) and cut-itout technique [3,5,6] (Figures 1-5). The choice of technique depends on the type of fish hook embedded, anatomical location of the injury, depth of injury and the experience of the treating physician [6,7]. ...
Introduction: Fishing is a common recreational activity among the children and young adults all over the world. This study was done to determine the efficacy of various techniques used for fish hook removal, the anatomical areas involved in fish hook injuries, type of injuries, types of analgesia used, need for tetanus prophylaxis and complications associated with fish hook injuries.
... We at the CJRM like this type of article and indeed have previously published the definitive how-to over a decade ago. 1 From this new work, it seems that, although all methods that the Thommasens' describe are used, the 'advance and cut' technique is most favoured on the Avalon Peninsula. ...
... Au JCMR, nous aimons ce type d'article et avons en effet déjà publié, il y a plus de dix ans, une description détaillée définitive. 1 Selon cette nouvelle étude, il semblerait que, même si toutes les méthodes décrites par Thommasens sont utilisées, la technique « avancer et couper » semble avoir la faveur des résidents de la presqu'île Avalon. ...
... Those which has proximity to vital structures like vessels, nerves or injury to the special organs like orbita, oropharynx need more attention and must be managed by a specialist [6]. Complications of this kind of important structures may compromise in irreversible results such as vision lost. ...
... No obstante, se debe tener cuidado en la eliminación para evitar un mayor perjuicio para el tejido subyacente y para evitar molestias al paciente. 8,9 Existen 4 técnicas descritas para la eliminación del anzuelo: Retrógrada, cadena de tirón, cubier-ta de la aguja, y el avance y corte. 10 Sin embargo, todos estos métodos son adecuados sólo para anzuelos simples superficialmente incrustados con una sola punta. ...
... Specific techniques have been developed to meet these aims. Complicated wounds, such as those involving the eye and those deeply embedded near tendons, blood vessels, and nerves should be referred to a specialist (1). Fishhook injuries to the eye can involve significant vision loss and can even involve intracranial trauma and should be sent for ophthalmologic consultation (2). ...
Background:
Fishhook injuries are common among people who fish for recreation, but can be encountered in anyone who has handled a fishhook. They represent a unique challenge for Emergency Physicians who seek to remove them without causing further tissue damage from the barbed nature of the hook.
Objective:
Our aim was to discuss the techniques available to providers in the removal of a barbed fishhook by illustrating actual cases seen in the Emergency Department.
Case reports:
We present two cases of patients with fishhook injuries. We discuss the proper assessment of these injuries. We describe techniques for removing a barbed hook from a patient's skin and offer images to guide management.
Conclusions:
Understanding the unique nature of fishhook injuries and awareness of techniques to manage them are essential to the practicing Emergency Physician.
Removing embedded fishhook without causing further tissue damage from the barbed nature of the hook is a challenge in emergency department (ED). The four most commonly used techniques include advance and cut, string-yank, needle cover, and retrograde removal. This study aims to describe a modified push- through technique without cutting the barb, namely advance without cut and retrograde removal, as an effective technique of successful removal of fishhooks. There is no risk of additional injury to patients and healthcare staff, and the technique does not need tools that are not generally readily available in EDs.
Objective
The aim of this study was to evaluate the effectiveness of a fishhook removal simulation workshop using investigator-developed diagrams, practice models, and a teaching video.
Methods
This was a descriptive, prospective educational study with Institutional Review Board approval. The primary outcomes were the learner’s perception of ease of learning, performance ability, and amount of tissue damage for each technique. A 2¾-minute educational video, instructional visual diagrams, and a simulated model were created to teach 4 techniques: simple retrograde, string pull, advance and cut, and needle cover. Learners performed each technique on a model to assess whether they could remove the hook on the first attempt for each technique. They then rank ordered their technique preferences for ease of learning, performance, perceived tissue damage, and overall choice.
Results
Of a total of 34 participants who completed the study, 71% of learners were emergency medicine residents or faculty, 65% were male, 42% were recreational fishers, and 68% had previous fishhook removal experience. On first attempt, more than 88% of participants demonstrated successful fishhook removal using all techniques except needle cover (47%). Simple retrograde was rated easiest to learn (74%) and perform (59%), was perceived to cause the least tissue damage (44%), and was the overall preferred technique. Needle cover was ranked hardest to learn (88%) and perform (82%), was perceived to cause the worst tissue damage (41%), and was the overall least preferred technique.
Conclusions
This study is the first to describe a simulation training program for uncomplicated fishhook removal, and to experimentally evaluate physician learning and preferences for fishhook removal techniques. After a brief educational session, physicians could effectively use all techniques except needle cover. Simple retrograde was the overall preferred technique.
We report the case of a 28-year-old male Nigerian student, who presented in the Accident and Emergency Department of our Hospital with a five-hour history of fish hook and line impaction in the oesophagus. Patient noticed the line dangling from his mouth after swallowing a bolus of food. His initial attempts to remove it by pulling the string failed and he then resolved to swallow some more boluses in an attempt to dislodge the hook which also failed. There was an associated history of dysphagia, odynophagia and drooling of saliva. There was no difficulty in breathing, chest pain or fever.
X-ray soft tissue neck done showed a radio-opaque foreign body in the oesophagus at the level of the 6th cervical vertebrate. A rigid oesophagoscopy was done to retrieve the foreign body and a size 18FR naso-gastric tube was passed to rest the oesophagus. Third day post surgery, patient was started on tubal liquid diet and the tube removed on day six and was discharged.
Key words: Fishhook, line, impaction, oesophagus
Fishing is a common recreational sport. While serious injuries are uncommon, penetrating tissue trauma involving fishhooks frequently occurs. Most of these injuries are minor and can be treated in the office without difficulty. All fishhook injuries require careful evaluation of surrounding tissue before attempting removal. Ocular involvement should prompt immediate referral to an ophthalmologist. The four most common techniques of fishhook removal and injury management are described in this article. The choice of the method for fishhook removal depends on the type of fishhook embedded, the location of the injury and the depth of tissue penetration. Occasionally, more than one removal technique may be required for removal of the fishhook. The retrograde technique is the simplest but least successful removal method, while the traditional advance and cut method is most effective for removing fishhooks that are embedded close to the skin surface. The advance and cut technique is almost always successful, even for removal of large fishhooks. The string-yank method can be used in the field and can often be performed without anesthesia. Wound care following successful removal involves extraction of foreign bodies from the wound and the application of a simple dressing. Prophylactic antibiotics are generally not indicated. Tetanus status should be assessed and toxoid administered if needed.
To review the literature involving removal of sharp foreign bodies from the hypopharynx and to present a case of a triple-barbed fishhook removed from the hypopharynx with suspension microlaryngoscopy. Study Design: Literature review and case presentation.
Review of the literature was done using a MEDLINE search with the keywords hypopharynx, foreign bodies, and laryngoscopy.
Review of the literature revealed no prior description of either foreign body removal using microlaryngoscopy or report of the removal of a triple-barbed fishhook from humans.
Removal of sharp foreign bodies from the aerodigestive tract always presents a technical challenge, and this case of a hypopharyngeal triple-barbed fishhook introduces new operative techniques. By using microlaryngoscopy and bimanual instrumentation to manipulate and remove the fishhook, an open surgical procedure was avoided.