TABLE 422 Indications for Foreign Body Removal

Thorns, spines, wood splinters, and other vegetative materials require immediate removal because they cause intense and excessive inflammation. 20 Foreign objects that are heavily contaminated, such as fractured teeth and soil-covered objects, should be removed as soon as possible; antibiotic treatment will not take the place of foreign body removal. Glass, metal, and plastic are relatively inert, and removal can be postponed, if necessary. Glass foreign bodies in hands or feet can cause persistent pain with gripping or walking, and they can sever nerves or tendons years after the initial injury. Patients with deep, sharp foreign bodies in these locations should be referred to appropriate specialists for eventual removal.

Sometimes harmless foreign bodies are psychologically distressing to patients, particularly when they are visible under the skin surface or produce a lump. Patient concern may be a justification for elective removal.

Successful removal of foreign bodies requires adequate local or regional anesthesia and good lighting. Depending on location and depth, tourniquet control of bleeding and assistance may be needed. Depth and accessibility of the object and physician time are the limiting factors for removal of foreign bodies by the emergency physician. Foreign bodies buried deeply in adipose tissue or muscle are difficult to locate. Most foreign bodies in hands should be removed because the hand is mobile and sensitive. Deep exploration of hands by the emergency physician is not recommended because magnification and experience are needed to avoid injury to numerous closely spaced vital structures.

The emergency physician may not be able to devote more than about 15 to 30 min to the removal procedure, particularly when other seriously ill or injured patients demand attention. This amount of time is sufficient for locating most foreign bodies. The patient should be informed before the procedure that the duration of the exploration will be limited. If more time is required, the patient should be referred to a surgeon.

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