I was working in a rural emergency department a little while ago and a patient was brought in, limping and screaming(and I mean screaming) in pain. He had something attached to his foot. See the photo. As it turns out, he’d been fishing for catfish in a river and had stepped on one and the barb that the fish has, had entered the sole of his foot. The fish had been thrashing around, so they killed it, (I’m not sure how), cut it’s tail off and taped it to his foot with electrical tape and brought him in.
Now I’m not a fisherman, and I’ve never quite had a case like this before, so I wasn’t aware of how long this barb might be, but I was certainly sure it was painful for this man. A quick look on the other side of the fish did give us a clue.
So we started with some reassurance……really? What were we thinking, that wasn’t very effective. Then rapidly delivered some nitrous oxide(no contraindications). I’m using more and more of this. It worked quickly and effectively and gave us a window to put in some local anaesthetic adjacent to where the barb had entered his foot.
It needed only a minor nick next to the barb, then the fish had to be broken off at that point, to allow access. All that was then needed was a gentle pull on the barb with some suture-holders……..and voila, the whole barb came out!
Some antibiotics and an ADT, a dressing and a review planned and we were set!
The patient embraced me and left soon after, taking the fish with him, so he could cook it for dinner…….