Fun little case discussion: fish in neck.
Started by MirrorTodd
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Holy s!
If I were the patient, I would want prop, sux, no tube, hypoxia, bradycardia, asystole
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D
deleted87051
Posterolateral injury. Give him some versed, get someone to fetch a sharp Japanese blade to cut the fish into a more manageable size, go to CT scan to evaluate for vascular or neuro injury. Then prop suxx tube and blah blah blah
Save the fish. Don’t let good meat go to waste
based on the photos I'm gonna go ahead and say the platysma was "violated" with severe prejudice
how do you kill the fish to stop it from moving without injuring the patient?
Ikejime?
Doesn't look like they pithed it. Ripping out the gills is usually how I would dispatch a fish after spearing it. Usually I'll put a blade into it's forehead and wiggle it around.
If you do the block, I'll so the surgery. Young, healthy, insured. Seems appropriate candidate. 😈
Fish already did the block. Combination cervical plexus + ISB
I had a patient with a similar type of neck injury once, though in that case the mechanism was a slash rather than a stab. The superficial cervical plexus had been damaged and so he was essentially insensate in the area of the injury- when I first saw the guy I was thinking AFOI, but we ended up letting the surgeon explore it under a very very light MAC. Worked out great. The plan was to go slow, supplement with local, and if any major injuries were identified (esophagus, trachea, carotid, etc) then to stop and intubate… Turned out not to be necessary. Was kind of a cool case.
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CT/CTA beforehand?
Can’t recall
prop, sux, no tube, hypoxia, bradycardia, asystole
What about the suxx fasciculations? Wouldn't high-dose roc be smoother?
No no no. I think we are overlooking the obvious. How long do fish survive outside water?
Drugs will ruin the meat, and if I am this kid, I am eating that fish with revenge in my heart!
As for anesthetic management. A CT/ CTA would be great but looking at pics, the airway looks spared so Prop/sux/tube.
Drugs will ruin the meat, and if I am this kid, I am eating that fish with revenge in my heart!
As for anesthetic management. A CT/ CTA would be great but looking at pics, the airway looks spared so Prop/sux/tube.
Maybe a dumb question, but would IM sux for sure kill the fish? Maybe we could drip some liquid iso onto its gills to get it to stop moving. May also kill it, who knows.
I’d also like some imaging, mostly because it would be fun to look at. IV contrast for both the fish and the patient.
If this were an oral board stem, I’d be talking about avoiding any stimulus to the fish which could cause it to discharge it’s “naturally occurring substances” in case the patient has a protamine reaction
Of course in reality, this would probably be prop/sux/tube.
I’d also like some imaging, mostly because it would be fun to look at. IV contrast for both the fish and the patient.
If this were an oral board stem, I’d be talking about avoiding any stimulus to the fish which could cause it to discharge it’s “naturally occurring substances” in case the patient has a protamine reaction
Of course in reality, this would probably be prop/sux/tube.
You know that protamine is made from fish sperm right? Why would the patient have a reaction to protamine unless he's already had prior exposu...
Yes. I am CT fellowship trained. I know where protamine comes from. That was the joke…
Times like these I miss Salty
yeah he got the joke too, thus the ellipsis at the end
Sounds like another guy who spends too much time baiting
yeah he got the joke too, thus the ellipsis at the end
Oh, missed that
Oh, missed that
I am a master baiter
impressed he left it there. prob good he did but if i were in that situation, i think my immediate reflex would be to pull it out. and id probably die afterwards
Serve that fish up for his first post op meal.
Scut an intern to walk it down to the hospital kitchen - that's one scut work story an intern will cherish to tell for the next 30 years.
Name checks out.
Not sure what species the fish is but be very careful using sux, this landmark study in Anesthesiology July 2018 about dolphins states:
addition, since Nagel et al.6 reported that the dolphin does not have plasma cholinesterase, which is needed for the metabolism of succinylcholine, it is important to note that succinylcholine is contraindicated in the dolphin.
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