Fun little case discussion: fish in neck.

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

MirrorTodd

It's a gas.
15+ Year Member
Joined
Apr 23, 2006
Messages
18,562
Reaction score
11,215
Not my case just something I found online on a spearfishing forum. Let's play what would you do? Teenager, healthy. No images, teen not in distress albeit nervous from you know, the giant ducking fish in his neck.
20210831_191826.jpeg
20210831_191804.jpeg
 
Last edited:
Wonder if you need ethics approval to kill the fish
 
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.
 
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.

CT/CTA beforehand?
 
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.
 
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.
 
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.

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...
 
What about the suxx fasciculations? Wouldn't high-dose roc be smooth

What about the suxx fasciculations? Wouldn't high-dose roc be smoother?
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.
 
Top