Fun little case discussion: fish in neck.

[MirrorTodd]

---

Members do not see this ad.

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.

 

[dabears505]

Holy s!

 

[patriot6]

If I were the patient, I would want prop, sux, no tube, hypoxia, bradycardia, asystole

 

[deleted87051]

 

[coffeebythelake]

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

 

[ProwlerturnGas]

Save the fish. Don’t let good meat go to waste

 

[Mman]

View attachment 342854

based on the photos I'm gonna go ahead and say the platysma was "violated" with severe prejudice

 

[wholeheartedly]

how do you kill the fish to stop it from moving without injuring the patient?

 

[coffeebythelake]

how do you kill the fish to stop it from moving without injuring the patient?

Ikejime?

 

[MirrorTodd]

how do you kill the fish to stop it from moving without injuring the patient?

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.

 

[Urzuz]

@nimbus would send him to his ASC to have surgery. 🙂

 

[ChiDO]

@nimbus would send him to his ASC to have surgery. 🙂

If you do the block, I'll so the surgery. Young, healthy, insured. Seems appropriate candidate. 😈

 

[ProwlerturnGas]

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

 

[woopedazz]

Wonder if you need ethics approval to kill the fish

 

[Hork Bajir]

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.

 

[coffeebythelake]

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?

 

[Hork Bajir]

CT/CTA beforehand?

Can’t recall

 

[GassYous]

how do you kill the fish to stop it from moving without injuring the patient?

prop, sux, no tube, hypoxia, bradycardia, asystole

 

[DocVapor]

prop, sux, no tube, hypoxia, bradycardia, asystole

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

 

[ProwlerturnGas]

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.

 

[Hork Bajir]

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.

 

[GassYous]

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...

 

[Hork Bajir]

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

 

[repititionition]

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

 

[GassYous]

Yes. I am CT fellowship trained. I know where protamine comes from. That was the joke…

Times like these I miss Salty

Sounds like another guy who spends too much time baiting

 

[Hork Bajir]

yeah he got the joke too, thus the ellipsis at the end
Oh, missed that

Sounds like another guy who spends too much time baiting

I am a master baiter

 

[anbuitachi]

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

 

[Sushirolls]

Save the fish. Don’t let good meat go to waste

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.

 

[IMGASMD]

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.

 

[Bones411]

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.