Monday, June 27, 2011

The weekend

Sorry for not posting this weekend - I worked 2 14 hour shifts, and I am exhausted. We were busy all weekend. It wasn't crazy busy, but steady enough and with enough complicated patients that I didn't have much time to eat or sit down.

We had a really fun, rewarding case come in yesterday afternoon, in the midst of all of the clamor. A man called to tell us that his dog had swallowed a fishing hook. This in and of itself isn't all that exciting - puppies get hooks embedded in their lips or swallow them all the time. My colleague took a 3 pronged, barbed hook out of a Labrador puppy's stomach just this weekend.

When this dog came in however, it was a new wrinkle on an old problem. Fishing line with a weight was hanging out of the dog's mouth. The dog was vomiting copiously and repeatedly, making me suspicious that the hook wasn't in the stomach at all. We sedated her and xrayed her head and neck. Sure enough, the hook was in the back of her oropharynx. Two of the barbs had engaged the soft palate and the other was through the glottis. The hook was effectually holding the airway partly closed. This was not a large dog (22.5 pounds), so getting back there to get that hook out was going to be a huge challenge.

If you're not a fisherman or if you've never looked at hooks closely - they are barbed in such a manner that once engaged, they will not back out of the tissue. This assures that your fish does not get away. The hook had done its job well...there was no way it was going to be backed out of the flesh.

We knocked the unlucky pup out with Propofol and intubated her, then examined our problem. It would take two people - one to push the barbs through and hold the tips with hemostats (to prevent the barbs from falling down the esophagus) - and one to clip with the wire cutters.

It took an incredible amount of finesse and finagling, but 20 minutes later, I held the fish hook in my hand. The puppy recovered well and went home no worse for the wear (although probably with a bit of a sore throat).

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