Here, Fishy, Fishy

The skilled ED provider always takes proper precautions before attempting fish bone removal and preparing for patient discharge. And a sensible provider never sends an anxious patient down river without a thorough exam.   Fish bones are usually slightly waxy, bendable, and sharp. These tiny bones lodge themselves in the throat with a vengeance. Common nesting sites of fish bones include the base of the tongue, tonsils, posterior pharyngeal wall, aryepiglottic fold, or upper esophagus. Late complications of leftover fish bones in the throat may cause airway obstruction or rarely esophageal perforation. The patient is always at risk of aspiration before and during the procedure. All fish bones should be removed immediately. ENT consultation with endoscopy may be necessary if you are unable to locate and remove the bone itself.   The literature is mixed about plain radiographs vs. a soft tissue CT of the neck. A CT scan of the neck is warranted if the patient has dysphagia, is bleeding or choking, or has any other concerning signs and symptoms. You may consider a CT scan if the patient has a negative neck x-ray and his symptoms are severe. Not all fish bones are visualized on plain films, and the anxious patient should not be overlooked. Photo by Martha Roberts Photo by Martha Roberts   The common laryngoscope or a fiberoptic nasopharyngoscopy such as a GlideScope are used to assist with this procedure. Don’t get too excited; we are not going to sedate and intubate this pa...
Source: The Procedural Pause - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs