Managing a fish induced injury

BMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7088.1199a (Published 19 April 1997) Cite this as: BMJ 1997;314:1199
  1. Philip D Henman, Orthopaedic registrara,
  2. David F Finlayson, Orthopaedic consultanta
  1. a Orthopaedic Department, Raigmore Hospital NHS Trust, Inverness IV2 3UJ

    Editor-We read David Berger's account of the emergency treatment of a fish induced chest injury with interest.1 In our area of the Scottish highlands patients are also frequently injured in remote areas where access to medical facilities may be limited and transfer complicated by distance, terrain, and weather. Help is readily available, however.2 We think that an accompanying commentary from a traumatologist would have been helpful since the one by John Rees referred to spontaneous pneumothorax, an entirely different condition.1 While admitting that the noble Scottish salmon rarely delivers more than a nasty suck, we would like to add our suggestions to the questions posed.

    1. What advice should have been given to the nurse over the radio?

      (e) None of the above.

      Use a big wound dressing and tape three sides.2 (What was the military physician thinking? Pre-BATLS [British advanced trauma life support], obviously.)

    2. Would it have been safe to fly him out and, if so, to what altitude?

      Yes, at 305 m. With a needle at the ready, a three way tap is unnecessary–and probably unavailable.

    3. How stupid was it to leave his wound uncovered…?

    Not stupid at all for two main reasons.

    Firstly, the patient was well. You should never miss a photo opportunity that is an aid to medical education.

    Secondly, once a barracuda has had its filthy way with you, a little sea breeze can only be of benefit.


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