Failure to diagnose the presence of a foreign body has emerged as a common cause of malpractice actions against general practitioners. It is particularly important to locate and remove foreign bodies, especially splinters in children, glass slivers after motor vehicle accidents and pub brawls and metal objects such as needles in the feet of children.
The larvae of the common blowfly can find their way into the most unexpected corners of the body, and can be extremely difficult to remove.
This unusual problem is more likely to occur in unkempt people, such as alcoholics and itinerants, and in those with exposed wounds. Examples of sites that can become infested are the eye, the ear, traumatic wounds in comatose victims, and rodent ulcers.
The presence of maggots should be suspected when an unkempt person presents with a red eye and with marked swelling (Fig. 10.1). When disturbed, the maggots crawl for cover and are difficult to see and remove.
Instil LA (e.g. amethocaine).
Instil two drops of eserine or pilocarpine to ‘paralyse’ the maggots.
Remove the maggots with fine forceps or flush out.
A writhing mass of maggots can be a difficult problem, and has to be rendered inactive. The old ‘trick’ was to use chloroform, but ether is just as effective.
Irrigate the infested wound with the anaesthetic until the activity ceases.
Carefully remove all the intruders.
Apply 10% dextrose to the maggots. If unsuccessful apply 50% dextrose.
There are several varieties of leeches in this country, but the most troublesome are the small, black leeches that inhabit the damp forests of New South Wales, Victoria and Tasmania. The major problem is the difficulty of removing a parasite adhering firmly to such awkward anatomical sites as the eye, or the urethral meatus in men.
No attempt should be made to extract the leech manually. There are several methods of inducing leeches to ‘jump off’ rapidly:
application of hot objects
application of salt
application of a detergent
application of toothpaste
slicing the leech in half with a knife.
Carefully apply a hot object near the end of the leech. The object could be the hot tip of a snuffed out match (Fig. 10.2) or the heated end of a paper clip.
The leech soon lets go!
Removal of leech from the eye
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