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 those who are homeless or have alcohol addiction, 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 (physostigmine) 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.
REMOVAL OF SUBCUTANEOUS FLY LARVAE (CUTANEOUS MYIASIS)
The cutaneous lumps of larvae (maggots) of flies tend to present as itchy ‘boils’. These are usually seen in travellers to tropical areas whereby the flies can introduce the larvae through a skin bite. Examples are the bot fly of Central and South America and the Tumbu fly of Africa. The simplest treatment is lateral pressure and tweezer extraction through the small circular hole or placing of petroleum jelly (Vaseline) or thick ointment over the lesion to induce emergence by oxygen restriction, then apply a topical antibiotic. A similar principle is to tape strips of plastic over the lesion, then bandage as appropriate. Leave for 2 days and then carefully squeeze out the maggot by lateral compression.
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, ...