Taking out splinters
Attention
- Wood splinters (eg from mulga) common in remote areas
- Can become infected if left in skin, especially if large
- If deep — consider underlying structures
What you do
Very small, shallow splinters
- If visible, attempt removal with fine tweezers
- If splinter remains — put on drawing dressing for 1–2 days. Splinter may come out
on its own
Larger splinters
- Sit or lie person comfortably
- Lay out dressing pack and equipment
- Wash hands, put on sterile gloves
- Clean site, drape with sterile towels
- Give local anaesthetic — wait 3–5 minutes for LA to work before starting the procedure
or ring block if needed
- Spear splinter with fine needle, lever out of skin
- OR cut skin with scalpel over length of splinter and then pull it out with forceps
- OR if wound shallow and splinter has jagged edges that will tear the flesh if pulled
back through entry site — cut opening at base of splinter, pull it through with forceps
- Suture if needed or leave open if risk of infection and review in 3 days
- OR if splinter under fingernail or toenail and unable to easily grasp end of splinter
with tweezers — Figure 7.3
- Use sharp scissors to cut small V shaped area out of nail over splinter — Figure 7.4
- Pull splinter out with small forceps — Figure 7.5
Taking ring off finger
Attention
If finger swollen from illness or injury — rings must be taken off to stop loss of
blood supply to finger
- If a lot of pain — ring block may be needed
- If following methods fail — ring may need to be cut off using metal ring cutters (best)
or wire cutters (if nothing else)
What you need
- Soap or grease
- Dental tape, fine string, mersilk
- Paperclip or fine wire
What you do
- Rub soap or grease finger, try to slide ring off
If that doesn't work
- Slide paperclip or fine looped wire under ring and loop dental tape through bend.
Pull one end of tape through under ring — Figure 7.6
- Hold tape end A and wind tape end B around finger toward fingertip, covering middle
joint — Figure 7.7
- Hold tape end B tightly, pull tape end A straight back over ring toward fingertip,
unwinding tape — Figure 7.8
Pressure of tape wound evenly around whole finger helps to reduce swelling. Ring should
slide over tape as tape unwinds
Taking out fish hooks
Attention
- Large hooks may need surgical removal — medical consult
What you need
- Strong string
- Sterile gloves
- Sterile dressing pack
- Chlorhexidine antiseptic solution
- Lidocaine (lignocaine) 1%, syringe and needles if needed
- Extra 5mL syringe and 16–18G needle
- Sterile suture set and sutures, if needed
- Pair of wire cutters, if needed
- Pair of pliers
- Goggles (fish hooks can become missiles!)
- Dressing
What you do
- Sit or lie person comfortably
- Clean area with chlorhexidine
- Lay out dressing pack and equipment
- Wash hands, don PPE including gloves and googles, put on sterile gloves
- Clean site, drape with sterile towels
- Give local anaesthetic — wait 3–5 minutes for LA to work before starting the procedure
or if trained and competent ring block
- Following curve of hook, push barb end of hook all the way through skin until it is
easily seen — Figure 7.9
- OR Loop some string or fishing line around hook where it enters skin
- Push down on hook shank while giving firm, sharp tug on string to pull out hook —
Figure 7.11. Be bold! — be careful of flying hook, keep out of its path and wear eye protection
- OR Push 16–18G needle attached to small syringe through hook entry site so needle bevel
is over barb point — Figure 7.12. Bring both needle and hook back out through entry site
- OR Make small cut in line with curve of hook — Figure 7.13
- Clean puncture sites with normal saline OR water — apply a dry dressing if required — give education on wound care