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earlobe) Technique See preparation above Tie fishing line, Suture or umbilical tape onto hook Tie at midpoint of bend in hook Hold string tightly or attach to Tongue depressor Stabilize involved skin against flat surface Stabilize the hook between the index finger (on the hook's curve) and the thumb (supporting the hook's eye) Depress hook's curve with the index finger (as in Retrograde Method) to disengage the barb Clear path of fishhook of people Give string a firm, quick jerk Resources String Yank Technique (Image) String Yank Technique (YouTube Video) Second-Line Technique Needle Cover Technique Indications Large hooks with single barbs Barb superficially embedded Images Needle Cover Technique Technique See Preparation above Advance 18 gauge needle along entrance of fishhook Insert parallel to shank Bevel pointing toward inside curve of hook Longer edge of needle matches end of hook angle Disengage barb by advancing fishhook Pull and twist hook so hook point enters needle lumen Back the needle and hook together out of the wound Third-Line Technique Advance and Cut Technique Indications Large fishhook Fishhook near skin surface Advantages Highly successful technique Disadvantages Increased Trauma to surrounding tissue Images Advance and Cut Technique Technique See Preparation above Advance hook/barb through skin (use needle driver) Single Barb Cut barb off and back hook through skin Multiple Barbs Cut off eye of hook and pull hook through skin Management Post-operative wound care Explore wound for additional foreign bodies Do not Suture wound Apply Antibiotic ointment and bandage General Antibiotic prophylaxis is not typically indicated in healthy, uncomplicated wounds Indications Immunocompromised Diabetes Mellitus Peripheral Vascular Disease Deep wound involving Muscle, tendon or ligament Typical prophylactic Antibiotic selection Start with coverage of typical skin flora (Staphylococcus Aureus, Streptococcus Pyogenes) Cephalexin or Cefadroxil Dicloxacillin Contaminated wounds (stagnant water, sea water, rivers, lakes, ponds) Possible exposure to many atypical organisms: Aeromonas, Vibrio vulnificus, Ersipelothrix, Mycobacterium Marinum Broad prophylaxis is NOT recommended (beyond typical described as above) Instead perform close interval follow-up Start with typical narrow coverage as above Significant active Wound Infections after contaminated water exposure are empirically covered broadly First Generation Cephalosporin AND Fluoroquinolone AND Doxycycline (if sea water for Vibrio species) AND Metronidazole (if contaminated with sewage) References Brothner in Stack and Wolfson (2024) Fish Hook Removal techniques, UpToDate, accessed 10/27/2024 Sinkoff (2024) Freshwater Fishhook Injuries and Antibiotic Prescribing Patterns, Henry Ford Scholarly Commons Doser (1991) Am J Emerg Med 9(5):413-5 +PMID: 1863292 [PubMed] References Haynes in Pfenninger (1994) Procedures, Mosby, p.128-32 Warrington (2024) Crit Dec Emerg Me 38(10): 20-1

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