Today’s article came suggested by a reader, so thanks Dan. If anyone else has any topics or articles they’d like covered, feel free to email me or hit me up on twitter.
Noodling is the practice of fishing using just your hands. Typically used on catfish, it involves putting your hand into holes where the fish typically dwell. The fish then bites the noodler’s hand or hands, usually in a defensive manner. This allows the fisher to grasp the fish and hopefully pull in the catch while it spins to try to release itself. If successful, then the fisherman gets to figure out how to remove his or her hand from the fish’s mouth.
It doesn’t take a lot of imagination to come up with numerous types of injuries the fisher can receive during this activity. The article itself describes a case report of multiple extensor injuries on the arm of a 14-year-old patient secondary to the bite of a 60 lb catfish. He did well, but serves as a good example of the forces involved from such large fish. And that’s not even mentioning the envenomations that can be received from the spines on the dorsal and pectoral fins, or the infections possible from the environment in which the injuries are received.
The recommendations for management of noodling injuries are reasonable. Sure, they should be examined carefully for neurovascular compromise, as well as structural injuries, like any other animal attack.Always consider imaging for suspected foreign bodies. If horned, hot water is best, like most if not all marine envenomation syndromes. I do like that they recommend early protected mobilization to decrease freezing of joints.
Then they go and recommend leaving wounds open to heal by secondary intention or delayed primary. With adequate irrigation, I would argue they can be closed primarily if no significant crush injury is noted. At least they don’t recommend using “loose closure” or anything else that isn’t useful. The need for surgical specialties for tendon or deep muscle injuries is not particularly earth shattering, but some may need to be reminded. As always, give the lifesaving tetanus prophylaxis and use antibiotics that cover gram negatives as well as gram positives.
Sure, nothing terribly new described in the for most marine or freshwater injuries, but still a pretty good article.
Kaar CR, Plikaitis C, Germino KW, Nakanishi AK. Catfish noodling forearm injury requiring urgent surgical treatment: a case report and review of the literature. Wilderness Environ Med. 2014 Mar;25(1):75-9. [PMID 24412658]
EBM Gone Wild