The Ole' Bead in the Nose

Welcome to 'The Newport Catch' series-- a collection of community emergency medicine cases from our local hospital in seaside Newport, RI.

As a PGY-4 EM resident, I feel that I can really manage sick patients. Not only am I up to date on the literature, but advanced procedures are now easy-peasy. Cardiogenic shock? Got it. Intrathecal pump with bolus issue? Done-zo. Buuuut a level 4 chief complaint? About a 50% chance I’ve actually seen it before. Paronychia?  Eeeh. Splinter removal? I mean, I could figure it out. Foreign body in a nose? Sure, I guess I've read about it. But let’s be honest -- usually patients with these complaints go to the Advanced Practice Providers (APPs) or the fast track doctor.

But on my community hospital rotation in Newport, I finally got to see my first Bead-In-The-Hole -- and I’d like to share my experiences. 

THE PATIENT: An unhappy four-year-old with a pale pink bead wedged high in her right nare. 

The first thing I considered was a technique described often in which the parent blows into the mouth of their child, often referred to as "the mother's kiss" technique.

Method 1: 'THE MOTHER's kiss'

Instruct the mother (or other loved one) to close the opposite nostril and blow into the child’s mouth. 

Sure. Sounds great. Everyone says it works so well. This technique is touted as a clever and effective method...except that it's totally awkward. At least when we tried it, it was downright weird, and felt like we were forcing both mother and child. The child kept screaming “no more KISSES! I don’t want to kiss you!" We tried it about 6 times, but it didn’t work and the awkward tenor of the interaction was palpable. 

So I moved on…

Method 2:GLUE ON A STICK

The Dermabond on the stick trick?  We didn’t try it. I imagine it works well with a blue bead, or purple bead. But with a pink bead? Well, pink beads look a whole lot like the rest of the inside of the nose. So I moved on.

Method 3: SUCCESS!

Thanks to Jerry (one of the APPs in Newport) and Dr. Pensa, I was introduced to the awesomeness that is the Katz extractor. See the picture below:

Figure 1: The Katz Extractor! 

It is essentially a q-tip with a balloon at the end. You just stick the skinny bit right by the bead, blow it up, pull downwards, and voila, you have yourself a bead!

If you don't have a Katz extractor, this can also be done with a Foley: see this ALiEM post for a description (and a video of the Katz extractor in action.) For even more on nasal body extraction techniques, see this post from Life in the Fast Lane.

The patient was so thankful she let me hold her stuffed horse, named Elsa. The very definition of success! 

Elsa -- and her 'all-better' owner -- say "thank you!"