| Cited |
| EMS Training Course |
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Subject: Body Modification and You: The Street Paramedics Overview
Site: EMS House of Defrance URL: www.defrance.org |
| WARNING |
| * This presentation will discuss in detail a lifestyle different from your own, and will contain slides of a graphic and adult nature. |
| * The purpose of this presentation is not to shock or offend, but to educate and facilitate better patient care. |
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* Every effort has been made to chose slides based on their medical merit, especially those showing genitals and similar features.
Dealing with piercings can be a pain in our butt |
| Objectives |
| * Understanding of people who undergo body modification so as to better interact with them in time of crisis. |
| * Identify basic types of Body Modification |
| * Identify common medical problems with body modification |
| * Successfully remove piercings that interfere with pt care. |
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I never wanted to be different , I just wanted to be me… |
| Brief introduction to Body Modification and its Culture |
| * Reasons |
| o Aesthetic |
| o Social Acceptance |
| + Rites of passage |
| + Social markings |
| o Identification |
| o Rebellion |
| o Sexual Enhancement |
| o Religious Reasons |
| o Others |
| + The Romans used their nipple rings to attach cloaks to. |
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+ Certain primitive tribes used piercings to mimic their prey.
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| Basic Types |
| * Tattoos |
| * Scarring and Branding |
| * Piercing |
| o Temporary |
| o Superficial |
| o Pocketing |
| o Deep |
| * Implants |
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* Incisions, amputations and other modifications
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| Mental Hold Issues |
| * There have been cases of patients being referred to mental health agencies for self mutilation |
| * Mainly for scarring, branding, and temporary piercing. |
| * The difference between self mutilation and body modification is INTENT. |
| * Other factors: |
| o Age of consent |
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o Desired outcome (changing sex, etc vs. body adornment)
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| Who can do this? |
| * Home Piercings are common because of a lack of safe, certified piercers to go to for the higher risk piercings. |
| * Legality |
| o Idaho |
| o Elsewhere |
| * Certifications |
| o Associations of Professional Piercers |
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o www.safepiercing.com
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| The Patients View |
| * Fear of: |
| o Ridicule by Medical providers |
| o Unnecessary removal |
| + Be prepared to justify your desire to remove any jewelry |
| + Fear of piercings healing closed. |
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* This leads to reluctance by patients to seek medical help for piercing problems.
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| The Piercers View |
| * If the pt didn’t go to a professional piercers, they would do it in their homes |
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* If more doctors were body art friendly, then the high risk piercings could be done safer in a clinic setting.
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| Piercings |
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“…Vanity looks best when it's wrapped in steel.” -Rev. Vain Jayne Church of Body Modification www.vainjayne .com |
| Standard/Surface |
| * All shapes and sizes |
| * Almost any location. |
| * Also includes |
| o Coring |
| o Stretching |
| o Pocketing |
| o Stapling |
| o Suspension piercings |
| * Flexible surgical plastic and solid bars |
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* Temporary and permanent
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| Deep |
| * Often go under or through tissues and structures. |
| * Usually flexible connection |
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o Surgical Teflon
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| Temporary |
| * AKA: “Play Piercing” |
| * Left in for only a short time |
| * More about the sensation than the piercing itself |
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* Often (not always) associated with BDSM or similar scenes.
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Temporary Piercings/Temporary Piercings-Other Examples
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| Stapling and Pocketing |
| * Easy to remove |
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* Not connected
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| What is normal after a piercing? |
| * Some redness, and bruising normal for up to 3 days afterward. |
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* Small amounts of white , clear, or off-white drainage is normal.
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| Understanding Bad Piercings |
| * Piercing Guns |
| o Hep B/C, etc |
| * Lack of sterile tech. and equipment |
| * Infections |
| * Rejection and Migration |
| * Scar tissue/Granulation |
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* Bad Locations
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| High Risk Piercings |
| * Cardiac Valve Disease |
| * Diabetes |
| * Immune suppressed |
| * Pregnancy |
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o Depending on location
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Infections and Abscesses
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| Infections |
| * Some redness 1-3 days post piercing is normal |
| * Drainage, pus, and red streaks are not. |
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* 95% of infections are from improper care by the patient.
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| Staph |
| * staphylococcus aureus bacteria |
| * Very common in our day to day environment. |
| * Becomes a problem when the integrity of skin is broken |
| * Causes abscess, boils, infections, and other problems with piercings. |
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* Depending on location of piercing may cause major problems to adjacent structures.
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| Allergic Reactions, Rejection and Migration |
| * An Allergic Reaction is generally acute, localized, and follows with other problems. Some people are allergic to certain lower quality metals. |
| * REJECTION is a process in which the pierced skin slowly dies. |
| * MIGRATION is the process where the weight, or position, of the piercing causes it to slowly “Grow out”. |
| * Takes weeks to months |
| * The jewelry may slowly be pushed to the surface of the skin, and may eventually grow out completely. This process may cause some scarring. |
| * Bets plan is to have the jewelry moving outward, you may wish to have the jewelry removed before complete rejection takes place. This will minimize any scarring. |
| * Some piercings are more prone to rejection than others. Low quality jewelry, non-implant grade metals, personal metabolism, ill health, bad diet, recurring infection, drug abuse, or inappropriate jewelry sizing are other contributing factors. |
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* The most common cause of rejection is untreated infection or irritation; treat problems quickly to avoid scarring and possible loss of your piercing.
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| Rejection |
| Non Emergent Treatments to Use |
| * Consider instructing the patient to call their professional piercer. |
| * No dial soap. |
| * The universally safe treatment for all piercings with no serious complications is SALTWATER. It can act as a maintenance treatment until you can see a qualified professional piercer or doctor. It is also an excellent non-irritating backup treatment in case of allergic reaction caused by another treatment. |
| * If you do not know the cause of your piercing difficulties, you are advised to eliminate all other treatments, and proceed with only SALTWATER, and seek professional assistance promptly. |
| * SALTWATER is made by adding 1/4 to 1/2 a teaspoon of Sea Salt to one cup (250ml) of warm water. Measurements provided are exact, do not use more or less salt. Do not use table salt. |
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* The piercing is then soaked in the solution using a cup or other container, or by wetting the piercing using saturated gauze or cotton balls. Keep the piercing soaked in the solution for about 5 minutes, then carefully move the jewelry within the piercing. Dry thoroughly with a clean tissue or paper towel.
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| General Removal Guidelines |
| * Remove a piercing emergently when: |
| o Airway is compromised |
| + Beware of lost pieces |
| o Inhibits Pt Care (Back Boards) |
| + Consider alternative or creative solutions |
| o May get torn or compromised during pt packaging. |
| o Poses a hazard to EMS providers (needles) |
| o X-rays of area are anticipated and it cant be removed later.(Optional) |
| o Defibrillation of chest when chest piercings are in place. |
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o Otherwise leave it in when ever possible.
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| General Removal Guidelines |
| * Always try to unscrew the ball first. |
| * Ring opening pliers are best |
| o Approx. $10.00-20.00 |
| o Stainless Steel |
| * Ring Cutters may rip out piercing |
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* Trauma shears may not get a good angle to cut
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| Using Ring Opening Pliers Simple and Quick |
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Don’t lose the Ball!
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| Other Methods |
| * Slower, but allow piercing to stay open. |
| * Threading an IV cath over piercing, and then through hole as piercing is removed. |
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* Remember, always use sterile tech. when messing with piercings!
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| The Ears |
| * Most common |
| * Improper piercing can cause: |
| o Infection |
| o Keliods |
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o Granulation/Scarring
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| Eye brow and Bridge Piercings, Around the Eyes, Anti-Eyebrow, Eyebrow, Eye Lid |
| * 25% of all Eyebrow piercings will migrate. |
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* Infection may migrate into orbit of eye, lachrymal glands, or sinus cavity
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| Nose Piercings |
| * Very Common |
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* Nostril, Septum, and Bridge are common.
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| Nasal Septum |
| * Causes problems with Nasal Airway and Nasal ETT Placement when in place. |
| * Repeated Peircings may develop scar tissue, posing minor placement problems |
| * May amplify blunt trauma forces |
| * May inhibit training of blood, causing airway issues |
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* Usually is a small diameter stylus between larger parts or is a Ring.
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| Naval |
| * Very Common |
| * Subject to rejection from rubbing, friction and irritation. |
| * 5-10% of all naval piercings will migrate. |
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* Increase in girth (pregnancy) may cause problems.
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| Oral General Info |
| * Relatively High Risk of Infection |
| * Airway Issues from: |
| o Abscess |
| o Bleeding and Soft tissue trauma |
| o Aspiration during removal |
| * Trauma from: |
| o Focusing blunt forces |
| o Erosion of tissues |
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o Dental damage
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| Uvula |
| * Poses complications for airway management |
| * Laryngoscope may tear ring |
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* Removal may result in Foreign Body Aspiration
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| Deep Oral |
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* High Risk piercing
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| Tongue |
| * Very Common |
| * Heals well |
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* May form white callous around piercing
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| Clavicle |
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* Poses complications for central line placement and Defib.
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| Nipple Rings |
| * Very common |
| * Should be removed if possible prior to cardioversion |
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* If cant be removed, tape in place (anecdotal advice)
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| Male Genitalia Piercings |
| * Anecdotal reports of Urethral shredding in blunt trauma. |
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* High risk of infection.
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| Female Genitalia Piercings |
| * Types: |
| o Hood |
| o Clitoral |
| o Labia |
| * May cause problems during childbirth. |
| o Obstruction of birth canal |
| o Tearing of soft tissue |
| o There are flexible items that reduce this chance |
| * Should be removed during active labor. |
| o May be replaced afterward by pt. |
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* Should be removed during Foley Catheter Placement.
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| Tattoos |
| * Ancient Art |
| * More widely accepted than piercings |
| * Also done in less than sterile environments, especially by minors and prisoners |
| * Same risks of infections apply |
| o HIV |
| o HEP B/C |
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* Ink problems as well.
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| Tattoo Infection and irritation |
| * Some redness is normal, it’s a dermal abrasion! |
| * Heat, red streaks, and puss are not normal, especially after 24-48 hours. |
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* Pain after 6 hours is not normal. Some very mild tenderness is OK.
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| Inks |
| * Technically falls under FDA as a cosmetic, However not currently regulated at federal level. (May change in next few years) |
| * The actual inks may be: |
| o Surface Cosmetics, not approved for injection |
| o Industrial grade printers ink |
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* Occasionally an allergic reaction may occur to the ink (rare)
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| Branding and Scarring |
| * Branding |
| o Tribal/Primitive |
| + Fire strike |
| o Modern |
| + Cautery Gun |
| * Scarring |
| o Skin Removal |
| o Tattoo Gun |
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o Ink Rubbing
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| Other Body Modifications |
| Ear Shaping |
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* Involves using an incision and sutures to reform the ear.
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| Implants (not THOSE type) |
| * Usually teflon domes or ˝ domes |
| * Low incident of rejection |
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* Risk of infection depends on piercers adherence to sterile technique
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| Dental Sharpening |
| * Prone to chipping |
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* May become airway problems if broken
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| Questions? |
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* Special Thanks to Nic , Professional Piercer at “Nobodies Hero”, Boise Idaho.
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| More info? |
| * www.safepiercing.com |
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* |
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Have a nice day
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| « Published |