Chapter 2: Appendages

Case 2-1: Turtle bite

Patient Presentation

This patient presented to the emergency department (ED) with the head of a very large snapping turtle biting down on his left thumb. The patient had caught the turtle, decapitated it, and placed the turtle’s head into a bucket. A short time later, while reaching into the bucket, he accidentally placed his left thumb into the turtle’s mouth, and the turtle head reflexively bit down on his thumb. The patient could not remove the head and presented to the ED for assistance. He was in a mild amount of painful distress.

Clinical Features

The turtle’s head was clamped down onto the patient’s left thumb. No open wounds were noted.

Differential Dx

• Musculoskeletal injury

• Fracture

• Open wound

• Tendon or joint injury

Emergency Care

The turtle’s head was pried off using two pliers. There were no significant wounds to his finger.

Outcome

The patient was discharged.

Key Learning Points

• Pliers are yet another tool that the emergency medicine physician should have in the departmental toolbox.

• An anecdotal statement was made by this patient that decapitated turtle heads will continue to reflexively bite down for up to 9 days after decapitation. Non–peer-reviewed, online discussions corroborate this postdecapitation reflex.

• The force of a turtle bite is dependent on several factors, including the size of the turtle and the shape of the turtle head. Forces of up to 400 N have been observed.

Further Reading

Case 2-2: Multiple subcutaneous broken needles

Patient Presentation

A 39-year-old male patient presented with bilateral arm swelling, pain, and a fever. He stated he had a long history of IV drug abuse and had broken off many needles in the process of self-injection.