maggots?

[billsnurse]

Hi Everyone,

Does anyone have any experience with patients coming into the ED with maggots on them? What do you use to remove them?

Just thinking about it gives me the willies and I want to be prepared if it comes my way.

Thanks

[edmia, BSN, RN]

The patient had severed 3 of his fingers and they were using leeches to help revascularize the digits. Apparently they excrete something in their saliva that helps improve blood flow to the re-attached part.

Maggot and leech therapy have great clinical results. Maggots only consume dead tissue, so all the stories about maggots actually helping preserve a wound from more rapid deterioration are true.

Leeches are really great for wounds that need revascularization. I've seen it on post-op head & neck surgery patients. They're used to maximize the chances that flaps will take.

There's no need to worry about removing the leeches; they fall off by themselves when they're nice and full. It's a very cool thing to see. Most patients grow very fond of their leech friends .

[NRSKarenRN, BSN, RN]

Procedure for Removal of Maggots

http://rnceus.com/mag/procremov.html

Depending on location, followup patient soak in Hubbard tank ideal to remove community acquired non-sterile maggots.

[EMT-2-RN]

Working in the ER I took care of a patient who was a burn victim 2 years prior. He was homeless and his legs had horrible wounds all over with dressings that looked like they had been there for at least a month. The smell was terrible. When taking of the patients socks and shoes, there were not only maggots but ants and small spiders crawling around. I had seen maggots in wounds before, but not like this. There were thousands. I tried soaking his wounds, flushing with betadine and Hydrogenperoxide. Nothing worked. As soon as you could scrape the maggots off and out of his wounds more would crawl out from. We did the best we could but I believe this man ended up having to have his legs amputated. It was certainly something to see.

[Ninaer]

7 years ago, I had a pt with the exact same thing. She lived with her husband and did not know anything about it. The reason why she had come to the hospital was that she became very lethargic. Too make the long story short, she had a rotting left breast/gangrenous/with strong odor/ and was very jaundiced.

[DoubleblessedRN, ADN, RN, EMT-B, EMT-P]

Pt was a lady in her 40s- well dressed and appeared clean. She had a fungating CA of the breast. She kept it covered all the time at home, and never looked at it, even when bathing.

Well, we convinced her to let us take the dressing off- and there were maggots in her rotting breast.

EEEEWWWWW!! I once saw the EXACT same thing.

[northshore08]

bringing back memories....

I agree that the smell is usually related to "other things" about the patient, not the maggots. My biggest memory about this subject was a morbidly obese bed-bound pt with tunnelling bedsore; you could see them under the skin. I believe she went off for debridement...I remember brushing the little buggers off the bed while cleaning up, and thinking how they looked like soft grains of rice.

I, for one, am grateful for decon showers.

[EMTandNurse2B]

I have a very strong stomach, but I draw the line here. I have yet to see maggots on a living human (thanks to a kind coworker who removed them from between the homeless psych pt's toes), but when I do I'm pretty sure I will faint.

The problem with community acquired maggots, as another poster pointed out, is that there are several kinds, and not all of them stay on the surface. Some kinds eat living flesh as well and will burrow into the person and literally eat them from the inside out.

I grew up on a farm, and saw this happen twice to long-haired rabbits. Once the process starts, and the maggots are inside, they are just about impossible to get out. Now, I imagine that a human being so much larger, it would be much easier to save them, but the limb/etc might have to go.

That said, ever since the rabbit incident, I DO NOT handle maggots very well. This ER nurse will be on the floor, despite her reputation for handling anything without even gagging. There is a line!

[Heatherheartsou, BSN, RN]

I just had to do a maggot removal yesterday. The patient was a homeless gentleman with bilat lower ext. cellulitus. He came in by EMSA for leg pain... but wow. He had maggots all over his legs and feet. He was also suffering from some psych issues (obviously) and he had lice. Anyway, we rolled him on the gurney to the decontamination shower to hose the suckers off because no one wanted to touch him until he had been bathed. The whole time he denied having maggots. He thought we were lying to him. But he also thought he was God... so.... We wore hazmat suits, face shields, taped our gloves down, etc. He is someone I will never forget, unfortunately.

[aknurs]

I have heard about maggot therapy before and when they remove them from the wounds of pts. they have grown 10x's their original size and are easy to remove. I would think a person walking into the ED would need a bar of soap and a hose. Yuck!

Soap & water are your friends . :wink2: Maggots are not as bad as someone coming in with roaches running from their clothing and out of their bag of medications. At least the maggots don't scurry off.

[AnnieOaklyRN, BSN, RN, EMT-P]

Magots happen, mostly on elderly patients with wounds and people at home htat cannot care for themselves. All it takes is a fly, and I dont think the eggs are visible to the naked eye until they become magets, so I can see how it happens.

They are not all that bad, maggots are good, they eat only the rotting dead tissue and leave the healthy stuff alone. I suppose, though in the wild they may add to the bacteria in the wound.

Sweetooth

[Athena1970]

We had a homeless man come in with the entire top of his foot swollen (with maggots). The nurse didn't realize it at first and was feeling for pulses, and "it all moved"....

I do believe at some point they were going to debride, but in the meantime, I got several bottles of betadine and had the man soak his foot in it.......those things just poured out.......we had him soak for about 15 minutes and, of course, by then, the betadine was thick with maggots.....some of which seemed to still be squirming around.......it was pretty awful, although he seemed to take it all in stride while most of the ED staff was horrified.

I hope not to see that again!

A.

[klcrn1987]

We have a pt that is a frequent flyer that routinely comes in with maggots in her bilat lower legs. She has elephantits and isn't very good at taking care of herself. All you have to do is say the initials "JH" in our place and everyone shudders!!

I've never had to deal with her when she first comes in but I think I could handle the maggots before I could do roaches.....I DON'T do roaches...

I think for me it would be more the smell than actually seeing the maggots....by the time they get maggots, the wounds are usually pretty nasty....