Case of a 22-year-old with a history of low-functioning autism and congenital motor dysfunction with a cactus spine injury to a large surface area of her chest, abdomen, and extremities. Conscious sedation utilizing intramuscular ketamine and Operating Room (OR) hair removal mitts were utilized to quickly and effectively remove the cactus spines.
A 22-year-old woman with a history of low-functioning autism and congenital motor dysfunction presented to the emergency department (ED) at Summa Health – Akron City Hospital (Akron, OH) with numerous cactus spine puncture wounds. Four days prior to presentation she fell into her parents’ decorative Opuntia(e.g., “prickly pear”) cactus. The wounds were distributed throughout her torso and upper and lower extremities. There was slight erythema surrounding the embedded spines. While the patient could not cooperate or provide a history because of her nonverbal status, her pain was evident in her moans, cries, and winces as the providers touched the spines during her physical examination.
The patient was morbidly obese with limited ability to ambulate. Her parents and an aide accompanied her to the ED. They reported an extensive history of combative behavior towards healthcare providers. For this reason, conscious sedation with ketamine was initiated prior to spine removal. 4 mg/kg of intramuscular ketamine was administered. Once conscious sedation was achieved, a team of four providers removed the spines using adhesive preoperative hair removal mitts. After fifteen minutes, essentially all of the superficial needles had been removed, with the exception of a few spines that were too deep to be removed with the adhesive gloves. The patient’s shirt was removed and disposed of as it too was covered in numerous spines. There was no incidence of hypoxia or emergence reaction following the administration of Ketamine.
Within the next hour, the patient recovered to her baseline mental status and was ambulating throughout the ED with her typical gait. Prior to discharge, she was given an oral dose of 875 mg amoxicillin/25 mg clavulanate (Augmentin) and an intramuscular dose of Tdap (tetanus immunization); her parents were instructed to bring her back to the ED if any fevers, chills, or swelling of the wounds occurred.
The patient was evaluated 2 weeks after the injury and was noted to have some persistent erythema on her arms and anterior thighs. The patient was given a prescription for Augmentin to be taken twice daily for 7 days. No additional spine removal was required.
Upon repeat evaluation at 4 weeks, the patient demonstrated complete resolution of the erythema and no further spine removal was necessary.