{ "schema_version": 1, "kind": "condition", "id": "skin-foreign-body", "name": "Foreign body in the skin (splinter)", "category": "acute", "sources": "Lidocaine Hydrochloride Injection BP 1% w/v SmPC sections 4.2 and 4.4 (eMC product 6277) · No dose - assessment step, no medicine given · Skinner EJ, Morrison CA. Wound Foreign Body Removal. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-.", "review_status": "reviewed", "verified_against": "Lidocaine Hydrochloride Injection BP 1% w/v SmPC sections 4.2 and 4.4 (eMC product 6277) · No dose - assessment step, no medicine given", "verified_date": "2026-08", "treatments": [ { "id": 1645, "generic": "No drug therapy in primary care (Assess first)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": "Most splinters are removed, not medicated. Settle three questions first. Can the whole object be seen and reached? Is it organic - wood, thorn, spine - in which case it must come out, because organic material always becomes infected? Is it glass or metal, which may sit far deeper than the entry wound suggests and should be x-rayed? Then check tetanus cover.", "adult_duration": "Assess, then decide", "dose_source": "No dose - assessment step, no medicine given", "rationale": "The harm here comes from leaving part of the object behind or missing a deeper injury, not from choosing the wrong drug. Getting the assessment right is the treatment.", "cautions": [ "Wounds contaminated with soil, saliva or manure, and every puncture wound, are tetanus-prone. Check the immunisation history and complete it - assume nothing about adult booster status.", "Refer rather than explore: glass or metal whose end you cannot see, anything near a tendon, joint, artery or nerve, anything in the eye or face, and any foreign body in a diabetic or ischaemic foot.", "A puncture wound through a training shoe is the classic route to Pseudomonas osteomyelitis of the foot. Have a low threshold for referral if it stays painful.", "Irrigate copiously with clean running water or saline. The volume of irrigation matters more than which antiseptic is used.", "There is no routine indication for a prophylactic antibiotic in a simple splinter that has been fully removed and cleaned. Treat infection if it develops.", "A retained fragment presents later as a persistent tender lump, a sinus that keeps discharging, or a wound that will not heal. Consider ultrasound - it shows wood and thorn, which x-ray does not." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "In a small child, weigh the distress of digging for a tiny superficial splinter against letting it work its own way out. Anything organic, and anything driven into the foot through a shoe, still has to come out.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "skin-foreign-body" }, { "id": 1646, "generic": "Lidocaine", "line": 1, "is_adjunct": false, "form": "injection", "strength_mg": null, "adult_dose": "Infiltrate the 1% solution around the entry site: 0.5 to 30 mL (5-300 mg), titrated to the size of the field. A single dose must not exceed 4.5 mg/kg or 200 mg, whichever is the lower.", "adult_duration": "Single dose at the time of removal", "dose_source": "Lidocaine Hydrochloride Injection BP 1% w/v SmPC sections 4.2 and 4.4 (eMC product 6277)", "rationale": "Local infiltration is what makes a clean, unhurried removal possible. The commonest reason a fragment is left behind is that the removal was attempted on an unanaesthetised patient who could not keep still.", "cautions": [ "Check the maximum against the patient's weight before drawing up, not after. 200 mg of a 1% solution is 20 mL.", "Aspirate before injecting and inject slowly. Inadvertent intravascular injection is what causes systemic toxicity.", "Perioral tingling, a metallic taste, dizziness, tinnitus or agitation after injection are the first signs of systemic toxicity. Stop, and give no more.", "The dose above is plain lidocaine. Do not use a lidocaine-with-adrenaline preparation on a finger, toe, ear, nose or penis without a deliberate reason - those are end-arterial sites.", "Injections in the head and neck can enter an artery and cause cerebral symptoms even at low doses.", "Wait for it to work. Infiltrating and cutting immediately is the other reason removals go badly.", "Contraindicated in known hypersensitivity to lidocaine or amide-type anaesthetics, complete heart block, and hypovolaemia." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Not recommended in neonates. Under 12 years: local infiltration must not exceed 3 mg/kg (not repeated more often than every 4 hours). Age 12-18 years: max 4.5 mg/kg or 200 mg.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": [ { "label": "1 month to 11 years", "age_min_months": 1, "age_max_months": 143, "dose_text": "Local infiltration must not exceed 3 mg/kg, and not more often than every 4 hours. Not recommended in neonates." }, { "label": "12 to 18 years", "age_min_months": 144, "age_max_months": 216, "dose_text": "Maximum 4.5 mg/kg or 200 mg" } ], "peds_doses": null, "brands": [ { "trade_name": "LIDOCAINE 1% (OTSUKA) AMP. 5 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "OTSUKA", "price_egp": 5.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "KAHICAINE 1% 50MG/5ML 3 AMP.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "KAHIRA", "price_egp": 10.5, "pack_count": null, "unit_price": null, "strength_mg": 50.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "LIDOCAINE HYDROCHLORIDE 10MG/ML AMP. 2 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHARCO B", "price_egp": 2.0, "pack_count": null, "unit_price": null, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "LIDOCAINE HCL 20MG/ML VIAL IM IV SC 20 ML (NET PRICE)", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SIGMA TEC > VODACHEM", "price_egp": 9.75, "pack_count": null, "unit_price": null, "strength_mg": 20.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "LIDOCAINE HCL 20MG/ML VIAL IM IV SC 50 ML (NET PRICE)", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SIGMA TEC > VODACHEM", "price_egp": 11.25, "pack_count": null, "unit_price": null, "strength_mg": 20.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DEBOCAINE HCL 2% 50ML VIAL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ARABCOMED > DEBEIKY", "price_egp": 33.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ULTRACAINE 20MG/ML VIAL 50 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEMPHIS", "price_egp": 33.0, "pack_count": null, "unit_price": null, "strength_mg": 20.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "LIDOCAINE 2% 10 AMP.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ALEXANDRIA", "price_egp": 90.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "skin-foreign-body" } ] }