Fahrenheit 500
Here's an ER story that came to me in a roundabout way. My brother used to work as a sales rep for a company (I'll call them Acme) that made power tools and other stuff for building contractors. They would share unusual stories during their sales meetings. This was one of them.
The rep, who I will call Adam, told about a call he'd received the prior week from a frantic ER doctor. He had a patient with an Acme glass tube in his rectum, and he had tried all sorts of ways to remove the tube—all to no avail. The doctor asked if it would be OK if he were to break the end of the tube, which was projecting an inch out of the anus. That, he figured, might make it easier for him to get a hold on the tube.
Adam implored, “No! Don't break the tube!”
The ER doctor inquired why, so Adam explained the technical details. The tube, which was 1¼ inches in diameter and 13 inches long, held two chemicals. When the tube broke the chemicals mixed to form an adhesive. The tube was designed to be inserted into a hole in concrete, into which a chisel-pointed threaded rod was inserted. The adhesive bonded the rod to the concrete, and 40,000 pounds of force were required to extract the rod once it bonded. That was not the worst part, though. When the chemicals mixed, an exothermic (i.e., heat generating) reaction occurred, which reached a temperature of 500° F. Had the tube broken inside the man, he would have been cooked from the inside out.
Now here's a question for prospective ER doctors: How would you handle this case? Breaking the tube is a poor choice even if the tube were empty, because fracture lines through glass can propagate in unexpected directions. Thus, breaking the tube could have turned a minor problem into a major one. So what would you do? Here is a chance to test your creative problem-solving ability. This is something that all ER docs should possess, because they're often faced with situations that aren't discussed in textbooks.
Incidentally, I posed this question on my www.ERbook.net site a few years ago, and I've received only two guesses thus far. One of them was an OK solution, but not the best. There is one way to treat such a case that is both simple and safe. Can you think of it? I'll give you a gold star (and perhaps more) if you figure out the optimal remedy. To submit your proposed treatment, see the Contact Me information on page 3.
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