Catfish Barb Removal: Expert Guide to Treatments, Symptoms, and Effects

16.03.202309.06.2023 by alexxlab

How does catfish barb removal work. What are the symptoms of catfish spine envenomation. How long does the pain from a catfish sting last. What are the potential effects of catfish barb injuries.

Содержание

Understanding Catfish Spine Envenomation: A Comprehensive Overview

Catfish spine envenomation is a common yet often underreported injury among freshwater and saltwater anglers. With over 1,000 species of catfish worldwide, many possess the ability to secrete a proteinaceous toxin or inflict venomous stings through their dorsal and pectoral fins. These fins are equipped with sharp, serrated cartilaginous spines containing microscopic venom glands along their lateral edges.

When threatened, catfish erect their fins, increasing the likelihood of puncture wounds. This defensive mechanism, while effective for the fish, can lead to significant discomfort and potential complications for humans who come into contact with them.

The Anatomy of a Catfish Sting

To better understand catfish spine envenomation, it’s crucial to examine the anatomy of a catfish sting:

Dorsal and pectoral fins end in sharp, serrated spines
Microscopic venom glands line the lateral edges of these spines
When erect, the fins become formidable weapons capable of penetrating human skin

This unique anatomy explains why catfish stings can be both painful and potentially dangerous, requiring prompt and appropriate medical attention.

Immediate Symptoms and Reactions to Catfish Stings

The symptoms of catfish spine envenomation typically manifest immediately after the injury occurs. Both children and adults may experience a range of symptoms, varying in severity depending on the species of catfish and the amount of venom introduced.

Common immediate reactions include:

Sudden weakness
Intense pain at the site of injury
Throbbing sensation
Pain radiation to the proximal extremity

Is the pain from a catfish sting localized or does it spread? While the initial pain is often localized to the site of injury, it’s not uncommon for the discomfort to radiate to nearby areas, particularly up the affected limb. This radiation of pain can be attributed to the inflammatory response triggered by the venom.

The Local Inflammatory Response

The venom injected during a catfish sting triggers a severe local inflammatory reaction. This reaction can manifest as:

Erythema (redness of the skin)
Edema (swelling)
Hemorrhage (bleeding)
Tissue necrosis (death of tissue cells)

The severity of these symptoms can vary significantly, influenced by factors such as the species of catfish, the amount of venom injected, and the individual’s response to the venom.

Long-term Effects and Potential Complications

While most catfish sting symptoms are self-limited, meaning they resolve on their own over time, there are potential long-term effects and complications that victims should be aware of.

Can catfish stings lead to serious complications? Yes, the most serious complications often arise from secondary bacterial infections rather than the initial venom itself. These infections can be caused by a variety of organisms, including:

Vibrio
Aeromonas
Enterobacteriaceae
Pseudomonas
Erysipelothrix
Chromobacterium
Nocardia
Actinomyces
Mycobacterium
Normal skin flora

In rare cases, more severe complications can occur. For instance, there have been reported cases of deep soft-tissue necrosis of the foot and ankle caused by catfish envenomation, as well as septic arthritis of the knee following a catfish puncture wound.

Proper Treatment and Management of Catfish Stings

Effective management of catfish spine envenomation begins with prompt and appropriate treatment. The primary goals are to control pain, neutralize the venom, prevent infection, and promote healing.

Immediate Pain Management

The first step in treating a catfish sting is aggressive pain control. This typically involves:

Administration of a long-acting local anesthetic (without epinephrine)
Immersion of the affected extremity in hot water (up to 45Â°C) for 30 minutes to denature the heat-labile toxin

How does hot water help in treating catfish stings? The heat from the water helps to denature the protein-based venom, reducing its potency and alleviating pain. This method is effective because catfish venom is heat-labile, meaning it breaks down under high temperatures.

Wound Care and Debridement

Proper wound care is crucial in preventing complications and promoting healing. This involves:

Careful exploration of the wound
Debridement of any necrotic tissue
Thorough irrigation with normal saline
Removal of any retained spines (which may be radiolucent and not visible on X-rays)

In some cases, a small incision may be necessary to remove the spine intact, as demonstrated in the case of the 2-year-old boy mentioned in the original text.

Antibiotic Prophylaxis and Follow-up Care

While the use of prophylactic antibiotics in catfish sting cases is somewhat controversial, many healthcare providers opt to administer them as a precautionary measure. This decision is often based on the high risk of secondary bacterial infections associated with these injuries.

Additional important steps in the management of catfish stings include:

Administering tetanus prophylaxis when indicated
Culturing the wound to identify any potential pathogens
Scheduling close follow-up to monitor for signs of infection or retained foreign bodies

Is follow-up care necessary after a catfish sting? Yes, follow-up care is crucial after a catfish sting. It allows healthcare providers to monitor the healing process, detect any signs of infection early, and address any retained foreign bodies that may not have been initially apparent.

Prevention and Safety Measures for Anglers

While catfish spine envenomation can be painful and potentially serious, there are steps that anglers and others who may come into contact with catfish can take to reduce their risk of injury.

Handling Catfish Safely

When handling catfish, consider the following safety measures:

Wear protective gloves when handling catfish
Use appropriate tools (like fish grippers) to hold the fish
Be aware of the location of the catfish’s spines and avoid direct contact with them
If removing a catfish from a trap or net, exercise extra caution as the fish may be agitated

How can anglers safely remove hooks from catfish? To safely remove hooks from catfish, use long-nosed pliers or a dedicated hook remover. This allows you to maintain a safe distance from the fish’s spines while manipulating the hook. Always grip the fish firmly but gently behind the pectoral fins to immobilize it during hook removal.

Educating Others About Catfish Risks

Raising awareness about the potential dangers of catfish spines is crucial, especially for those new to fishing or living in areas where catfish are common. Consider sharing information about:

The anatomy of catfish and location of their venomous spines
Proper handling techniques to avoid injuries
Symptoms of catfish envenomation
First aid measures in case of a sting

By educating others, we can help reduce the incidence of catfish-related injuries and ensure that those who do experience a sting seek appropriate medical care promptly.

Case Studies: Learning from Real-world Incidents

Examining real-world cases of catfish spine envenomation can provide valuable insights into the variety of presentations, treatment approaches, and outcomes associated with these injuries.

Case 1: Delayed Presentation in an Adult

In one reported case, an adult patient presented with a delayed reaction to a catfish sting. The initial injury seemed minor, but over the course of several days, the patient developed increasing pain, swelling, and signs of infection. This case highlights the importance of seeking medical attention even if initial symptoms seem mild, as complications can develop over time.

Case 2: Pediatric Catfish Spine Injury

The case of the 2-year-old boy mentioned in the original text provides several important lessons:

Catfish spine injuries can occur even when adults are handling the fish
Immediate pain, erythema, and edema are common symptoms
Removal of the spine may require medical intervention
Proper wound care and antibiotic prophylaxis can lead to successful outcomes

What can we learn from these case studies? These cases emphasize the unpredictable nature of catfish spine injuries and the importance of prompt, appropriate medical care. They also highlight the potential for complications, even in cases that initially seem minor, underscoring the need for careful follow-up and monitoring.

Emerging Research and Future Directions

While our understanding of catfish spine envenomation has grown over the years, there is still much to learn about these injuries and how best to treat them. Ongoing research is focusing on several key areas:

Venom Composition and Effects

Scientists are working to better understand the composition of catfish venom and its effects on human tissues. This research could lead to more targeted treatments and potentially even antidotes specific to catfish venom.

Improved Diagnostic Techniques

Developing more accurate ways to detect retained catfish spines, which are often radiolucent, could improve treatment outcomes and reduce the risk of long-term complications.

Antibiotic Prophylaxis Protocols

Given the controversy surrounding the use of prophylactic antibiotics in catfish sting cases, more research is needed to establish evidence-based guidelines for when and how to use antibiotics in these situations.

How might future research impact the treatment of catfish stings? Future research could lead to more targeted treatments, improved diagnostic techniques, and clearer guidelines for antibiotic use. This could result in better outcomes for patients, reduced risk of complications, and more efficient use of medical resources.

As our knowledge of catfish spine envenomation continues to grow, we can expect to see improvements in both prevention strategies and treatment protocols. This ongoing research not only benefits those who may experience catfish stings but also contributes to our broader understanding of marine and freshwater injuries and envenomations.

Catfish Spine Envenomation | Consultant360

myelolipoma

One hour after sustaining a puncture wound to the left ankle, a 2-year-old boy was brought the emergency department. The father, a commercial fisherman, was attempting to free a catfish from a crab trap when it fell and its dorsal spine punctured the child’s ankle. The boy had immediate pain, erythema, and edema. After several unsuccessful attempts at removal, the father cut the spine 1 cm above the skin with a pair of pliers.

The child was sedated. The catfish spine was removed intact in an anterograde fashion through a small incision in the overlying skin. The wound was irrigated copiously with normal saline and left to heal by secondary intention. The patient tolerated the procedure well and was discharged with oral clindamycin. The wound healed without any complications.

Although the incidence is not well documented, there are numerous case reports of catfish envenomation among freshwater and saltwater anglers. ^1-10 Many of the 1000 species of catfish worldwide secrete a proteinaceous toxin from specialized epidermal cells or inflict venomous stings with their dorsal and pectoral fins.^1,2 The fins end distally as sharp, serrated cartilaginous spines and contain microscopic venom glands along the lateral edges.^2,3 When a catfish is threatened, the fins become fully erect, which contributes to their propensity for causing puncture wounds.^1,7,8

Children and adults with catfish stings have immediate weakness, pain, and throbbing at the site of injury.^2,5,6 Radiation to the proximal extremity is common.^3,6 The venom causes a severe local inflammatory reaction with erythema, edema, hemorrhage, and tissue necrosis.^2-5 The severity of symptoms is highly variable and depends on the species of catfish as well as the amount of envenomation.^1-4 Symptoms are usually self-limited. Most serious complications arise from secondary bacterial infection. ^2-4,7 Common organisms include Vibrio, Aeromonas, Enterobacteriaceae, Pseudomonas, Erysipelothrix, Chromobacterium, Nocardia, Actinomyces, Mycobacterium, and normal skin flora.^2,7

Management begins with aggressive pain control. This involves a long-acting local anesthetic without epinephrine.^1-5 The affected extremity is immersed in water as hot as can be tolerated (up to 45°C) for 30 minutes to denature the heat-labile toxin.^1-4,11 Careful exploration, debridement, and irrigation of the wound is important because retained spines may be radiolucent.² Tetanus prophylaxis should be administered when indicated.⁴ Culture of the wound is highly recommended. Although controversial, empiric antibiotic prophylaxis is frequently administered.^2,3,7 Patients require close follow-up to monitor for signs of infection or retained foreign body.

REFERENCES:

1. Mann JW 3rd, Werntz JR. Catfish stings to the hand. J Hand Surg Am. 1991;16(2):318-321.

2. Blomkalns AL, Otten EJ. Catfish spine envenomation: a case report and literature review. Wilderness Environ Med. 1999;10(4):242-246.

3. Murphey DK, Septimus EJ, Waagner DC. Catfish-related injury and infection: report of two cases and review of the literature. Clin Infect Dis. 1992;14(3):689-693.

4. Ajmal N, Nanney LB, Wolfort SF. Catfish spine envenomation: a case of delayed presentation. Wilderness Environ Med. 2003;14(2):101-105.

5. Zeman MG. Catfish stings: a report of three cases. Ann Emerg Med. 1989;18(2):211-213.

6. Baack BR, Kucan JO, Zook EG, Russell RC. Hand infections secondary to catfish spines: case reports and literature review. J Trauma. 1991;31(10):1432-1436.

7. Eiland LS, Salazar ML. Polymicrobial catfish spine infection in a child. Pediatr Infect Dis J. 2006;25(3):281-282.

8. Roth BJ, Geller SM. Deep soft-tissue necrosis of the foot and ankle caused by catfish envenomation: a case report. J Am Podiatr Med Assoc. 2010;100(6):493-496.

9. Fredette SE, Derk FF, Nardozza AJ. Catfish spine injury of the foot. J Am Podiatr Med Assoc. 1997;87(4):187-189.

10. Ashford RU, Sargeant PD, Lum GD. Septic arthritis of the knee caused by Edwardsiella tarda after a catfish puncture wound. Med J Aust. 1998;168(9):443-444.

11. Satora L, Pach J, Targosz D, Szkolnicka B. Stinging catfish poisoning. Clin Toxicol (Phila). 2005;43(7):893-894.

References

1. Mann JW 3rd, Werntz JR. Catfish stings to the hand. J Hand Surg Am. 1991;16(2):318-321.

2. Blomkalns AL, Otten EJ. Catfish spine envenomation: a case report and literature review. Wilderness Environ Med. 1999;10(4):242-246.

3. Murphey DK, Septimus EJ, Waagner DC. Catfish-related injury and infection: report of two cases and review of the literature. Clin Infect Dis. 1992;14(3):689-693.

4. Ajmal N, Nanney LB, Wolfort SF. Catfish spine envenomation: a case of delayed presentation. Wilderness Environ Med. 2003;14(2):101-105.

5. Zeman MG. Catfish stings: a report of three cases. Ann Emerg Med. 1989;18(2):211-213.

6. Baack BR, Kucan JO, Zook EG, Russell RC. Hand infections secondary to catfish spines: case reports and literature review. J Trauma. 1991;31(10):
1432-1436.

7. Eiland LS, Salazar ML. Polymicrobial catfish spine infection in a child. Pediatr Infect Dis J. 2006;25(3):281-282.

8. Roth BJ, Geller SM. Deep soft-tissue necrosis of the foot and ankle caused by catfish envenomation: a case report. J Am Podiatr Med Assoc. 2010;100(6):
493-496.

9. Fredette SE, Derk FF, Nardozza AJ. Catfish spine injury of the foot. J Am Podiatr Med Assoc. 1997;87(4):187-189.

10. Ashford RU, Sargeant PD, Lum GD. Septic arthritis of the knee caused by Edwardsiella tarda after a catfish puncture wound. Med J Aust. 1998;
168(9):443-444.

11. Satora L, Pach J, Targosz D, Szkolnicka B. Stinging catfish poisoning. Clin Toxicol (Phila). 2005;43(7):893-894.

Clinical Considerations in Initial Evaluation and Treatment of Hardhead Catfish Spine Puncture Wounds

On this page

AbstractIntroductionCase ReportDiscussionConflicts of InterestReferencesCopyrightRelated Articles

A 17-year-old male presented to our ED complaining of pain and swelling at the base of the first metacarpal after attempting to remove a catfish from his fishing line 12 hours prior to arrival. Radiographic images demonstrated a foreign body (FB), which was detectable by ultrasound. Hand surgery was consulted and took the patient to the operating room for exploration and removal of two serrated radiopaque catfish spines that were deeply embedded in the left thumb. Conclusion. Penetrating injury from hardhead catfish (Ariopsis felis) spines can cause hidden FB, envenomation, infection, and secondary damage to nearby structures. Imaging should be done for these patients to ensure they obtain timely and complete extraction of the venomous structures. Surgery should be consulted for operative management to avoid damage on removal of the catfish spine remnants.

1. Introduction

The saltwater catfish is more formally known as the hardhead catfish (Ariopsis felis). Its natural habitat is between the Northwest Atlantic and the Gulf of Mexico. They are commonly found near the Florida shoreline. They are considered a nuisance to fisherman since they are attracted to most types of bait and are often accidentally caught despite their undesirable taste. They have six long barbels surrounding their mouth and chin to help them catch prey and sharp, serrated, mucous-covered pectoral, and dorsal spines. These spines stand erect when the fish feels threatened to help protect it from would-be predators [1]. They contain an integumentary sheath of venom that, when released, can cause a severe localized inflammatory reaction that may spread systemically. For most people, the venom can be neutralized by immersing the wound in a warm water bath for 30 minutes but is most concerning due to its high association with secondary infections, especially in immunocompromised patients [2, 3]. Puncture wound by these spines can penetrate easily and is serrated such that they can be very difficult and even damaging if not removed appropriately. There have been only a few case reports in specialty journals reporting these injuries, including a penetrating renal injury and punctures to the feet and hand [2–6].

2. Case Report

A 17-year-old male presented to our ED complaining of stinging pain and swelling at the base of the first metacarpal after attempting to remove a catfish from his fishing line 12 hours prior to arrival. As per the father, the patient was a high school baseball star being recruited by several Major League Baseball teams. The patient and his father were concerned for any future disability to his hand that could threaten his career. The patient stated he had an initial stinging sensation upon contact and felt minor relief after handwashing and acetaminophen, but the pain returned and became progressively more severe overnight with associated throbbing, edema, and erythema. The patient had no history concerning for immunocompromise, was fully vaccinated, and denied signs of systemic infection including fevers, chills, nausea, vomiting, or diffuse rash.

Upon presentation, the patient was afebrile with normal vital signs. Exam was significant for 2 cm of edema and erythema along the base of the 1^st metatarsal with overlying coagulated blood at puncture site and intact range of motion. Labs demonstrated a leukocytosis of 11.96 and 82.1% neutrophils. Attempt was then made to visualize a foreign body under ultrasound which demonstrated a thin linear hyperechoic structure with soft tissue edema in the thenar region of the left hand (Figure 1). X-rays demonstrated a 1.8 cm and 0.8 cm radiopaque foreign body within the soft tissue at the ulnar margin of the first metacarpal (Figures 2 and 3). Hand surgery was consulted and took the patient to the operating room for exploration and removal of two serrated radiopaque hardhead catfish spines that were deeply embedded in the left thumb. The first was located along the flexor tendon, and a second spine was located buried within the adductor pollicis muscle. Careful operative dissection under loupe magnification was used to ensure preservation of the neurovascular bundles, flexor tendon, pulley system, and thenar musculature. Once the serrated spines were located, gentle manipulation was used to free and release them from the surrounding tissues without causing additional damage (Figures 4 and 5). The patient was prophylactically treated with antibiotics for prevention of secondary infection.

3. Discussion

Initially, along with history, radiographs may be adequate for the identification of a fish bone as a foreign body, but generally have low sensitivity (25-39%) [7]. Soft tissue swelling or gas may be the only sign of a foreign body especially with smaller fragments and with some species of fish bones which may not be adequately radiopaque [7, 8].

Ultrasound correlates well with visibility and radio-opacity on radiographs. Ultrasound is especially helpful in detecting superficial foreign bodies not radiopaque on X-ray [9–11]. Compared to radiographs and ultrasound, non-contrast CT has improved sensitivity (~95%) [7].

There are several independent factors that play a role in the ability to identify a FB on ultrasound. Substances such as subcutaneous air or calcifications can obstruct the view or be mistaken for a FB. The detection sensitivity is also impacted by size, location, and scanning plane (parallel to the long axis) of the FB [9, 11]. Certain regions, especially in the hand and foot, can be more difficult to ultrasound considering their contour and close proximity to anatomical structures with varied sonographic appearances [11]. Technique modifications to improve acoustic windows, such as utilizing a water bath or standoff pad as the acoustic medium and scanning in multiple orientations, can improve visualization of both the foreign body and the artifacts they generate [11, 12]. The chemical composition of a foreign body induces different far field artifacts (i.e., metal and glass can induce reverberation artifacts) [13]. Organic matter can produce a circumferential hypoechoic halo secondary to inflammation/edema, abscess, or granulation tissue surrounding the foreign body and as a result helps in its localization [11, 13].

Lastly, a provider must consider the type of FB when choosing the modality to detect it. Ultrasound would be a better choice for compounds which are radiolucent and largely missed on radiography. In one study, radiography identified none of the foreign bodies which were radiolucent (wood, plastic, and organic material such as cactus spine) [9]. Wood, a common foreign body, has repeatedly been shown to be missed by plain radiography [11, 13, 14] with one study reporting a 7. 4% sensitivity on plane radiograph [15]. A 2015 meta-analysis suggested that for ultrasound detection of a foreign body, the pooled sensitivity was 72% and specificity was 92% [12]. CT scans have a 5-15 times greater sensitivity than plain radiographs but are expensive, expose patients to high radiation burdens and may not be readily available in certain clinical environments [13]. These factors should lead providers to consider a multimodal approach when evaluating suspicious injuries for a retained foreign body. The order in which radiography and ultrasound are performed depends on the type of foreign body suspected, skill of the provider to perform the ultrasound, and availability of the imaging modalities. Those with easy access to point-of-care ultrasound should consider performing it as part of their initial evaluation but certainly if the radiography did not detect a foreign body when there is a high index of suspicion one may be present. Considering the overall success, plain radiograph and ultrasound should occur before performing a CT scan. CT can be considered the next imaging modality for foreign bodies that are not visualized on X-ray or ultrasound.

In our case report, ultrasound was able to identify the larger of the two foreign bodies noted on hand radiography and intraoperative exploration. This is likely secondary to the size and location of the foreign bodies. It is also necessary to consider operator skill, as this may have played a role in identifying only the larger FB. The findings, nonetheless, show the spine of the Ariopsis felis (hardhead catfish) can be visualized by bedside ultrasound and appear radiopaque on simple radiograph.

Surgery must be consulted to avoid causing further damage to the nearby structures and for potential surgical management under fluoroscopy. Intraoperative fluoroscopy is frequently helpful, as the objects can be difficult to locate in plain view (Figure 4). Once the foreign body is removed, the wound should be scrubbed and irrigated. Antibiotics and judicious pain management should be administered and the wound should be left open for prevention of secondary infections.

Appropriate antibiotic administration should cover gram negative rods with special consideration of Vibrio and Aeromonas species. Oral antibiotics such as ciprofloxacin or cephalosporins are preferred in the literature for both initial prophylactic treatment and treatment of active infection from catfish spine injuries. Tetanus prophylaxis should be given when indicated. Wound follow-up should be given within 1 week or sooner if systemic symptoms arise [2, 3].

3.1. Why Should an Emergency Physician Be Aware of This?

Penetrating injury from hardhead saltwater catfish dorsal spines can cause hidden foreign body, infection, and secondary damage to nearby structures. Imaging should be done for these patients to ensure they obtain timely and complete extraction of the venomous structures. Surgery must be consulted for operative management to avoid damage on removal of the catfish spine remnants.

Conflicts of Interest

The authors declare that they have no conflicts of interest.

References

“Hardhead Catfish, Ariopsis felis, Mississippi saltwater fish profiles from GCRL,” 2020, https://gcrl.usm.edu/public/fish/hardhead.catfish.php.
View at:
Google Scholar
C. Spitler and J. Rehm, “A zone-II flexor tendon injury secondary to a catfish spine,” JBJS Case Connect., vol. 7, no. 3, article e61, 2017.
View at:
Publisher Site | Google Scholar
A. L. Blomkalns and E. J. Otten, “Case report catfish spine envenomation: a case report and literature review,” Tech. Rep., 1999.
View at:
Publisher Site | Google Scholar
G. E. Noonburg, “Management of extremity trauma and related infections occurring in the aquatic environment,” The Journal of the American Academy of Orthopaedic Surgeons, vol. 13, no. 4, pp. 243–253, 2005.
View at:
Publisher Site | Google Scholar
V. Haddad, R. A. De Souza, and P. S. Auerbach, “Marine catfish sting causing fatal heart perforation in a fisherman,” Wilderness & Environmental Medicine, vol. 19, no. 2, pp. 114–118, 2008.
View at:
Publisher Site | Google Scholar
A. Ayub, J. R. Zatarain, K. Bowen-Jallow, and S. Tran, “Fishing out a foreign body for a penetrating renal injury by a dead catfish in a pediatric patient,” Journal of Pediatric Surgery Case Reports, vol. 47, p. 101239, 2019.
View at:
Publisher Site | Google Scholar
S. E. Mirvis, K. Shanmugaratnam, L. A. Miller, and C. W. Sliker, EmergencyRadiology: Case Review Series, Mosby Elsevier, Philadelphia, PA, USA, 2009.
L. C. Knight and T. H. Lesser, “Fish bones in the throat,” Archives of Emergency Medicine, vol. 6, no. 1, pp. 13–16, 1989.
View at:
Publisher Site | Google Scholar
D. E. Manthey, A. B. Storrow, J. Milbourn, and B. J. Wagner, “Ultrasound versus radiography in the detection of soft-tissue foreign bodies,” Annals of Emergency Medicine, vol. 28, no. 1, pp. 7–9, 1996.
View at:
Publisher Site | Google Scholar
M. H. Aras, O. Miloglu, C. Barutcugil, M. Kantarci, E. Ozcan, and A. Harorli, “Comparison of the sensitivity for detecting foreign bodies among conventional plain radiography, computed tomography and ultrasonography,” Dento Maxillo Facial Radiology, vol. 39, no. 2, pp. 72–78, 2010.
View at:
Publisher Site | Google Scholar
F. J. Gilbert, R. S. D. Campbell, and A. P. Bayliss, “The role of ultrasound in the detection of non-radiopaque foreign bodies,” Clinical Radiology, vol. 41, no. 2, pp. 109–112, 1990.
View at:
Publisher Site | Google Scholar
J. Davis, B. Czerniski, A. Au, S. Adhikari, I. Farrell, and J. M. Fields, “Diagnostic accuracy of ultrasonography in retained soft tissue foreign bodies: a systematic review and meta-analysis,” Academic Emergency Medicine, vol. 22, no. 7, pp. 777–787, 2015.
View at:
Publisher Site | Google Scholar
M. Gomaa and A. Abdelaal, “Ultrasonography versus radiography in detection of different foreign bodies in a cadaveric calf thigh specimen,” Res J Vet Pract, vol. 3, no. 4, pp. 83–88, 2015.
View at:
Publisher Site | Google Scholar
M. D. Tantray, A. Rather, Q. Manaan, I. Andleeb, M. Mohammad, and Y. Gull, “Role of ultrasound in detection of radiolucent foreign bodies in extremities,” Strateg Trauma Limb Reconstr., vol. 13, no. 2, pp. 81–85, 2018.
View at:
Publisher Site | Google Scholar
M. R. Levine, S. M. Gorman, C. F. Young, and D. M. Courtney, “Clinical characteristics and management of wound foreign bodies in the ED,” The American Journal of Emergency Medicine, vol. 26, no. 8, pp. 918–922, 2008.
View at:
Publisher Site | Google Scholar

Copyright

Copyright © 2021 Hannah Gordon et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

online training from Skillbox in Kyrgyzstan

Summer sale Discounts up to 60% valid 0 days 00:00:00

Enroll in the course

900 10 HELP YOU FIND A JOB OR GET YOUR MONEY BACK*

Learn how to build a semantic core , work in SEO services and prepare reports on the results of promotion. You will understand how to audit sites, bring them to the top of the search and attract targeted traffic. Master the skills that are in demand, build a portfolio and be able to work in a company, agency or take freelance orders.

5 courses for mastering a profession
Real case for a portfolio final work on a real site
Work with real tasks and cases

9 0017 Help in finding a job

About the profession

SEO- specialist promotes the site in search engines and brings it to the top of the search results. The higher the position of the site in the search results, the more interested visitors go to it, and the business gets new customers.

All you need to work is a computer and Internet access, so an SEO specialist can easily work remotely, take on several clients at once and receive additional income.

The course was updated in 2022 and fully complies with the current requirements of employers. You will study in detail the most popular tools for SEO promotion and web analytics.

Who this course is for

Beginners in SEO
Learn the profession from scratch: understand how search engines work, learn how to collect semantics, learn SEO tools and web analytics. You can start a career in a company or take orders as a freelancer.
Internet marketers and business owners
Learn how to promote your project on your own. You will understand how to select contractors, evaluate their work, set clear and competent tasks. You will be able to drive traffic to the site, increase the flow of applications and sales.
Freelancers
You will understand the intricacies of collecting semantics for websites, master layout, analytics and get other skills that are in demand. You will understand how to automate your routine, you will be able to take more orders, solve complex problems and increase your income.

What you will learn

Assemble the semantic core
You will be able to select queries for search engines, check the frequency, conduct clustering and form the site structure based on this data.
Conduct a technical audit of the site
Learn how to find technical errors, optimize site loading speed and fix bugs in the mobile version.
Monitor the effectiveness of website promotion
Understand how to set up Yandex.Metrica and Google Analytics, connect the site to Yandex.Webmaster and Google Search Console.
Drive targeted traffic with inbound links
Learn to evaluate the quality of inbound links and remove link spam. You will be able to get links from authoritative sites and avoid search engine sanctions.
Analyze data and prepare reports
Learn how to analyze site performance in Excel and Google Spreadsheets, build traffic forecasts and prepare reports for management.
Bring customers from the search
Learn how to use meta tags and titles. Master Rush Analytics, Serpstat and Netpeak services and be able to automate routine work.

Learn now, pay later!

Start learning on the platform now and pay after 1 month. During this time, you can watch videos, practice on real tasks, upgrade your skills and start earning.

Loan program from reliable banks

How the Career Center can help you:

Resume
We present you to employers from a favorable side
We will hold an online meeting where we will evaluate your strengths , skills and professional experience. We will help you create a profile on job sites and develop an attractive resume that will definitely impress employers.
Individual career plan
We will tell you how to start and develop a career
We will conduct an online consultation, define your goals and tell you how to achieve them. We will form an individual path for your development in the profession. You will learn where to look for a job and what skills to develop to advance in your career.
Partner vacancies
We will recommend your candidacy to partners
You will have access to a private chat with vacancies of our partners. You will be able to select suitable offers, and the consultant will help you write a cover letter and prepare for the interview. Your candidacy will be considered among the first.
Designing a portfolio
We will help you present your projects effectively
We will tell you how to create a selling portfolio. Together we will select attractive works and submit them to an expert for review. We will help arrange projects in such a way that employers will appreciate them.
Career advice
Prepare you to start your career
Consultants will answer your career questions, prepare for interviews and collect feedback from employers. You will learn how to behave in an interview and avoid mistakes when looking for a job. You can participate in career workshops and webinars.

People who have changed lives thanks to Skillbox

Skillbox users learn new professions. They build a career, change lives and find themselves. You will succeed too.

Employer reviews

Yulia Ilyaeva Team for Dream Development Director
Skillbox candidates are always highly motivated, so we are happy to invite them to internships and offer them a job. For several times, we have accepted participants in the Profession Event Manager course for junior positions.
Maxim Zubtsov Marketing Director at Checkroi
Skillbox selects candidates with burning eyes and a desire to develop. For example, the head of our SEO department was once a newbie whom we met through the Career Center.
Roman Gorbachev Founder of the Logomashina design studio
When we were invited to speak at Skillbox, we decided: this is a great chance to replenish the team with talented specialists. Now we have several designers working for us, and we are very pleased with them.
Olga Novodvorskaya HR BP at Nauka
Cooperation with Skillbox is a guarantee that we will get future employees with certain knowledge. The beginners who came to us grew up and approached the middle level after 8 months.
Bogdan Pilipenko Account manager at Appollo Digital
Skillbox helps to find enterprising beginners who are interested in simple but valuable tasks. After completing the courses, the guys leave with structured, fresh knowledge in the disciplines.

Curator support and closed community

Attentive curators will help you correct mistakes in practical work, share life hacks and useful literature.
In a private chat, you can communicate and exchange useful materials with other users of the platform. And the curator will answer questions about the course and give advice on completing assignments.

Hello! I’m submitting a task for review. Please answer questions in the comments.
Kristina
Checked the task, answered the questions in the file. Great job, some work left to finish 😊
Curator
Thank you, I fixed it 👍
Kristina

We understand how difficult it can be to apply new knowledge in practice, and we will support you on this path ❤️

Course co-recorded with AMDG

The AMDG digital agency is engaged in the comprehensive promotion of businesses on the Internet. The company’s services include Performance Marketing, SMM, SEO and others. Over 14 years of work, the AMDG team has implemented more than 2,000 projects for international and national advertisers. She collaborated with Gazprombank, Pony Express, SaveTime and others.

SEO specialist from AMDG
- 1. Let’s discuss the tasks and responsibilities of an SEO specialist
  2. Let’s talk about how search engines work
  3. Learn how to use the basic tools of an SEO specialist 9002 0
  4. Learn how to select and cluster the semantic core
  5. Understanding media planning tools
  6. Dive into website technical optimization
  7. Learn the features of regional promotion
  8. Optimize content and meta-information
  9. Understand how to work with commercial ranking factors
  10. Learn how to optimize behavioral factors
  11. Learn how to work with the backlink mass of the site and external links
  12. Learn how to optimize a site for viewing with mobile devices
  13. Let’s understand why you can get sanctioned by search engines
  14. Let’s learn how to work in conditions of restrictions from the site or the client
  15. Let’s figure out how to post-analyze the results of search engine promotion
  16. Learn how to communicate with clients correctly
  17. Let’s discuss how customers perceive SEO specialists and build work with them
- End-to-end analytics
  - 1. Find out why end-to-end analytics is needed
    2. Learn the basics of online advertising analytics: sales funnel, hypotheses, performance indicators
    3. Learn how to collect, structure personal data for web analytics and use platforms to store it
    4. Learn the concept of end-to-end analytics and learn how to build multi-channel funnels
    5. Let’s master data analysis and reporting in Roistat. Learn what is cohort analysis, multi-channel analytics, split tests and tracking the sources of calls and letters
    6. Understanding how to analyze data and reporting in CoMagic
    7. Understanding the features of web analytics for different types of businesses and websites
- Web analytics from zero to Junior
- Excel + Google Spreadsheets from scratch to PRO