Body Modification and You:

The Street Paramedics Overview

WARNING
This presentation will discuss in detail a lifestyle
different from your own, and will contain slides of
a graphic and adult nature.
The purpose of this presentation is not to shock
or offend, but to educate and facilitate better
patient care.
Every effort has been made to chose slides
based on their medical merit, especially those
showing genitals and similar features.
Dealing with piercings can be a
pain in our butt
Objectives
Understanding of people who undergo
body modification so as to better interact
with them in time of crisis.
Identify basic types of Body Modification
Identify common medical problems with
body modification
Successfully remove piercings that
interfere with pt care.
I never wanted to be different ,
I just wanted to be me
Brief introduction to Body
Modification and its Culture
Reasons
Aesthetic
Social Acceptance
Rites of passage
Social markings
Identification
Rebellion
Sexual Enhancement
Religious Reasons
Others
The Romans used their
nipple rings to attach
cloaks to.
Certain primitive tribes
used piercings to mimic
their prey.


Basic Types
Tattoos
Scarring and Branding
Piercing
Temporary
Superficial
Pocketing
Deep
Implants
Incisions, amputations
and other modifications
Mental Hold Issues
There have been cases of patients being
referred to mental health agencies for self
mutilation
Mainly for scarring, branding, and temporary
piercing.
The difference between self mutilation and body
modification is INTENT.
Other factors:
Age of consent
Desired outcome (changing sex, etc vs. body
adornment)
Who can do this?
Home Piercings are
common because of a
lack of safe, certified
piercers to go to for the
higher risk piercings.
Legality
Idaho
Elsewhere
Certifications
Associations of
Professional Piercers
www.safepiercing.com



The Patients View
Fear of:
Ridicule by Medical providers
Unnecessary removal
Be prepared to justify your desire to remove any
jewelry
Fear of piercings healing closed.
This leads to reluctance by patients to
seek medical help for piercing problems.
The Piercers View
If the pt didnt go to a
professional piercers,
they would do it in
their homes
If more doctors were
body art friendly, then
the high risk piercings
could be done safer in
a clinic setting.
Piercings
Vanity looks
best when it's
wrapped in
steel.


-Rev. Vain Jayne
Church of Body Modification
www.vainjayne .com
Standard/Surface
All shapes and sizes
Almost any location.
Also includes
Coring
Stretching
Pocketing
Stapling
Suspension piercings
Flexible surgical plastic
and solid bars
Temporary and
permanent

Deep
Often go under or
through tissues and
structures.
Usually flexible
connection
Surgical Teflon
Temporary
AKA: Play Piercing
Left in for only a short time
More about the sensation than the piercing itself
Often (not always) associated with BDSM or similar
scenes.
Temporary
Piercings
Temporary Piercings-Other
Examples
Stapling and Pocketing
Easy to remove
Not connected

What is normal after a piercing?
Some redness, and bruising normal for up
to 3 days afterward.
Small amounts of white , clear, or off-
white drainage is normal.

Understanding Bad Piercings
Piercing Guns
Hep B/C, etc
Lack of sterile tech.
and equipment
Infections
Rejection and
Migration
Scar
tissue/Granulation
Bad Locations

High Risk Piercings
Cardiac Valve
Disease
Diabetes
Immune suppressed
Pregnancy
Depending on location
Infections and
Abscesses
Infections
Some redness 1-3
days post piercing
is normal
Drainage, pus, and
red streaks are not.
95% of infections
are from improper
care by the patient.
Staph
staphylococcus aureus bacteria
Very common in our day to day environment.
Becomes a problem when the integrity of skin is
broken
Causes abscess, boils, infections, and other
problems with piercings.
Depending on location of piercing may cause
major problems to adjacent structures.
Allergic Reactions, Rejection and
Migration
An Allergic Reaction is generally acute, localized, and follows with
other problems. Some people are allergic to certain lower quality
metals.
REJECTION is a process in which the pierced skin slowly dies.
MIGRATION is the process where the weight, or position, of the
piercing causes it to slowly Grow out.
Takes weeks to months
The jewelry may slowly be pushed to the surface of the skin, and may
eventually grow out completely. This process may cause some scarring.
Bets plan is to have the jewelry moving outward, you may wish to have the
jewelry removed before complete rejection takes place. This will minimize
any scarring.
Some piercings are more prone to rejection than others. Low quality jewelry,
non-implant grade metals, personal metabolism, ill health, bad diet,
recurring infection, drug abuse, or inappropriate jewelry sizing are other
contributing factors.
The most common cause of rejection is untreated infection or irritation; treat
problems quickly to avoid scarring and possible loss of your piercing.
Rejection
Non Emergent Treatments to Use
Consider instructing the patient to call their professional piercer.
No dial soap.
The universally safe treatment for all piercings with no serious complications
is SALTWATER. It can act as a maintenance treatment until you can see a
qualified professional piercer or doctor. It is also an excellent non-irritating
backup treatment in case of allergic reaction caused by another treatment.
If you do not know the cause of your piercing difficulties, you are advised to
eliminate all other treatments, and proceed with only SALTWATER, and
seek professional assistance promptly.
SALTWATER is made by adding 1/4 to 1/2 a teaspoon of Sea Salt to one
cup (250ml) of warm water. Measurements provided are exact, do not use
more or less salt. Do not use table salt.
The piercing is then soaked in the solution using a cup or other container, or
by wetting the piercing using saturated gauze or cotton balls. Keep the
piercing soaked in the solution for about 5 minutes, then carefully move the
jewelry within the piercing. Dry thoroughly with a clean tissue or paper
towel.

General Removal Guidelines
Remove a piercing emergently when:
Airway is compromised
Beware of lost pieces
Inhibits Pt Care (Back Boards)
Consider alternative or creative solutions
May get torn or compromised during pt packaging.
Poses a hazard to EMS providers (needles)
X-rays of area are anticipated and it cant be removed
later.(Optional)
Defibrillation of chest when chest piercings are in
place.
Otherwise leave it in when ever possible.

General Removal Guidelines
Always try to unscrew
the ball first.
Ring opening pliers are
best
Approx. $10.00-20.00
Stainless Steel
Ring Cutters may rip out
piercing
Trauma shears may not
get a good angle to cut
Using Ring Opening Pliers
Simple and Quick
Dont lose the Ball!
Other Methods
Slower, but allow piercing to stay open.
Threading an IV cath over piercing, and then
through hole as piercing is removed.
Remember, always use sterile tech. when
messing with piercings!
The Ears
Most common
Improper piercing can
cause:
Infection
Keliods
Granulation/Scarring

Around the Eyes
Anti-Eyebrow
Eyebrow
Eye Lid
Eye brow and Bridge Piercings
25% of all Eyebrow
piercings will migrate.
Infection may migrate
into orbit of eye,
lachrymal glands, or
sinus cavity
Nose Piercings
Very Common
Nostril, Septum, and
Bridge are common.
Nasal Septum
Causes problems with Nasal
Airway and Nasal ETT
Placement when in place.
Repeated Peircings may
develop scar tissue, posing
minor placement problems
May amplify blunt trauma
forces
May inhibit training of blood,
causing airway issues
Usually is a small diameter
stylus between larger parts or
is a Ring.
Removal:

Naval
Very Common
Subject to rejection
from rubbing, friction
and irritation.
5-10% of all naval
piercings will migrate.
Increase in girth
(pregnancy) may
cause problems.

Oral General Info
Relatively High Risk of Infection
Airway Issues from:
Abscess
Bleeding and Soft tissue trauma
Aspiration during removal
Trauma from:
Focusing blunt forces
Erosion of tissues
Dental damage
Uvula

Poses complications
for airway
management
Laryngoscope may
tear ring
Removal may result
in Foreign Body
Aspiration

Deep Oral
High Risk piercing
Tongue
Very Common
Heals well
May form white callous around piercing
Clavicle
Poses complications
for central line
placement and Defib.
Nipple Rings
Very common
Should be removed if
possible prior to
cardioversion
If cant be removed,
tape in place
(anecdotal advice)
Nipple Shields
Male Genitalia Piercings
Anecdotal reports of
Urethral shredding in
blunt trauma.
High risk of infection.

Female Genitalia Piercings
Types:
Hood
Clitoral
Labia
May cause problems during
childbirth.
Obstruction of birth canal
Tearing of soft tissue
There are flexible items that
reduce this chance
Should be removed during
active labor.
May be replaced afterward by
pt.
Should be removed during
Foley Catheter Placement.


Would this be a problem in
childbirth?
Tattoos
Tattoos
Ancient Art
More widely accepted
than piercings
Also done in less than
sterile environments,
especially by minors and
prisoners
Same risks of infections
apply
HIV
HEP B/C
Ink problems as well.
Tattoo Infection and irritation
Some redness is
normal, its a dermal
abrasion!
Heat, red streaks, and
puss are not normal,
especially after 24-48
hours.
Pain after 6 hours is
not normal. Some
very mild tenderness
is OK.
Inks
Technically falls under FDA as a cosmetic,
However not currently regulated at federal
level. (May change in next few years)
The actual inks may be:
Surface Cosmetics, not approved for injection
Industrial grade printers ink

Occasionally an allergic reaction may
occur to the ink (rare)
Branding and Scarring
Branding and Scarring
Branding and Scarring
Branding
Tribal/Primitive
Fire strike
Modern
Cautery Gun
Scarring
Skin Removal
Tattoo Gun
Ink Rubbing

Other Body Modifications
Ear Shaping
Involves using an
incision and sutures
to reform the ear.
Implants (not THOSE type)
Usually teflon domes
or domes
Low incident of
rejection
Risk of infection
depends on piercers
adherence to sterile
technique
Transdermal Implants
Suturing
Dental
Sharpening
Prone to
chipping
May become
airway
problems if
broken
Tongue Splitting
Questions?
Special Thanks to Nic , Professional
Piercer at Nobodies Hero at
Fairview/Liberty
Modified Minds Body Piercing
Inside Nobodies Hero Tattoos
1505 N. Liberty
Boise Idaho 83702
208-429-8850
More info?
www.safepiercing.com
www.bmezine.com

Have a nice day