11.07 Pencil Point Puncture
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agk's Library of Common Simple Emergencies

Presentation
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The patient will tell you that he was stabbed or 
stuck with a sharp pencil point. He may be 
overtly or unconsciously worried about lead 
poisoning. A small puncture wound lined with 
graphite tattooing will be present The pencil tip 
may or may not be present, visible, or palpable 
If the puncture wound is palpated, an underlying 
pencil point may give the patient a foreign body 
sensation.

What to do:
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- Reassure patient or parent that there is no 
    danger of lead poisoning. Pencil "leads" are 
    made of clay and graphite, which is carbon 
    and non-toxic.
- Palpate and inspect for a foreign body. If 
    uncertain, get an x ray, xerogram or 
    ultrasound to rule out the presence of a 
    foreign body.
- Scrub wound.
- Administer tetanus prophylaxis, if necessary.
- Warn the patient or family about signs of 
    infection, and inform them that there will be 
    a permanent black tattoo that can be removed 
    later if the resulting mark is cosmetically 
    unacceptable.

What not to do:
---------------

- Do not excise the entire wound on the initial 
    visit.

Discussion
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In order to reduce the amount of tattooing, the 
wound may be anesthetized and scraped 
(dermabraded) with the tip of a scalpel blade. It 
is unwise to excise the entire wound because the 
resultant scar might be more unsightly than the 
tattoo. If a superficial pencil-tip foreign body 
exists, then see [subcutaneous foreign body] for an 
easy removal technique. Deep punctures and/or 
foreign bodies may require exploratory surgery in 
the operating room.

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 from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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