What to do with an internal tick? - briefly
Remove an «internal tick» promptly with fine‑tipped tweezers, grasping it as close to the skin as possible and pulling straight out. Disinfect the bite site and observe the patient for any signs of infection or illness.
What to do with an internal tick? - in detail
An embedded tick that has migrated beneath the skin requires prompt, sterile intervention to avoid infection and disease transmission.
Initial assessment should confirm the tick’s location, depth, and any surrounding inflammation. Palpation combined with magnification often reveals a small, raised nodule. If the tick is not visible, ultrasonography can locate it precisely.
The removal procedure follows these steps:
- Disinfect the surrounding area with an appropriate antiseptic (e.g., chlorhexidine).
- Apply a local anesthetic (topical lidocaine or sub‑cutaneous injection) to minimize discomfort.
- Use fine‑point forceps or a specialized tick‑extraction tool; grasp the tick as close to the skin as possible without crushing the body.
- Apply steady, upward traction along the axis of entry; avoid twisting or jerking motions that could leave mouthparts embedded.
- After extraction, inspect the tick for completeness; any retained fragments warrant surgical exploration.
- Clean the wound with antiseptic solution and cover with a sterile dressing.
Post‑removal care includes:
- Monitoring for signs of infection (redness, swelling, pus) over the next 48 hours.
- Documenting the tick’s appearance and, if possible, sending it to a laboratory for species identification and pathogen testing.
- Initiating prophylactic antibiotics only if the bite occurred in a high‑risk area for tick‑borne diseases or if the patient presents with systemic symptoms.
- Considering a single dose of doxycycline (200 mg) within 72 hours for prevention of Lyme disease when exposure criteria are met.
Follow‑up evaluation should assess:
- Development of erythema migrans, fever, headache, or arthralgia, which may indicate early infection.
- Any delayed allergic reaction at the extraction site.
Prevention strategies focus on:
- Wearing protective clothing and using EPA‑registered repellents containing DEET or picaridin.
- Performing thorough body checks after outdoor activities, especially in wooded or grassy environments.
- Prompt removal of any attached tick before it can embed deeply; early extraction reduces the risk of internal migration.
Adhering to sterile technique, accurate localization, and appropriate post‑procedural monitoring minimizes complications associated with an internalized tick.