ER Doctor Answers Injury Questions From Twitter

In the emergency department all the time,

I'm like, I'm sorry, your bone is fractured

and they're like, Whew, I'm just glad it's not broken

and I'm like, No, that's actually the exact same thing.

Hey, I'm Dr. J. Mack Slaughter

and I'll be answering your questions from Twitter today.

This is Injury Support.

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This is from @_sid_1998

How many concussions is too many concussions?

Asking for a friend.

I'm thinking by the way that you delivered that

that you're actually asking for yourself.

A concussion is the state that you are in mentally,

temporarily, after a mild traumatic brain injury.

The symptoms range from decreased attention span, lethargy

or feeling really tired, feeling a little confused,

severe headaches, light sensitivity, and nausea,

the feeling that you're gonna throw up.

So there's a very wide range of symptoms

that you can have with this condition.

It depends on the type of concussion.

How big was the concussion

and also how severe were your symptoms afterwards?

I'd say the most feared outcome of multiple concussions

is something called CTE or chronic traumatic encephalopathy.

People with chronic traumatic encephalopathy,

a lot of them are boxers or football players who get

repetitive head traumas and end up with very severe issues

long term like dementia, really bad headaches,

behavioral changes, aggressiveness and suicidality.

There was one study that showed that about 17 concussions

was the average of a lot of people

who had chronic traumatic encephalopathy.

But the answer is avoid concussions at all costs.

From @hohlohlona, what happens when you break a bone

and don't set it back correctly?

It depends on where the fracture is, how severe

the fracture is and how well aligned the bones are.

I hear about people really hurting themselves,

a bone is facing in the wrong direction and they're like,

I'm gonna be a man and just fix it on the spot.

Don't do that, you have no idea what injury

that looks like under the surface of your skin.

It may not need any realignment at all

so do not try to set your bones back.

Do not try to put your dislocations back in place.

Please don't do this at home.

Also, is it going into a joint?

A joint is basically where two bones meet.

We have joints all over our body and if a fracture

goes into that joint, it's more important

for that fracture to heal very, very well

and for everything to be aligned, because you can imagine,

if there are, well, bone fragments inside the joint

and then you try to move your extremity

and it can be very painful and it can lead

to a significant amount of arthritis long term.

So go see an orthopedic doctor.

Don't try to fix your own breaks at home.

That's my answer.

From @thisisntfabia, I think I've dislocated my shoulder.

Help, how do I know if I've dislocated it?

First of all, you'll know if you have a dislocation

or a fracture, because it'll be one of the most

painful things that you've ever experienced in your life

and these are things that need to be seen by doctors

so don't try to diagnose yourself at home using

Dr. Google and try to pop things back in place.

But I will say in the emergency department,

before I get x-rays if somebody thinks that there's

a shoulder dislocation, I will have them

take the arm that's affected

and try to touch the other shoulder.

So if somebody has a shoulder dislocation,

they're not gonna be able to do it.

So that's one of the things I do after I pop a shoulder

back in place, which is awesomely satisfying, I must say.

We check to see if it's back in place before x-rays

by seeing if that arm goes up to the contralateral shoulder,

that is the opposite shoulder.

This question is from @amserres.

How does one know when stitches are needed?

Asking for a friend.

It's a difficult answer.

There are certain stitches that we put in place

because it's just gonna have a better cosmetic outcome.

That is, it's gonna look better long term

but there are other stitches, real real deep lacerations

that we absolutely need to stitch up.

For instance, if it gets deep enough

to go to this layer called the fascia.

Now fascia is like really dense tissue

and that kind of holds certain structures in place.

Think of it as like layering,

layering of a cake or something like that.

So that particular layer called the fascial plane

that separates those two areas a lot of times

needs to be repaired and so we'll put stitches in there

to bring that back together and if you don't,

the muscles or structures that are under

that fascial plane can kind of herniate through

and they'll cause you some issues.

Also I should mention, there are absorbable sutures

and there are non-absorbable sutures.

There's certain stitches that

we don't want your body to absorb.

For instance, if there's a tendon that's been cut

and we're repairing that, a lot of times,

we're gonna use a non-absorbable suture.

We want that stitch to stay in place because it takes

a long time for tendons to heal fully, okay?

There are other areas of the body or certain situations

where we want the stitches to dissolve

and those dissolvable stitches or absorbable stitches

are made out of either synthetic polymers

or they're made out of animal intestines.

So come to the emergency department

and we might stitch you up with animal intestines.

All right, this next question is from @justinwolfson.

I broke my femur in a car wreck and I have some Q's.

By the way, this is a terribly painful experience

so Justin Wolfson, my heart goes out to you, brother.

How much force does it take to break a frigging femur?

How do they get that rod in there?

Don't I need that missing bone marrow

and how did these heal before this surgery existed?

It's a lot of force.

The answer is about 4,000 Newtons of force.

4,000 Newtons is about equivalent to

900 pounds here on Earth's gravity

so you can think of a sea lion or a really big moose,

that is the amount of force that it takes.

You think about surgeries in general

as being a very gentle, precise operation.

Orthopedic surgeries are not gentle.

They're putting force in there.

They're using muscles 'cause it genuinely requires

a significant amount of force to get these surgeries done

and to put bones back in place.

To get that rod into your femur,

they basically have to align it where the cavity is

where your bone marrow is, okay,

and it's called an intramedullary rod.

They align it and they take a big old hammer

and they go wonk, wonk, wonk, wonk, wonk

until it's all the way in there.

So it is violent and it takes a lot of force

and it's impressive to see.

Don't I need that missing bone marrow?

Now, you really don't.

I mean, you have bone marrow throughout

the rest of your bones, you'll be fine.

Last question, how did these heal

before this surgery existed?

And the answer is very, very poorly.

They probably didn't heal very well at all.

That person maybe never walked again

if you were in a car accident in the 1500's.

All right, the next question is from @kiraankahlon_.

Why are shin splints so painful?

So shin splints are known as median tibial stress syndrome

and that's basically where there's inflammation

of a lot of the structures that are there around your tibia.

Your tibia is this long bone here in your lower extremity

right next to your fibula, which is the skinnier bone

that runs along the side.

Runners always get these shin splints,

a lot of cheerleaders get shin splints

and these can be very, very painful.

Now here's the thing though,

that pain should resolve with rest.

Definitely get seen if that pain doesn't resolve

with cessation of that activity.

This is from @LondonHearts1.

What is a defibrillator?

Do I have to be trained to use one?

So a defibrillator is basically a device

that administers electricity to the heart.

The bottom part of your heart are the ventricles, all right,

and when the heart naturally does its thing,

the top part squeezes first, the atria squeeze,

the bottom part squeezes afterwards.

Boom, boom boom, boom boom, boom boom.

So if the bottom part of the heart

isn't given a good, hearty squeeze there,

see what I did there with hearty?

That was a total accident.

You're not going to get blood flow

to your brain or to your extremities

and you are going to start dying.

When you go into these dangerous heart rhythms,

you get electricity of the heart as soon as possible.

Ask for an AED or automatic external defibrillator.

Don't be worried, you can do this.

You can save someone's life.

Call for 9-1-1 as well because they're trained,

they're gonna know what to do, especially in the field.

But if you can get an AED, it'll tell you to

put these pads on the chest and, and on the back

and you're gonna basically sandwich the heart

and that's gonna make it to where

the electricity runs between the two pads.

If you don't have access to an AED

and or you're a professional,

this is what you're gonna need.

This is called a LIFEPAK. [groans]

So this bad boy is over $50,000 worth of machine.

What we do is we hook this up to somebody's chest.

When it's hooked up, you'll be able to see the rhythm

that the heart is in, you'll be able to tell is that person

in ventricular fibrillation or ventricular tachycardia?

And then we can determine, do they need defibrillation

or do they need something called synchronized cardioversion?

This will basically take someone who is inevitably

going to die and bring them back to life very rapidly.

This is one of the best inventions

that modern medicine has, to be honest.

So this thing's pretty amazing.

The next question is from @PtWorx

and the question is, what is the most serious

or painful injury you've ever encountered?

I mean, the most serious injuries

are the ones where the patient comes in dead

but you classify traumas based on what hit what.

So you'll say like motor vehicle versus bicyclist

or train versus pedestrian.

You can imagine that train versus pedestrian was the most

serious thing that I've seen in the emergency department.

The guy, not to gross you out, but had

a traumatic amputation that is his arm

was ripped off from the force and he was already

D-E-A-D dead by the time he came in

and so that is the most serious injury that I've seen.

Some of the most painful injuries that I see

actually are ones that cause ischemia.

Now ischemia is lack of blood flow

to tissue or lack of oxygen.

So if there is an injury that either

rips the blood vessel apart or causes a certain abnormality

that would decrease the blood flow to a certain area,

that is exquisitely painful.

Hopefully you never have to experience

something like that in your lifetime.

This is from @mediocentr0, is an achilles tendon tear

the worst injury an athlete can get?

So I should tell you what an achilles tendon is.

Rah, rah, rah, rah, rah, rah, rah, rah.

Your Achilles tendon is this tendon back here

that attaches your calf basically to your foot

and allows you to flex your foot and so when this pops,

you can't do this anymore and that's pretty important

for running, walking, jumping, et cetera.

This is a shocking, morbid injury, but I would argue

this is not the worst injury that an athlete can sustain

because think about a spinal cord injury, man.

You get a cervical spine injury that is,

you essentially fracture the bones here in the neck

and it ends up pushing on your spinal cord

and you may never be able to walk, use your arms or legs.

I think paralysis, that's the worst

injury that an athlete can get.

All right, this next question is from @LezDoMedLegal.

Is it okay to treat my dog bite injury at home?

Absolutely not.

These are at very, very high risk for infection.

You need antibiotics.

Also, when was the last time you got a tetanus shot?

Also rabies, that's a problem.

Chances are pretty low, right?

But if you get it, guess how fatal it is?

A hundred percent.

Now if they can catch the animal

and if it's a stray animal, that's different.

What they do is they watch the dog for multiple days,

make sure they don't exhibit any signs of rabies.

If they don't, then it's fine.

You don't have to get all your rabies shots

and stuff like that but if it's some rando dog

that bit you ran away and you're never gonna see it again,

you need to get your rabies shot.

You also want to get x-rays to make sure

there isn't a big old chunk of bone under the surface there

because again, very, very high risk for infection.

From @41shiesty, what is Tommy John surgery?

Let me get my little arm model right here.

This is your humorous, all right?

This is your ulna right here and this is your radius

and what happens in people that require Tommy John surgery

is they end up having a rupture of this tendon

called the ulnar collateral ligament.

The ulnar collateral ligament connects the humorous,

which is this bone here right, down to the ulna

and if you are throwing overhead all day, every day

for years and years and years, you put yourself at risk,

especially if you're putting a ton of force behind it,

you're throwing fast balls and once that thing pops,

you're gonna have a lot of pain when you're throwing.

It's gonna be really tender over that area

where the ligament naturally is.

So what do they do during a Tommy John surgery?

They end up taking a tendon to fix your ligament.

They'll either take a tendon from your forearm,

your hamstrings, or your foot and they will reconnect

those bones to kind of stabilize that area

on the medial aspect of your elbow

and you wonder, do you not need the tendon

that they're taking out from the other area of your body?

And the answer is no, not really.

You're gonna do fine without it.

@P1P31150, I have no idea what that stands for

but how do you know if you have a broken rib?

Asking for a friend.

It's always asking for a friend

It's gonna be very painful.

If it hurts a lot or you're having any difficulty breathing

you absolutely need to be seen because you can have

pain on one side and you think,

oh it's just a broken rib, whatever,

they don't do surgery on that, which is true.

But what can happen is that rib, if that fractures

and pokes your lung, you can pop a lung.

You can have a collapsed lung.

If you get air in your thoracic cavity

that's outside of your lung, it can compress your lung

to the point where one, you have difficulty breathing

and two, you can put so much pressure

in the thoracic cavity that you can cut

off blood supply to the heart.

You can squeeze the blood vessels closed that are

responsible for getting blood back to the heart

and you can imagine it's only a matter of time before

you die, if you're not getting blood flow to your heart

because if you don't get blood flow to your heart,

you don't get blood flow to the rest of your body.

So if you think you have a rib fracture,

get seen, might be more serious than you think.

Next question is how to treat cooking oil burn?

[beep], I hate scars.

That was a quote, that was a quote, I didn't...

The answer is you treat a cooking oil burn

by getting seen in person.

Unfortunately, you do need to get seen.

This isn't something you should be treating at home.

You have multiple different depths of injuries with burns.

They pretty much all need some sort

of antibiotic cream to put on there.

Now Neosporin does work really well for a burn,

especially if it just looks like it's a sunburn

and there's no bubbling or anything,

that's probably gonna be a superficial thickness burn

or a first degree burn but when you start

getting into those deeper burns

when it's bubbling up on the surface,

go see a doctor to determine what depth of injury it is

and then long term, depending on where the burn is,

you may end up needing the skin graft

which is where they take skin somewhere else in the body

and then we attach it to the area where the burn is

because our skin provides a very important role.

It one, makes sure that we don't lose

a lot of water to our environment

but the skin also protects you against infections

so they're very, very high risk for infections.

Also, if the burn is over a joint, you can get scarring

to kind of resist your normal movement of the elbow

and you may develop contractures

and they may need to get essentially released surgically.

So go see a doctor, especially if it is bubbling

or turning a white-ish color.

From @StrawHatRuby, what's the difference

between a sprain and a strain?

A sprain is when you have an injury to your ligaments.

Ligaments directly connect bone to bone.

Tendons are affected when you have a strain.

I said it right and tendons connect muscle to bone.

and how do you kind of know the difference between the two?

it's difficult to say because both of them are very painful,

but one of the big differences is that

muscle strains can end up having a lot of cramping

associated with the muscles.

Now that technically can happen with sprains as well,

just a little less likely and you can have

limited movement around that joint that's affected.

Now that's with a strain.

With a sprain, you won't have as much muscle spasm

and you may have more movement at that joint

because the ligament that was there kind of stabilizing

and holding it in place is injured, stretched,

maybe totally torn and so you may be able

to move it more than you could before.

You could have instability of that joint.

So that's the difference between a sprain and a strain.

From @luxembitch, can you break your funny bone?

Not a rhetorical question, I really slammed

that bitch on a changing room locker.

The funny bone can be a very painful injury

and it's usually very temporary

but what happens is you have an ulnar nerve.

You have this big old nerve right on the medial aspect,

the middle side of your elbow, and that nerve

is responsible for your ability to feel there

and so that's why when you hit it,

your fingers might kind of tense up and you get this really

weird tingling sensation all the way down your hand.

So no, you can't break your funny bone

but it can hurt a lot.

All right, that's all for now.

Hope you guys learn something today.

I'm Dr. J Mack signing off.

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