- 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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