All posts by Jeffrey Sterling, MD

Straight, No Chaser: National Minority Organ Donor Awareness Month

Health Prevention, , , , , , ,

Organ-donor-shortage-001
August is National Minority Donor Awareness Month, which brings attention to the more than 118,000 people nationwide waiting for lifesaving organ transplants. Of the these men, women and children listed on the national organ transplant waiting list, 56% are minorities. People of most races and ethnicities in the U.S. donate in proportion to their representation in the population. Minorities are disproportionately affected by illnesses, like high blood pressure and diabetes, which can lead to end-stage renal disease and the need for dialysis or a kidney transplant.  This contributes to a disproportionately higher number of minority patients on the national organ transplant waiting list.
Here’s a representation of waiting list candidates by ethnicity:

  • Caucasians: 43.7%
  • African-Americans: 29.6%
  • Hispanics/Latinos: 18.4%
  • Asians: 6.7%
  • Native Americans and Alaska Natives: 1%
  • Native Hawaiians and other Pacific Islanders: 0.5%
  • Multiracial: 0.5%

In 2012, 11,309 minority patients received organ transplants; while there were 2,762 minority deceased donors and 1,711 minority living donors. The wait is long and, sadly, 18 people die every day because the transplant they desperately needed did not come in time.  These facts make the need for more donors from ethnic minority groups critical.  However, minority organ donation often lags due to misinformation about the need and process.
Learn The Facts (most information provided by U.S. Department of Health and Human Services)
These facts may help you better understand organ, eye, and tissue donation:

  • Fact: Regardless of age or medical history, anyone can sign up to be a donor. The transplant team will determine at an individual’s time of death whether donation is possible.
  • Fact: Most major religions in the United States support organ donation and consider donation as the final act of love and generosity toward others.
  • Fact: If you are sick or injured and admitted to a hospital, the number one priority is to save your life.  Hospitals simply are not in the business of allowing patients to die to harvest their organs.
  • Fact: When matching donor organs to recipients, the computerized matching system considers issues such as the severity of illness, blood type, time spent waiting, other important medical information, and geographic location. The recipient’s financial or celebrity status or race does not figure in.
  • Fact: An open casket funeral is usually possible for organ, eye, and tissue donors. Through the entire donation process, the body is treated with care, respect, and dignity.
  • Fact: There is no cost to donors or their families for organ or tissue donation.
  • Fact: Every state provides access to a donor registry where its residents can indicate their donation decision.
  • Fact: Federal law prohibits buying and selling organs in the U.S. Violators are punishable by prison sentences and fines.
  • Fact: People can recover from comas, but not brain death. Coma and brain death are not the same. Brain death is final.

In order to sign up to be on the donor registry, or to receive more information, visit http://organdonor.gov/becomingdonor/stateregistries.html.
Meet the challenge.  Address the need.

Straight, No Chaser Poll: Help Improve the Experience!

General Health and Wellness, , , , , , ,

Thank you for taking the time to answer a few very simple questions.  Doing so will help me provide an even better blog for you.  Of course, I expect your answers to be Straight, No Chaser.

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Thank you sincerely for your support and feedback.  Feel free to offer suggestions and topics you’d like to see covered.

Jeffrey Sterling, MD

Straight, No Chaser: Trauma Quick Tips and The Week In Review

Medical Treatment, Health Prevention, , , , , , , , , , , ,

cch trauma
This week in Straight, No Chaser, we reviewed multiple topics related to Trauma, the #1 cause of death between ages 1-44.  Here’s the Week In Review and featured Quick Tips.
1)   Over the weekend, we started with discussions of Amputations of Permanent Teeth and Fingers.

  1. Remember, you lose 1% viability per minute for a dislodged tooth.  Get help quick!  https://jeffreysterlingmd.com/2013/07/27/straight-no-chaser-saturday-quick-tips-the-tooth-of-the-matter-is/
  2. The transport of displaced fingers and teeth is vital to successful reimplantation.  Never place them directly on ice!  https://jeffreysterlingmd.com/2013/07/28/sunday-quick-tips-give-me-the-finger/

2)   On Monday, we talked about Motor Vehicle Crashes.
https://jeffreysterlingmd.com/2013/07/29/straight-no-chaser-human-shark-week-part-1-motor-vehicle-trauma/
https://jeffreysterlingmd.com/2013/07/29/trauma-quick-tips-how-to-survive-that-motor-vehicle-crash-mvc/

  1. Avoiding distracted driving is the most important factor in preventing crashes.
  2. Wearing your seat beat is the most important factor in surviving crashes.
  3. The middle back seat (while wearing a seat belt) is the safest place in the car.

3)   On Tuesday, we reviewed Traumatic Brain Injuries/Concussions.
https://jeffreysterlingmd.com/2013/07/30/straight-no-chaser-heads-up-traumatic-brain-injuries-concussions-part-i/
https://jeffreysterlingmd.com/2013/07/30/straight-no-chaser-heads-up-traumatic-brain-injuries-concussion-part-ii/
https://jeffreysterlingmd.com/2013/07/30/straight-no-chaser-concussions-post-script-a-neurologists-thoughts/

  1. Dr. Flippen, a neurologist from UCLA, reminded us that most patients will recover but never as fast as they wish.
  2. After a head injury, expect not to be released back to sporting activity for at least two weeks.

4)   On Wednesday, we reviewed Mass Disasters and talked about the importance of an Emergency Kit.
https://jeffreysterlingmd.com/2013/07/31/straight-no-chaser-when-disaster-strikes/

  1. Remember to have access to 1 gallon per day per person, half for drinking and half for cooking/hygiene.

5)   On Wednesday, we also discussed Dog, Cat and Shark Bites.
https://jeffreysterlingmd.com/2013/07/31/straight-no-chaser-who-let-the-dogs-out-animal-bites/

  1. Cat scratches are also a major infection risk and should be evaluated.
  2. Who’d have thought sharks were nibbling you out of curiosity instead of biting you out of hunger?

6)   On Thursday, we reviewed Penetrating Trauma (Gunshot and Stab Wounds).  https://jeffreysterlingmd.com/2013/08/01/straight-no-chaser-gunshot-and-stab-wounds/

  1. Remember the ‘Golden Hour’ of Trauma and get seen as soon as possible after being stabbed or shot, just as soon as you ensure your safety.
  2. It is very important to avoid worsening possible spinal injuries by excessive movement.

7)   On Friday, we reviewed Residential Fires and its associated trauma.

  1. In Part I, we emphasized the importance of installing smoke and carbon monoxide detectors, having an escape plan and not sticking around to fight the fire.   https://jeffreysterlingmd.com/2013/08/02/straight-no-chaser-the-roof-is-on-fire-the-trauma-of-residential-fires/
  2. In Part II, we discussed treatment of possible injuries that may occur.  https://jeffreysterlingmd.com/2013/08/02/straight-no-chaser-your-questions-on-treatment-of-fire-related-injuries/
  3. Remember if any head or neck injuries exist, try your best not to move.
  4. Remember that if you’re feeling like you have the flu after being exposed to a fire, it could be carbon monoxide poisoning!

8)   On Saturday, we reviewed Snakebites.
https://jeffreysterlingmd.com/2013/08/03/straight-no-chaser-stop-the-life-you-save-may-be-your-own-snake-bites/

  1. We debunked the myth about sucking venom out of snakebite wounds.  Don’t do it!

9)   Saturday, we also reviewed Elderly Falls.
https://jeffreysterlingmd.com/2013/08/03/straight-no-chaser-ive-fallen-and-cant-get-up-quick-tips-on-elderly-falls/

  1. We identified head injuries/bleeds, lacerations and hip fractures as injuries to guard against.
  2. We discussed the importance of home improvements, diet, exercise and checking for osteoporosis and vision checking for maintainance of health.

Quick Tips on Elderly Falls

Health Prevention, , , , , , , , , , , ,

Introduction

This post is about elderly falls

elderly falls
Are all of you DIYers (do it yourself) ready for a weekend project to help a loved one? Here you go. First, let’s start with some not so fun facts.

  • Every year, one of every three adults older than 65 has a fall.
  • Falls are the #1 cause of injury death in senior citizens.
  • Falls are the #1 cause of nonfatal injuries and trauma hospitalizations.
  • Typical injuries include lacerations, hip fractures and head injuries (including intracranial bleeds). These injuries occur in approximately 20-30% of falls.

Quick Tips

elderly falls prevention

How can older adults prevent falls and the complications of falls? Here are six Quick Tips I hope you’ll share with your loved ones.

  • Start by doing some home improvements to accommodate the shortcomings of your elderly relatives. Consider railings and grab bars – near the bed, on the stairways, shower, tub and toilet. Improve lighting. Clear out and widen walking paths. Consider using a walker.
  • Exercise regularly. It keeps the brain sharp and the leg muscles strong. Inactivity promotes bad outcomes when activity is attempted. Have their doctors arrange for home health care and physical therapy if indicated.
  • Have your loved one and your family review medications with their physician. You need to know which medications and drug interactions can promote loss of balance, dizziness, drowsiness, and/or mental status changes, all of which can lead to falls.
  • Keep those eyes checked. This should be happening at least once a year. Be diligent in changing prescriptions as needed. Could you imagine being a little confused and not being able to see? What would you expect to happen?
  • Pay attention to diet. Nutritional needs are even greater in those with health issues, which is always the case in the elderly. Supplement Vitamin D and calcium for bone strength.
  • Of course, get screened and, if needed, treated for osteoporosis.

The key is to pay attention. You don’t have to let your loved ones wither into oblivion. Simple quick fixes and some love and attention can go a long way to preventing falls and the injuries that accompany them. My mother fell and suffered a massive intracranial bleed with herniation 2 years ago. I’m pleased to note that she’s made a full recovery, and these tips I’ve offered you make a world of difference. Good luck.

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Straight, No Chaser: Stop, The Life You Save May Be Your Own – Snake Bites

Medical Treatment, , , , , , , , , , , , ,

snakes-on-a-plane
So you’ve been snake bitten.  What will you do next?
First things first.  Stay calm.  Call 911.  Realize that most snake bites are non-venomous (A really quick tip regarding the likelihood of a venomous snake: most have triangular heads.).  Here’s 10 additional steps to take while waiting for your help to arrive.
5 Things To Do

  1. Protect yourself.  Get out of the snake’s striking distance.  It should be trying to get away from you as well.
  2. Lie down.  Keep the wound below the level of the heart.
  3. Be still.  Activity simply facilitates spreading of any venom present.
  4. Cover the wound with a loose, clean dressing.  Immobilize the extremity if possible.
  5. Remove all restrictive clothing and jewelry from the area, because the area will swell.

5 Things Not to Do

  1. Try to suck out venom.
  2. Try to cut out the area bitten.
  3. Apply any constrictive dressings.
  4. Apply any cold or ice packs to the wound site.
  5. Run to help.

If you’re lucky enough to have a snake bite kit, you’ll simply follow those instructions, which are a modified version of the instructions I’ve just given.
You will need to be seen by a health care provider for consideration of the following:

  • Anti-venom may be needed.
  • Tetanus immunization may be needed.
  • Appropriate wound cleaning will be needed.
  • Antibiotics for skin infection may be needed.

Let me know if you have any questions.

Straight, No Chaser: Your Questions on Treatment of Fire Related Injuries

Medical Treatment, Health Prevention, , , , , , , , ,

firevictim
Questions, you’ve got questions (Why are you so shy about posting them?).  Here we go.  Today, your focus is on the aftermath and treatment of fire related injury.
1)   What does carbon monoxide poisoning look like?

  • Carbon Monoxide (CO) poisoning is very dangerous because the gas is colorless and odorless.  You should suspect that you’re feeling its effect when you’re feeling like you have the flu after perhaps being in a contained area with a motor running or after a fire.  Headache is the most common symptom, and you may also feel nauseated, with malaise (feeling ‘blah’) and fatigue also being common symptoms.

2)   How are the burns treated?

  • Burns cause serious illness.  The thermal component can cause direct damage to your airway.  The toxins contained within (carbon monoxide and cyanide) can kill you independent of any other consideration.  Burns are especially prone to infection, so you don’t want significant skin burns exposed to everything outside of a burnt house while you’re waiting for the ambulance.
  • The burns will be treated according to the severity.  A lot of intravenous fluid, pain management, clear blister removal and infection control will be in order.  Especially serious burns may require a burn unit and skin grafting.

3)   What can I do to treat while waiting for the ambulance?

  • Keep calm, and keep them calm.
  • Be prepared to start CPR if necessary.
  • If any injuries have occurred to the head and neck, lay the person down and don’t move them.
  • Cover any bleeding areas, and apply enough pressure to stop external bleeding.
  • If you have a clean sheet, wrap the person in it.

4)   I know someone who says she was intubated (i.e. had a ‘breathing tube’ placed), and they were feeling fine after a fire.  Why would this have been done?

  • It’s hard to comment on the management of individual cases sight unseen, but most likely soot or burning was noted somewhere inside the airway (e.g. the mouth, nose or oral cavity).  Intubation would have been done to protect and secure the airway before in collapses.  If you wait until the last possible moment, it could be too late.

Straight, No Chaser: The Roof Is On Fire – The Trauma of Residential Fires

Trauma, Health Prevention, , , , , , , , , , , , ,

Image
As Trauma Week winds down on Straight, No Chaser, we work our way back home, which sadly is the site of most traumatic injuries.  In fact, about 85% of all U.S. fire deaths occur in homes.
The good news is the number of residential fire-related deaths and associated injuries is going down, but that won’t help you if you aren’t aware of how to prevent them and get to safety and cared for in the event a fire occurs in your home.  Let’s address this right off the bat.  You’re most likely to die or be injured from a fire if you’re in one of the following groups, according to the Center for Disease Control (but of course, the fire doesn’t check who’s being burnt):

  • Poor
  • Rural
  • African-American
  • Native American
  • Ages less than 4 or over 65

In the U.S. (2010 data), someone dies every 169 minutes and is injured every 30 minutes, amounting to over 2,500 deaths and over 13,000 injuries (and that’s not including firefighters).  Interestingly, victims aren’t burning to death as much as they are dying from inhalation injuries from smoke and gases (estimated to be the cause of death in between 50-80% of cases).  Speaking of smoke, although cooking is the #1 cause of fires, smoking is the leading cause of fire-related deaths.  Alcohol consumption is a contributing factor in 40% of residential fire deaths.  Most fires occur in the winter.
So What To Do?

  • Install a smoke alarm.  They work.  Over one-third of residential fire deaths occur in homes without alarms.
  • Plan your escape in advance.  Have an exit strategy based on where a fire might break out in your home.
  • Don’t fight the fire.  Nearly ½ of fire related injuries occur from efforts to fight the fire.  Get out of the house.  Of course if you have easy access to an extinguisher, use at your discretion.

Tips on How You’ll Be Treated
Fire-related injuries commonly involve burns and bony injuries (bruises, sprains, fractures), which will be addressed as needed.  However, the most important fire-related injuries involve the airway.  These injuries may be due to the heat’s effects on the airway (burns, swelling and inflammation) and/or the effects of carbon monoxide and/or cyanide (inability to oxygenate).  One important fact for families to realize is the presence of any soot/burns anywhere near or in the mouth or nose needs to be evaluated.  Such signs and symptoms are powerful predictors of potential airways damage and imminent failure.

Straight, No Chaser: Your Questions About Gunshot and Stab Wounds

Medical Treatment, Skin/Dermatology, Trauma, Health Prevention, , , , , , , , , ,

 Your Top Five Questions:
 1. Why don’t the bullets always get taken out? 
Removal of bullet may cause more damage than leaving them in.  It’s sometimes not worth the effort.
2. What’s with the tubes that go in the chest?
Chest tubes are used to treat a pneumothorax (a collapsed lung).  The problem is there’s air in the space between the lung and the chest wall.  This can interfere with normal breathing and may be life threatening.  The tubes go through the chest wall to release the air from that space, thus allowing re-expansion of the lungs.
3. Why would doctors ever need to slit someone’s throat to save their lives?
That describes either a cricothyrotomy or a tracheostomy, and it’s not ‘slitting’ the throat as much as it’s creating an opening in the airway to permit airflow.  This is usually necessary because of some airway obstruction at the upper throat (foreign body in the throat, etc.) with an inability to clear it.  This procedure is only done to save a life.
4. Why would you die from a wound to the thigh?
Fractures of certain bones and laceration of certain blood vessels are potentially associated with enough blood loss that you could bleed to death.  Infection and blood clots are additional considerations that could be life-threatening.
5. What about gunshot or stab wounds to someone pregnant?
Penetrating trauma to the abdomen is typically less fatal to the mother than to a fetus because the fetus is literally acting as a shield.  In the event any wound has placed the mother’s life at risk or the mother has died from the wound, under certain extreme circumstances, an emergency C-section may be performed to save the baby.

Straight, No Chaser: Violent Crimes – Gunshot and Stab Wounds

Medical Treatment, Skin/Dermatology, Trauma, Health Prevention, , , , , , , , , ,

Penetrating trauma (PT) is of such magnitude in this country that it is nearly impossible to do it justice in short form. This is primarily a medical blog, and as such I’ll defer addressing the politics of it all. The fact remains that gunshot and stab wounds take an astounding toll on human life in the U.S, with over 16,000 homicides annually (approximately 45 deaths every day). The ramifications of these wounds encompass much more than medical considerations, but I’ll devote this space to discussing basics of penetrating trauma.
What Happens
By design, intentional stab and gunshot wound aim to kill. Just as I noted in discussing the blunt trauma seen in motor vehicle crashes, any area of the body can be shot or stabbed. Unintentional injuries are also a source of common emergency room presentations. Major ERs and Trauma Centers are known within the industry as the ‘knife and gun clubs’.
Penetrating injuries to virtually all areas (brain, neck, chest, back, abdomen, groin, extremities) can be fatal. Gunshots wounds have several ways of injuring you, including the direct damage to tissue, indirect damage from the shock waves and direct damage from fragments (of the bullet or bone).

  • PT that reaches blood vessels can cause fatal bleeding. In the abdomen, the liver is the most commonly injured organ because of its large size and can bleed enough to cause shock and death.
  • PT that reaches the spinal cord can cause paralysis and death.
  • PT to the brain can cause all manners of dysfunction, including loss of speech, motion, sensation, bodily functions, paralysis and death.
  • PT to the chest can cause puncture, rupture and/or loss of lung and heart function, leading to a pretty rapid death.

Be reminded that although both gunshot wounds and stab wounds involve penetration and may puncture your internal organs, gunshots are more prone to deeper penetration with higher energy and may create exit wounds, causing damage throughout its course.
What You Can Do
Here are the things you must consider after becoming a victim of penetrating trauma.

  • Get to safety. Perpetrators of penetrating trauma meant to hurt you and often mean for you to be dead. They may be looking to finish the job. I’ve been involved in many scenarios where individuals came to the ER to do just that.
  • Once you’re safe, immediately call 911 regardless of how you feel. You may be in shock and your body will fight feverishly to normalize how you feel – right up until you crash. In other words, you can’t trust how you feel. Another vital consideration about getting medical attention rapidly is what we call ‘The Golden Hour’. The opportunity to address many of the truly life threatening considerations in penetrating trauma is best done within the first 60 minutes of the injury.
  • Once you’re safe, apply pressure (clean towels) to any bleeding sites. Cover yourself with blankets as needed to preserve heat.
  • Avoid movement. Gunshot wounds are associated with spinal cord injuries, so movement could be dangerous.

What You Should Expect
Treatment of penetrating trauma is very dramatic and necessarily regimented due to the early lack of knowledge of the depth and location of injuries. As such, assessment and treatment protocols generally are in place for the region of the body penetrated. The first consideration is always ensuring that the patient’s Airway is intact, Breathing is still ongoing, and Circulation (blood flow) is sufficient (The ‘ABCs’ of Trauma management). After that, use of x-rays, CT scans and other radiologic modalities to identify the location and extent of injuries will be employed based on the stability of the patient. Sometimes immediate surgical intervention is needed.
This is another situation where prevention is the best course of action. Avoiding injuries when possible should go without saying but often does not. Gun safety for gun owners is crucial to avoid unintentional injuries. Attention to detail is very important when handling guns and knives. Unintentional injuries tend to occur when handlers of these weapons get too comfortable. Unfortunately, once penetrating trauma has occurred, it seems like a game of chance. For every person who is told “If that bullet was one more inch to the right, you’d be paralyzed (or dead)”, another family has to be told to make arrangements. Unfortunately, my father was the victim of a random fatal gunshot wound when I was six years old, so I know that story all too well.
If you remember anything from this blog post, remember time is of the essence. Get your loved one to us inside of ‘The Golden Hour’ to give the best chance of a good outcome.

Straight, No Chaser: Who Let The Dogs Out? Animal Bites

Infectious Disease, Medical Treatment, Skin/Dermatology, Trauma, Health Prevention, , , , , , , , , , ,

shark-attack-792816
Human Shark Week wouldn’t be complete without reviewing something getting bitten.
Bow-Wow Ows
Dogs bite almost 5 million people yearly, resulting in 800,000 visits to a healthcare provider. Injuries are highest for kids between ages 5-9.
Most dog bites are to the upper extremities (imagine yourself reaching out, petting or slapping a dog), but in kids most injuries are to the head and neck (they’re smaller). Here’s some tips to avoid getting bitten.

  • If you’re considering bringing a dog into your family, remember that dogs or dog breeds with histories of aggression are inappropriate in households with children (I’m talking to you, pit bull owner.). Also, spend time with a dog before committing. If your kids are afraid of any individual dog, hold off. That fear may create cues the dog will pick up on and create a self-fulfilling prophecy. Spaying/neutering a dog actually reduces aggressive tenderness (no puns necessary).
  • Once you’ve acquired a pet dog, please never leave infants or young children alone with the dog. Train your dogs, focusing on submissive behaviors. Do not wrestle or otherwise become overly aggressive with your dog. If your dog develops aggressive tendencies, either get better training, or remove the pet from the household before it’s too late. Don’t disturb your pet if sleeping, eating or caring for puppies. Also avoid staring down your or any dog.
  • Do not approach an unfamiliar dog.
  • Regarding dogs you don’t know: Don’t pet any new dog without allowing it to see your hand and smell you beforehand. Do not run away screaming from a dog and scream; in fact, if you’re approached by an unfamiliar dog, your best move is to remain motionless. If you trip or fall over, roll into a ball and lie still.

Mee-Ow Ows
In general, cat bites and scratches are much worse than dog bites. Cat bites and scratches are more of the puncture wound variety, seeding and walling off very infectious bacteria deep inside of you, which then grow and cause infections. Dog bites are more of the ripping, tearing variety, which poses different problems, but they aren’t as dangerous from an infectious disease standpoint. Cat bites cause skin and blood infections. You’ll know this by warmth, redness, pain, and pus from the wound site. Fever may also be present if the infection is severe enough, and yes, cat bites can be fatal if untreated. You may have heard of ‘cat-scratch fever’. It’s a real phenomenon.
All bite wounds should immediately be washed under high pressure running water but you want to avoid any scrubbing. Pressure to bleeding wounds is important. Time is also important. Both cat and dog bites need to get evaluated. Expect to receive antibiotics in the vast majority of cases. Some bites will require stitches; others will not. That’s a decision for the medical professionals. Treatment may include tetanus and rabies vaccines.
Get in and be seen, especially with cat bites/scratches, which can cause loss of life and limb if not dealt with rapidly and effectively.
By the way, since this is my blog, I’ll just say stop it with letting your dogs lick you and kiss you in the mouth. That’s just nasty (and that’s medically speaking). Don’t you know where their mouths have been?
The Big Yow Wow! Ow
Shark bites are the things of legends, thanks to movies like Jaws and The Deep Blue Sea, which gives the impression that sharks are serial human killers. In fact, there are about 100 shark attacks worldwide yearly, with about 15-20% of attacks being fatal. I doubt that most Straight, No Chaser readers will be shark bait anytime soon, but the first thing I will mention that’s important to know is unlike other attacks by potential predators, playing possum doesn’t work with sharks. Fight back and fight dirty, attacking the eyes and gills. Apparently, sharks like easy food. In case you’ve ever wondered, sharks aren’t biting you because they’re hungry but because they’re curious. They don’t encounter humans often and similar to how a baby puts about anything in its mouth, sharks will take an ‘exploratory bite’. The typical human who swims frequently enough to be in shark infested waters isn’t obese enough to keep sharks’ interest and be a focus of their diets, particularly with so many other options. The other curiosity about sharks is after that first nibble, they tend to back off and wait for prey to die before returning for the kill. They don’t seem to like fighting wounded and aggressive victims. Rather lazy, I’d say.
The real danger in shark bites is the amputation. Single bites of arms and leg can cause enough blood loss and subsequent infection to kill you, just like any other amputation. Obviously a bite to your skull, chest or abdomen can kill instantly. Treatment primarily involves aggressive fluid resuscitation and other life-supportive measures, along with assessment of infection risk with antibiotics as necessary.
The Most Dangerous Animal of Them All
I’ll blog on human bites as a separate topic; it’s that frequent and important. For now, understanding that the human mouth is especially dirty and dangerous should hold you over. In the meantime, pay attention to your household pets and use the tips mentioned to avoid infection.

Straight, No Chaser: Concussions Post-Script – A Neurologist's Thoughts

Medical Treatment, Neurology, Health Prevention, , , , , , ,

I’d like to welcome and thank my good friend and noted UCLA Neurologist, Dr. Charles Flippen, II to Straight, No Chaser as a contributor to this topic.
His words:
“Everyone should understand the need for both physical and cognitive rest following concussion to allow full recovery (no symptoms, no meds). That may include postponing tests and/or reduced academic workload with graduated “return to play”. Regarding post-concussion syndrome, most patients will recover, never as fast as they would wish. It will usually be stepwise with headache as usually among the last symptoms to resolve.”

Straight, No Chaser: Heads Up! Traumatic Brain Injuries (Concussion), Part II

Medical Treatment, Neurology, Health Prevention, , , , , ,

concussionboxing_facial__4_

Your son is a star in Friday Night Lights (actually football, not the TV show) and has been concussed.  Amazingly, the most common question I get asked is not “Will he be ok?”, but “When will he be able to get back on the field?”.   My answer, coming out the ER, is never going to be less than two weeks, and I won’t be the one who provides medical clearance.  It’ll either be your family doctor or preferably, a neurologist.  Don’t just take my word for it.  Consider the following Quick Tips from the Center for Disease Control and Preventions.
CDC’s Discharge Instructions

  • You may experience a range of symptoms over the next few days, such as difficulty concentrating, dizziness or trouble falling asleep.  These symptoms can be part of the normal healing process, and most go away over time without any treatment.
  • Return immediately to the ED if you have worsening or severe headache, lose consciousness, increased vomiting, increasing confusion, seizures, numbness or any symptom that concerns you, your family, or friends.
  • Tell a family member or friend about your head injury and ask them to help monitor you for more serious symptoms.  Get plenty of rest and sleep, and return gradually and slowly to your usually routines.  Don’t drink alcohol.  Avoid activities that are physically demanding or require a lot of concentration.
  • If you don’t feel better after a week, see a doctor who has experience treating brain injuries.
  • Don’t return to sports before talking to your doctor.  A repeat blow to your head-before your brain has time to heal-can be very dangerous and may slow recovery or increase the chance for long-term problems.

Finally, there are two particularly impactful consequences about which you should be aware.

  • The ‘second impact syndrome’ is irreversible brain injury triggered by a fairly routine second head impact after a prior concussion.  You must take the time off needed for the brain to heal.  I care more about your child’s mental future than the upcoming playoff game.
  • The ‘post-concussive syndrome’ represents long-term neurologic and psychologic consequences of the head injury.  It includes such symptoms as inability to sleep, irritability, inability to concentrate, headache, dizziness and anxiety.

There are no treatments for concussions other than prevention of an additional injury, and that fact should be chilling to you.  Be mindful of the risks involved in choosing to engage in activities putting the brain at risk.

Straight, No Chaser: The Drama of Motor Vehicle Trauma

Trauma, Health Prevention, , , , , , ,

crash01
‘Tis not my task to preach but to inform.   Maybe you think you’ve heard it all before, but let me lay it all out for you so you can truly be an informed consumer.  Forewarned is forearmed.  There’s a reason you hear so much about drinking or texting and driving, wearing seat belts/helmets and speeding.  We have to kick off Human Shark Week with the biggest and baddest predator in the Trauma World: motor vehicle crashes.
Motor vehicle collisons are the single leading cause of death among those between ages 5-34 in the US.  More than 2.3 million adult drivers and passengers were treated in ERs as the result of being injured in motor vehicle crashes in 2009.   Let’s lay this out simply and review the risks, the consequences and preventative efforts you should be taking.
Risky Behavior: Danger is enhanced by various distractions and inadequate protection.  The mistake people make is not understanding that much of the danger is outside of your control – other drivers.  If you’re impaired or distracted, you can’t respond effectively.  I’ve seen it all.

  1. Drinking while driving – Stop it with the “I can handle my liquor” nonsense.  Someone dies every hour from drinking while driving.  It’s not just drunk driving, it’s impaired driving.  Your senses are altered and ability to respond diminished at any level of alcohol consumption and is incrementally more so with more consumption.
  2. Texting while driving
  3. Eating while driving
  4. Reading while driving
  5. Doing your hair/shaving/makeup while driving
  6. Kissing and other sexual activities while driving
  7. Motorcycle driving/riding without a helmet
  8. Letting your children drive without a license and/or formal training: it’s all too true.  Teens are most at risk for accidents and being impaired/distracted/drunk while driving.
  9. Letting your children ride in the front of the car
  10. Not wearing seat belts (the biggest mistake of them all)

Injuries:
I’ve seen nearly every conceivable injury from motor vehicle collisions.  It doesn’t take as much effort as you’d think to have a very bad life after a crash.  Consider the following possible going head to toe (and yes, the list is abbreviated)…

  • Traumatic Brain Injury, including intracranial bleeds, strokes, seizures, concussions, herniation and death…
  • Neck Injury, including fractures, strains, pinched nerves, temporary and permanent loss of motion/sensation in your extremities…
  • Chest wall bruising, heart and lung bruising, collapsed lungs, stab wounds to the heart and lungs, ruptured heart vessels…
  • Abdominal injuries, including contusions to and rupture of the liver, spleen, pancreas, diaphragm and intestines…
  • Genital, urinary and pelvic injuries, including the kidneys and multiple fractures…
  • Nervous, psychologic and musculoskeletal system injuries, including contusions, life-threatening fractures and dislocations, paralysis, facial disfigurement and other scarring, post-traumatic stress syndrome and long term pain syndromes.

Prevention:

  1. Seat belt use reduces serious injuries and deaths in crashes by 50%.  Air bags provide added protection but are not a substitute for seat belts in a crash.
  2. Wear a seat belt every time, every trip.
  3. Seat all kids under 12 in the back seat.
  4. Seat backseat passengers in the middle (it’s the safest spot in the car)
  5. Regarding any function on a smartphone, if you can’t be hands free, it can wait.  If you must use your hands, pull over.
  6. Remember designated drivers?  Yes, that’s still a thing.
  7. If you’re on a motorcycle, wear a helmet, every time, every trip.
  8. Protect your teen.  No license, no vehicle.  Consider driving school.

Impaired and distracted driving will cause you harm; it’s not an ‘if it’ll happen’ situation, it’s ‘when it happens’. Please consider the points I’ve mentioned and the lives of passengers/other drivers when deciding how you handle your vehicle.  Good luck.

Straight, No Chaser: Trauma Quick (Finger)Tips – Give Me the Finger!

Medical Treatment, Orthopedics/Bones, Trauma, , , , , , ,

amputations
What you’re seeing is not a five-finger salute gone bad. It’s an all too often occurrence: amputated fingers. Believe it or not, 90% of reattached fingers are done so successfully, although many end up with decreased motion and sensation. Today’s tips are to tell you how to handle the time between when the amputation occurs and when you get to the hospital. It’s actually pretty important to be meticulous in how you handle the finger prior to reattachment.

  • Wrap the amputated part of the finger in moist, clean gauze. Moist – not wet, not dripping.
  • The gauze should be placed in a sealed plastic bag or sterile container.
  • Take the plastic bag and place in another sealed plastic bag or container, with the second containing ice or cold water. The finger never should touch the ice!

It’s actually more important to support the person than the finger. We can survive without a finger. Fingers are worthless without a live person. To that end, calling an ambulance should be the very first thing you do, and don’t forget to place a clean dressing or the cleanest towel you can over the bleeding part of the hand.
You should be aware that not all amputations are reattached, particularly when a poor outcome is likely. However, don’t make any assumptions, and make the effort to give yourself the best possible chance for the best possible outcome.

Straight, No Chaser: Why is Life so Traumatic? (aka Human Shark Week!)

Trauma, Health Prevention, , , , , , ,

Introduction

shark_week

If there were a human equivalent to shark week, it would be TRAUMA WEEK!  That’s right.  Trauma has all the drama, excitement and tragedy as shark bites and often makes about as much sense as exposing yourself to a shark.

Trauma is the #1 cause of death between ages 1 and 44.  In fact, according to the Centers for Disease Control and Prevention, trauma accounts for more deaths during the majority of life than all other causes combined, checking in at just over 50%.  Traumatic causes of injury are so common and avoidable that it’s worth looking at the top entities separately.  This week we will do just, informing you of where the danger lies and offer simple tips to keep you alive.

So buckle up (literally).  We’ll get into motor vehicle collisions, brain injuries, domestic abuse, suicides and homicides, drownings and other home/recreational injuries.  Trauma. Unfortunately, it’s for everyone.

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Ask your SMA expert consultant any questions you may have on this topic. Also, take the #72HoursChallenge, and join the community. Additionally, as a thank you, we’re offering you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!

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Straight, No Chaser: Saturday Quick Tips – The Tooth of the Matter is…

Head/Eyes/Ears/Nose/Throat, Medical Treatment, Dental, Health Prevention, , , , , , ,

MissingTooth_jpg
What would you do if your tooth fell out or got knocked out? Here’s today’s Quick Tips.
1) Most importantly, be quick about it. You have a loss of survival of about 1% per minute. Get to your closest Emergency Room.
2) Take the tooth and gently rinse it off. Don’t scrub it!
3) Transport it in either milk or your saliva. Don’t let it get dried out. This is not to say that you should keep the tooth in your mouth. We don’t want you to choke!
Final point about your kids’ teeth.
Avulsed primary teeth in the kids (ages 6 months to 5 years) aren’t replaced into their sockets if they fell out.

Straight, No Chaser: Beat the Heat (and Not Just in Miami)

Environmental, Medical Treatment, Neurology, Health Prevention, , , , , , ,

When a loved one dies, families often ask “Is there something I could have done?” Usually I give you information. Today I want to give you information and power to act if needed. There are several varieties of heat related illness, and you would do well to be aware of them, because you can make a difference if someone’s suffering in the heat.
For starters, I really want you to become mindful of Heat Stress, which is the earliest complex of problems arising from excessive heat exposure. Heat stress is that strain and discomfort you get (usually during outdoor exertional activity) that reminds you that you’d be better off inside. You may notice such symptoms as cramping, a prickly-type rash, swelling and a sensation that you want to lose consciousness. If you must remain outdoors due to work, or choose to (playing sports or enjoying the sun), hydration means everything. It really is true that in some instances if you’re not actively urinating, you’re not drinking enough fluid.
Ok, so you’ve ignored both me and your body, and you’re still outdoors, not rehydrating enough. Heat exhaustion may occur next, and it’s defined by ongoing body salt and fluid losses. Now you’re feeling faint, thirsty, anxious, weak, dizzy, you want to vomit and may have a headache, and your body temperature starts to climb. I see a lot of these patients, usually because once you get wobbly, your employers or co-workers are getting concerned, which is good, because at this point, you are actually in danger.
Or maybe you didn’t come to see me when you had the chance, and you’ve collapsed outdoors, to be found and brought in. This is Heat Stroke, and is defined by changes in your mental status, increases in your temperature and disruption of your bodily functions, including a loss of ability to sweat and a loss of your kidney and liver’s abilities to detoxify your body the way they normally do.
Well, in case you’re feeling good about yourself because you’re too smart to exert yourself outdoors, all I’ve been describing is ‘Exertional’ Heat Stroke. The more deadly form of heat related illness is ‘Classic’ Heat Stroke. This is the type that captures the headlines every year in places like Chicago, New Orleans, Miami and Houston. Classic Heat Stroke is seen in those with underlying disease, bad habits or the elderly. I’m talking about the obese, alcoholics, meth and/or cocaine users, folks with thyroid or heart disease or on certain medications like diuretics or beta-blockers. These folks can get the same symptoms simply by not being able to escape the heat. They may actually just be sitting around in a less than optimally air-conditioned home.
So that’s what you’re up against. And yes, many people die from this. By the way, you’re not protected from the heat related illness just because you’re in shape. Let’s end with some 2 tips (one for prevention and the other for assessment and treatment) to help you Beat the Heat.
1) Take caution during the following conditions

  1. 95 degrees is high risk, regardless of the humidity
  2. 85 degrees and 60% or above humidity
  3. 75 degrees and 90% or above humidity

Here, you want to remove yourself from that environment. You need to keep plenty of fluids around. You need to visit an environment where there’s adequate air conditioning. Dress very lightly.
2) If symptoms of heat related illness short of mental status changes occur, think “Check, Call, Care, Cool”

  1. Check – look for those signs and symptoms I mentioned earlier
  2. Call – call 911 immediately. Better to have it and not need it than need it and not have it.
  3. Care – Lie in a cool place, elevate the legs, place cool, wet towels on the body (especially in the armpits and groin), and drink cool fluids. If mental status changes occur, or if the heart or lungs appear to give out, cool by any means necessary while waiting for the ambulance. This could include ice bath, ice packs, fans or cold water, but don’t drown someone trying to put them in a tub of water if you can’t handle them. Don’t forget to remove those layers of clothing.

Please be mindful that it is hotter in July, and unfortunately lives are lost every year to the heat. If you can’t avoid the exposure, at least have a plan for managing the heat and acting on any mishaps. The life you save may be your own.

Straight, No Chaser: Back From the Dead (aka The One Piece of Medical Equipment I Wish You Had in Your House)

Cardiology/Heart, General Health and Wellness, Medical Treatment, Health Prevention, , , , , , ,

Have you ever heard of an AED (automated external defibrillator)? Well, you’re about to. We’ve promoted CPR (cardiopulmonary resuscitation) a ton over the years, but recent recommendations place added emphasis on trying to literally shock patients back into consciousness. Thus, let’s start at the literal end of life, when you actually have a chance to save a life.
There are a couple of abnormal heart rhythms that suggest death is imminent. They’re called ventricular fibrillation (V-Fib) and pulseless ventricular tachycardia (V-tach). In these conditions, the heart is more or less quivering (V-Fib) or pumping too fast (V-tach) instead of giving off an optimal forceful beat. Effective beats pump blood (containing oxygen and nutrients) around the body you need to not only function, but to survive. Now, those two bad rhythms I just mentioned are unsustainable indefinitely, because without effective blood flow, vital organs such as the brain, lungs and ultimately the heart itself will give out within minutes, and that’s why you go ‘flat-line’ (aka asystole, aka dead, or soon to be). Even if you do survive, every minute these organs are starved of blood leads to damage that could be irreparable.
AEDs are designed to shock/stimulate the heart out of these deadly rhythms and back into an effective pumping state when possible (AEDs do not work for asystole, the flat-line rhythm.). The beauty of these machines is they are simple (and have been proven to be useable by untrained 6th graders), small/portable and if you pay attention, they’re all over the place. And even better: all AEDs used in the US talk to you and tell you what to do! My goal for you is simple: even if you can’t have one, know about them so you will think to use them if the opportunity presents.
Here are some frequently asked questions and answers regarding usage:
1) How do you connect it? AEDs have pads that need to be placed on the chest while staying attached to the machine. Instructions embedded on the machine will show you exactly where.
2) How does it know what to do? AEDs will detect the heart’s underlying rhythm and inform you if a shock is needed. Some machines will deliver it automatically; others will require you to press a button.
3) Are there limitations based on age? AEDs may safely be used on children and used by children. Appropriately sized pads must be used for kids.
4) Can I be sued for using this if the person dies? Users are protected by Good Samaritan Laws in case something (else) bad happens.
5) Should I own one? How expensive is it? I’d recommend one if you can easily afford it. I’d also recommend incurring the expense if you have a high-risk profile for heart disease and potentially fatal heart rhythms. This should be discussed with your physician. I paid $300 for mine, but you can pay up to $1100 for no good reason.
6) How long is it good for? You must be sure to stay up to date on the expiration dates on the components, most importantly the battery.
7) What should I do if the victim gets ‘back to normal’ after using an AED? Still call 911 and get to the Emergency Department for further investigation.
Of course the biggest question is “Do they work?” I’ll reference a study that reviewed effectiveness over two years of usage in Chicago’s Heart Start program, in which 22 individuals developed potentially fatal abnormal rhythms. 18 of these people met criteria to be treated by an AED. Of these 18, 11 survived. Of these eleven, bystanders with no prior training treated six.
I have an AED in my house and transport it in my family’s car because after all, I’m the one most likely to need it and benefit from it anyway (and I could shock myself, assuming I was still conscious). If it’s within your means, consider doing the same. It’s all about giving you the best opportunity to survive.

Straight, No Chaser: Understanding Asthma – Toothpicks and Snot (Part 2 of 2)

Medical Treatment, Respiratory/Lungs, Health Prevention, , , , , ,

As we move into discussing asthma treatment, remember that asthmatics die at an alarming rate.  I mentioned yesterday (and it bears repeating) that death rates have increased over 50% in the last few decades.  If you’re an asthmatic, avoid taking care of yourself at your own peril.  Your next asthma attack could be your last.
The other thing to remember is that asthma is a reversible disease – until it’s not.  At some point (beginning somewhere around age 35 or so), the ongoing inflammation and damage to the lungs will create some irreversible changes, and then the situation’s completely different, possibly predisposing asthmatics to other conditions such as chronic bronchitis, COPD (chronic obstructive pulmonary disease) and lung cancer.  This simply reiterates the importance of identifying and removing those triggers.
Given that, let’s talk about asthma control as treatment.  Consider the following quick tips you might use to help you reduce or virtually eliminate asthma attacks:

  • Avoid cigarette smoke (including second hand smoke) like the plague!
  • Avoid long haired animals, especially cats.
  • Avoid shaggy carpets, window treatments or other household fixtures that retain dust.
  • If you’re spraying any kind of aerosol, if it’s allergy season, if you’re handling trash, or if you react to cold weather, wear a mask while you’re doing it.  It’s better to not look cool for a few moments than to have to look at an emergency room for a few hours or a hospital room for a few days.
  • Be careful to avoid colds and the flu.  Get that flu shot yearly.

If and when all of this fails, and you’re actually in the midst of an asthma attack, treatment options primarily center around two types of medications.

  • Short (and quick) acting bronchodilators (e.g. albuterol, ventolin, proventil, xopenex, alupent, maxair) functionally serve as props (‘toothpicks’, no not real ones, and don’t try to use toothpicks at home) to keep the airways open against the onslaught of mucous buildup inside the lungs combined with other inflammatory changes trying to clog the airways.  These medications do not treat the underlying condition.  They only buy you time and attempt to keep the airways open for…
  • Steroids (e.g. prednisone, prelone, orapred, solumedrol, decadron – none of which are the muscle building kind) are the mainstay of acute asthma treatment, as they combat the inflammatory reaction and other changes that cause the asthma attack.  One can functionally think of steroids as a dump truck moving in to scoop the snot out of the airways.  The only issue with the steroids is they take 2-4 hours to start working, so you have to both get them on board as early as possible while continuing to use the bronchodilators to stem the tide until the steroids kick in.

If you are not successful in avoiding those triggers over the long term, you may need to be placed on ‘controller’ medications at home, which include lower doses of long-acting bronchodilators and steroids.
So in summary, the best treatment of asthma is management of its causes.  Avoid the triggers, thus reducing your acute attacks.  Become educated about signs of an attack.  When needed, get help sooner rather than later.  And always keep an inhaler on you.  It could be the difference between life and death.
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