Sunday, December 27, 2009
The snowstorms that hit the Great Plains states over the Christmas holiday may have made many cities and towns look like a Norman Rockwell scene, but beneath the beauty lays the grim reality of snow and ice in the winter. Travelers are delayed; civic budgets are stretched with overtime for snowplows and hospital ERs brace for the onslaught of patients. The snow brings an unusual trio of patients to be seen emergently.
Depending upon how much snow falls, and how much water content it contains, will determine how many people present with back injuries. Some show up with an acute twisting injury or fall while others present hours later after the muscle spasms become too painful. Often the injury is due to poor preparation. It’s hard to begin a lifting workout without warming up, but few people stretch and gradually attack the piles of snow drifted across their sidewalk. And the first snowstorm of the year may be the first time the person has done any activity since the winter before. Off season training to get ready for snow season isn’t the first thing that is on the “to do” list in autumn.
The second group of patients has forgotten that machines with sharp blades are dangerous and can cut off body parts, especially fingers. Snow blowers handle light snow easily, but add a little water and some ice and pretty soon the machine can get clogged up. No worries, just turn off the engine and reach in to clean out the ice jam…sorry, wrong answer. While the engine may be off, the paddle blades are under extreme torque like a spring, and when the clog it removed, the blades spin back to where they belong and cut off anything in their way. While most people know not to put their hands and fingers in things like snow blowers and lawnmowers, trying to take a short cut makes for permanent problems. If the person is lucky, only a tip of the finger is lost, but sometimes it’s the whole finger or more than one that is lost. By the way, the proper method to remove an ice jam is to use a thick stick like a broom handle to clear the mess.
Chest pain and heart attacks make up group number three. Shoveling snow is hard work and major stress test for the heart. If blockages are present in the arteries that supply the heart, asking the heart muscle to work hard and need more oxygen that is delivered by those arteries may be an issue of supply and demand. Like any other muscle, when the heart doesn’t get enough oxygen, it starts to hurt and that’s called angina. But unlike leg or arm muscles, the heart can’t stop to take a breather and recover; it needs the body to stop working and asking it to pump extra blood. Sometimes people listen to their body and stop what they are doing and the pain goes away. Hopefully, they call 911 or make their way to the closest hospital. Sometimes, they don’t listen to the pain and keep shoveling. That can be a bad decision since heart muscle that lacks adequate blood supply can get irritable causing abnormal electrical activity leading to sudden death.
It’s not only the ER personnel who care about the snowstorm; it’s the rest of the people in the hospital as well. Hand surgeons, cardiologists, operating room nurses, cath lab techs and all the other on-call people who need to come in on their “day off” also care. Holidays are special times to spend with family and friends and in the medical world that includes co-workers and patients.