Random ER thoughts from the week

Friday, April 20, 2018

Random ER thoughts for the week

Carrie Underwood makes her new face debut months after falling, lacerating her face and needing a significant repair. There a couple teaching points.t:

  • The only reason to repair a wound is for its cosmetic results. Every cut will heal eventually.
  • The primary concern when caring for any wound is to prevent infection and make certain that the structures underneath the cut, like tendons, arteries and nerves, aren’t damaged.
  • Scars take time to mature. The timeline starts first with a raised,r ed healing ridge, followed by gradual flattening of the scar, and finally weathering and whitening. It may take 6 months or longer for the final outcome to be realized.

Justice Sonia Sotomayer falls at home and fractures her humeral head, the ball part of the shoulder joint. The fracture often heals on its own with a sling, but the bigger question we ask, especially of older people who fall, is why did the fall happen? Was it a trip on a rug or did the patient pass out and then fall.

Passing out is never normal and can be due to a variety of reasons and it takes detective work to find the cause.

  • Was it low blood sugar (hypoglycemia)? This is one of the complications of medications (including insulin) used to treat diabetics and the Justice has had hypoglycemic events in the past.
  • Was it dehydration or anemia (low red blood cell count)
  • How about a heart rhythm disorder, where the electrical system made the heart beat two fast or too slow?
  • Maybe a seizure?
  • And sometimes it’s normal physiology that runs amok, like a vasovagal episode where the vagus nerve is stimulated and causes the heart rate to slow and blood vessels to dilate, temporarily decreasing blood supply to the brain.

The fracture is a consequence of the fall and taking care of a broken bone is easy. The most important job in in the ER is to understand the why of the injury.


Kevin Love of the Cleveland Cavaliers hurts his hand and damages a ligament in his thumb, most likely the ulnar collateral ligament, which is responsible for keeping the thumb in place as it is used to grasp.

  • A completely torn ligament is a third-degree sprain and would require surgery for repair.
  • Fortunately for Mr. Love, his is not that severe and he is able to continue to play.
  • But injured ligaments can’t do their job as well and a partially torn ligament can completely rupture in the near future
  • With a sprained UCL, it’s tough to pinch the thumb and index together and make a powerful fist.
  • UCL tears are also known as Gamekeeper’s Thumb or Skier’s Thumb.


Minnesota Wild Zach Parise is done for the playoffs after fracturing his sternum or breastbone. It sounds like a terrible injury and it takes significant force as a direct blow for this to happen. Most often it’s in car wrecks or during sports.

  • Sternal fractures can be associated with other injuries and it’s important to look for those, including lung and rib damage.
  • While the heart sits right behind the sternum, it is usually not damaged An EKG is often done, looking for abnormalities that might be associated with a bruising of the myocardium (heart muscle).
  • The treatment is all about pain control so that the victim can take deep breaths and keep the lungs expanded.
  • Unfortunately, the healing time is measured in months not days and Mr. Parise is done till next season.


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