Back to previous post: Open thread 91

Go to Making Light's front page.

Forward to next post: Robert Jordan (James Oliver Rigney), 1948-2007

Subscribe (via RSS) to this post's comment thread. (What does this mean? Here's a quick introduction.)

September 12, 2007

Trauma and You, Part Three: Sticks and Stones
Posted by Jim Macdonald at 03:39 PM * 217 comments

Let’s talk about skeletons for a bit.

Our bones have all kinds of functions. They provide shape. They provide support. They allow movement. They provide protection. They store minerals. They produce red blood cells.

Those last two functions aren’t so important on a trauma scene. What is important is that broken bones are highly vascular (they bleed), and sharp ends can cut other blood vessels.

If you were to ask me how many bones there are in a skeleton, I’d have to say “Beats the heck out of me.” The book answer is 206, but … well. Throughout our lives cartilage is turning to bone (somewhere around age 60, for example, the thyroid cartilage (the voicebox) starts to ossify). Whether you call bones that have fused one bone or two might be debated. Most people have four bones in their coccyx, but some have three, and some have two. Plus, you can have any number of sesamoids. Those are tiny round bones (the word means “seeds”) that form in tendons to reduce friction. They form in response to exercise. Everyone has at least two sesamoids: they’re the patellas (kneecaps).

Definition time! “Proximal” means “closer to the trunk.” “Distal” means “farther away from the trunk.” (On the trunk itself, “superior” means “closer to the top of the head,” while “inferior” means “farther away from the top of the head.”) “Lateral” means “toward the side” (right or left, away from the centerline.) “Medial” means “closer to the centerline.” “Dorsal” means “back,” “ventral” means “front.”

Bones come in several shapes: long (such as the femur (thighbone)), short (such as the carpals (wrist bones)), flat (such as the costals (ribs)), and irregular (such as the various vertebrae).

Joints too have several varieties: hinge (such as knee), ball-and-socket (such as hip), fused or fixed (such as in the pelvis), pivot (the joint between C-1 (the Atlas) and C-2 (the Axis) for example, which allows the head to turn from side to side), gliding (for example in the wrists), and saddle (uniquely in the base of the thumb).

Ligaments attach bones to bones. Tendons attach muscles to bones. Damage from pulling on ligaments is called a sprain. Damage from pulling on tendons and muscles is called a strain.

Damage to joints takes three forms: Distraction, subluxation, and dislocation. In distraction, the bones that form the joint are still in line, but the surfaces are separated. The binding ligaments aren’t ruptured. Subluxation is an incomplete dislocation; the joint has moved beyond its normal range, the alignment between the joint surfaces is distorted, but the articulating bones remain in contact. The binding ligaments may or may not be ruptured. In a dislocation (the old name is luxation), the joint is completely disrupted; the joint surfaces are no longer in contact. The binding ligaments are usually ruptured.

Just because a joint is dislocated doesn’t mean that one or more of the bones isn’t fractured, too. Without X-rays, you can’t tell for sure. So—hope for the best, but treat for the worst. Assume every dislocation includes one or more fractures.

Shoulder dislocations are fairly common. Falls, where the patient tries to catch himself with his hands, and motor vehicle accidents where the driver is grasping the wheel, are common causes. One common subluxation is “Nursemaid’s Elbow,” where the proximal head of the radius (the lower arm bone on the thumb side) is pulled out of alignment in the elbow joint. You see that in little kids who are holding hands with an adult; when the kid steps off a curb and suddenly all the weight of his body is suspended through one arm. Distraction — you see that in hanging, and when folks get entangled in machinery.

A fracture is when the body of the bone itself is disrupted or broken. Wrist fractures are the most common fractures in persons under age 65.

You can have a lot of fun memorizing bone names. (For example, the mnemonic for the bones in the wrist is “Some Lovers Try Positions That They Can’t Handle” for Scaphoid, Lunate, Triquetium, Pisiform, Trapezium, Trapezoid, Capitate, Hamate. (You can have even more fun memorizing the names and functions of the twelve cranial nerves, but that’s for another post.)

The most common wrist fracture is a fractured Scaphoid. That’s the bone on the thumb side that articulates to the radius (thumb-side forearm bone). The other forearm bone (little finger side) is the ulna. When you bend your elbow, the point of the elbow is the olecranon process on the proximal end of the ulna.

Oftentimes a fractured scaphoid presents as a “sprained wrist” that keeps hurting for four to six weeks. The most common mechanism of injury for a scaphoid fracture is a fall where you catch yourself on your outstretched hand, palm open and down.

There are all kinds of different fractures. You have your transverse fractures — they go from side to side at 90 degrees to the axis of the bone. You have your oblique fractures, your spiral fractures, your greenstick fracture (an incomplete fracture), your comminuted fracture (that’s where the bone shatters), your impacted fracture (one broken end is rammed into the other broken end, resulting in a bone that’s a bit shorter than it should be), and depressed fractures (you see them in skulls, but the sides of long bones aren’t immune) … lots of kinds of fractures. Your friendly EMTs have to know them because the book was written by the American Academy of Orthopaedic Surgeons, and the orthopods think fractures are fascinating. Therefore types of fractures’ll be on the test. But what you have to know in the field is this: It doesn’t matter to you and unless your name is Clark Kent you may not be able to tell.

The happy fact about strains, sprains, fractures, dislocations, all of the jolly trauma to the musculoskeletal system, is that they’re all treated the same way.

The only real categories you have to worry about are Open and Closed Fractures. In open fractures, the skin has been broken. In closed fractures it hasn’t. (Those used to be called “Compound” and “Simple” fractures. That’s old terminology. We don’t use it any more.) If the injury is bleeding, treat the bleeding first. Remember, bleeding falls under Circulation, and Circulation is C in the A-B-Cs.

Joint and bone injuries:

How to assess a hard-tissue injury: Look and feel for DOTS.

That is, the signs and symptoms are: a body part is

  • Deformed,
  • Open,
  • Tender, and/or
  • Swollen.

Deformity is generally obvious. If a guy has two elbows, one of them half-way down the forearm, you can figure there’s a fracture. If the shoulder has a step-off you can figure on a dislocation. A joint that’s locked in position is often a dislocated joint.

Open means an open wound. If someone got hit hard enough to break the skin, assume that the bone underlying that point is also broken. A guy chopping firewood hits his leg with his axe, assume fracture. A guy playing baseball gets hit on the arm hard enough to break the skin, assume a fracture. (Or, if you see bone ends sticking out … well, what do you think?)

Tender means “If you press on it and the guy says, ‘Ouch!’” (or “$*^#*^@!!!!!”) then it’s tender.”

Swollen means … well, swollen. That can be from bleeding around the injury site, or it can be from fluid going into the inter-cellular spaces around the injury site as part of the body’s immune reaction. In general, the body reacts to trauma by swelling at the site. The classic lump on the head is an example. Swelling can threaten the viability of the limb, through something called compartment syndrome. The various muscle groups in your limbs are inside of tough fibrous sheathes, or compartments. Fluid going into those compartments can have enough pressure that it overcomes blood pressure, creating, in effect, a tourniquet. This has all of the problems of a tourniquet that you applied, only without being as obvious, and not as easy to take off. You really do want to limit swelling as much as you can.

If a patient tells you “I broke my arm,” believe him.

The signs and symtoms go together so often that we abbreviate them: “PSD” for Painful/Swollen/Deformed. (“Hey, Bill, what to you have?” “Guy over there’s got a PSD left wrist….”)

A fun project for a rainy Saturday afternoon! Get a fresh turkey at the market. Using a pair of pliers and a hammer, break its thigh bone. Using your gloved hand, check what that feels like through the flesh. That’s what a broken bone feels like to you the provider (it feels considerably worse to the patient).

What to do about all these injuries: Throw rice at them. The mnemonic here is RICE. That stands for Rest, Ice, Compression, and Elevation.

Rest means that you don’t try to use the part any more. Muscle movement can make bone ends grate on each other (the word for broken bones grinding together is “crepitus,” and it feels nasty under your fingers; the patient can feel it too). I’ve seen people walking on broken legs, though. Part of that is because shock means that it stops hurting. Part of that is distracting injury. If a guy’s got a very painful injury one place he might not even notice a less-painful injury somewhere else. So, get the guy lying down and not moving. Fortunately you’re already doing this because you’re already treating for shock.

Ice means a cold pack. If you’re using genuine ice, put it in a plastic bag and wrap that bag in a towel before placing it on an injury. You don’t need to add frostbite to the guy’s other problems. Ice reduces swelling and reduces pain. Reducing pain is a good thing.

Compression means wrapping with an elastic bandage (an Ace bandage, for example). The compression reduces swelling, limits movement, and keeps the parts aligned. All good stuff.

Elevation puts the injured part above the heart. This lets gravity help in reducing swelling and reducing pain.

After that comes Splinting.

Splinting provides the support that the bone formerly provided, but is no longer capable of giving. It stops further damage from occurring. Even if the bone isn’t broken, a splint at the site of a deep laceration will limit movement and help prevent more damage. Splinting also reduces pain.

Danger Will Robinson alert: You can kill people by splinting them, even if you do perfect splints.

If you get distracted by a fracture to the point you forget to check your patient’s airway, breathing and circulation, that guy will be dead. Fractures can be grotesque to look at, but they probably won’t kill the guy today. A blocked airway will kill him in the next five minutes.

If you have an open fracture and it’s bleeding, control the bleeding first before you consider splinting.

On to splinting. You can use almost anything quasi-stiff to make a splint. You’re building an exoskeleton. Rolled up newspapers, a copy of National Geographic, a pillow, a tree branch, and umbrella — anything. The rule for splints is that you want them to be BUFF. That is, Big, Ugly, Fat, and Fluffy. A narrow splint that cuts into the guy’s flesh isn’t going to help. You can pad the splint with the patient’s own clothing (you cut it off the injured part anyway, when you were examining it). I carry SAM splints, and suggest you put ‘em in your own first aid kit.

First thing to do: Manually immobilize the part. The patient is probably doing this himself, but you can have a bystander help with holding the bone or joint steady. Next, check movement, circulation, and sensation distal to the injury. Can you feel a pulse? Can the patient feel you touching him? Can the patient wiggle his fingers and toes? If you can’t feel the patient’s pulse in the affected limb (but you can in the other, unaffected limb), what you do next will depend on how long it’ll be before you can get the guy to definitive care (that is, to an emergency room). If it’s going to be over an hour, consider applying gentle, in-line traction until you can feel a pulse. But for heaven’s sake, be careful. Pulling the guy’s arm off is usually considered bad form.

For a broken (sprained, dislocated) joint, immobilize from the bone above to the bone below. For a broken bone, immobilize from the joint above to the joint below the injury. That is, for a broken forearm, you immobilize the wrist and the elbow. For a broken hip you immobilize the pelvis and the knee. You need a minimum of two ties on the splint above and two below to immobilize each part. I like to wrap the entire length of the splint with roller gauze to make sure the part is immobilized. Use wide, soft material to tie the splint in place. Triangular bandages are perfect for this. Strips of cloth (cut from the patient’s clothing if necessary) are great. Wire or fishing line is right out.

After you’ve applied the splint, check the patient’s circulation, sensation, and movement again. If you could feel the guy’s pulse before you applied the splint, but you can’t feel it now, you might have the splint on too tight. You don’t want to cut off circulation. If you’ve lost the pulse, or his hand is suddenly numb, or some such thing, take the splint off and reapply it.

And keep checking airway, breathing, and circulation.

Human necks are delicate and lots of important things go through them. Any time you have a serious mechanism of injury (e.g. high speed automobile crash, fall over three times the patient’s height), or any time you see any injury above the collarbone, assume the patient’s neck is broken until Mr. X-ray tells you different. What to do then: Hold the patient’s head steady in a neutral, in-line position until the nice ambulance guys get there. (Note: there are protocols for clearing the cervical spine in the field. Don’t do it unless you do this kind of thing a lot, are supremely confident, and have a desire to see yourself in court explaining your decision.) I have personally had a patient with a fractured C-2, who had suffered a fall from a standing height, whose only signs were a small abrasion on the point of the chin and in the center of the forehead.

How to hold c-spine: Stand or kneel behind the patient (after explaining what you’re going to do and getting his permission to do it), spread your fingers, rest the little-finger side of your hands on his shoulders, and with the tips of the fingers hold his head up and pointing straight forward.

If the patient is unconscious you can skip the “get permission” part.

If you are the first one on scene at an automobile accident, after calling 9-1-1 and setting out flares, pretty much 100% of what you’ll be doing is holding c-spine, assuming that airway, breathing, and circulation are okay. Note: Training bystanders to hold c-spine is fast, easy, and frees you up to do other things.

Special cases:

Let’s work from the bottom up. First:

Femur fractures

The femur is one of the largest and strongest bones in the body. It takes significant force to break one. Once it’s broken, there are several life-threats present. One is the embolus. You have large veins present in the leg. Fat, marrow, or a blood clot from the injury site can get sucked into one of the large veins and carried to the heart or lungs. Your pulmonary embolus can kill you dead, fast. Second is bleeding: the femoral artery, a blood vessel the diameter of your thumb, runs along the bone along the medial aspect. If sharp bone ends cut that artery, you can bleed out very rapidly.

The large muscles of the leg (quadriceps, biceps femoralis) contract on injury. (The only trick a muscle has is to contract.) That makes the sharp ends of the bone override, and increases the danger of cutting a major vessel.

Internal bleeding at the injury site, apart from the femoral artery, can also cause significant blood loss. As the leg muscles contract the shape of the leg changes with the thigh getting shorter and wider, providing more volume for the blood to go into.

The field intervention for all of this is the traction splint. Without traction splinting a fractured femur is 80% fatal. With traction splinting, it’s only 20% fatal. There are several kinds of manufactured traction splints. No one expects you to carry one in the trunk of your car on the off-chance you’ll be first on scene where there’s a fractured femur. Instead, let’s talk about an improvised traction splint.

Here’s one way to improvise a traction splint: Gather together a stick that’s longer than the patient’s leg, a coffee cup, some cord, and some strips of cloth.

Check circulation, sensation, and movement in the foot on the injured side. Cut or tear away the clothing from the injured leg. (That’ll give you your cloth strips right there.) This intervention is only for an isolated mid-shaft femur fracture. Hips are different, and a fracture that involves the knee is something else again. Tie an ankle hitch around the ankle of the injured leg using a strip of cloth, a triangular bandage, or something else wide and soft. (Cutting off circulation is a bad idea.) Take the patient’s shoe from the affected side and put it, sole up, into the patient’s crotch. Put one end of the stick (umbrella, ski pole, what-may-have-you) into the shoe. Lay the stick along the length of the leg. Put the coffee cup over the other end of the stick. Tie the cord to the ankle hitch, then put it through the handle of the coffee cup. Pull on the cord, using the handle of the cup as a pulley. Continue, gently, until the injured leg is the same length as the uninjured leg. The patient will usually tell you that the pain has diminished when you have it right. The usual amount of traction is around 15 pounds. Tie off the cord to maintain tension. Tie the stick to the leg using more strips of cloth. Check circulation, sensation, and movement in the foot again. Continue to recheck the splint at regular intervals.

Pelvic fractures

The pelvis is also a very strong structure that requires significant force to fracture. Again, bleeding is a major risk. Any movement in a fractured pelvis risks further injury, including cutting blood vessels. So, you want to keep it from moving.

Assessing the pelvis: Press in, press down, and pull up on the wings of the pelvis. Press down on the pubic bone. Any movement, crepitus, instability, pain or tenderness suggests a fracture.

What to do: Check circulation, sensation, and movement in both feet. Take a sheet. Fold it until it’s approximately four inches wide. Run it from side to side under the pelvis (to do this: run it under the small of the back, or under the thighs, then work it until it’s in place). Take the folded sheet around in front of the pelvis and tie the ends together with a square knot. Insert a stick into the knot and tighten down as you would a tourniquet until snug. Recheck circulation, sensation, and movement.

Flail chest

Flail chest is two or more contiguous ribs broken at two or more places. This produces a section of the chest wall that’s just floating free. You see this in injuries such as when someone’s chest hits a steering wheel. You’ll note that the patient is having difficulty breathing, and you’ll note paradoxical movement: That is, when the chest is expanding while the patient is inhaling, part of the chest wall is going in. When the patient is exhaling, while the rest of the chest is contracting, that part of the chest wall is going out.

What to do about it: First, stabilize the flail segment with your hand. Then, tape a bulky dressing (towel, pillow, large folded cloth) over the area. Be ready to perform artificial ventilation.

Upper extremity fractures

The general treatment for anything involving the upper extremities (arms, shoulders) is the sling-and-swathe. For forearms and wrists, put on a splint first. For upper arm or shoulder, just the sling-and-swathe is enough.

First, check circulation, sensation, and movement in the hand on the affected side. Remove watches and rings, since when the hands swell (and they will) those can cause loss of circulation and tissue death downstream. Splint wrist (from bone to bone, metacarpals to radius/ulna) or forearm from joint to joint (wrist to elbow).

To do a sling and swathe: Take one triangular bandage. Lay it on the chest so that the long edge is straight up and down and the 90-degree angle faces toward injured side. Tie a knot in that 90-degree angle to make a pocket for the elbow. Now put the hand from the injured limb in the “pledge allegiance” position (on the chest above the heart). Wrap the bottom point of the triangle up, around the neck and down to meet the other point. Tie them together on the side of the neck. (If you put your knot in the back it’ll be uncomfortable for the patient, and impossible for you to get to once the patient is on a stretcher.) The sling should take the weight of the limb. Now, take a second triangular bandage and tie it over the upper arm on the injured side and under the arm on the uninjured side. The purpose of this is to hold the arm tight against the ribs so it doesn’t go flapping around. This keeps an elbow or a shoulder from moving, and splints the humerus.

Skull fractures

Look for Battle’s Sign (bruising over the mastoid process—the area just behind the ear) and/or “raccoon eyes” (bruising around both eye sockets). (These are both late signs.) Look for blood, particularly if mixed with clear fluid, coming from the nose or ears. Look and feel for depressed areas in the skull.

What to do about it: Assume the neck is also broken and keep it stabilized. Keep the patient’s upper body slightly elevated, since the brain is going to swell and you can help a bit by letting gravity move fluid away from the brain. Watch for the pulse to get slower, for blood pressure to go up, and for respiration to become patterned, then cease. (Note: if you see an isolated head injury and blood pressure is going down while heartrate is going up, there’s another injury somewhere that you haven’t found yet. See what you can do to locate it and treat it.)

Take good notes on the patient’s mental status. Particularly note if the patient was unconscious, woke up, then became unconscious again. A neurosurgeon somewhere wants to know the duration of that lucid interval and will thank you if you’ve written down the times.

That’s pretty much it for broken and dislocated bones. I recommend that y’all either take a first aid course, or check out a first aid manual for illustrations and some hands-on play. Unless you’ve made a sling a few times in practice, you probably won’t be able to do one in an emergency situation.

Trauma and You will return in Part Four: The Squishy Bits


Summary:
  1. Call 9-1-1 (or your local emergency number)
  2. Scene safe? If not, make it safe. If you can’t, stay out.
  3. Treat the A-B-Cs.
  4. Immobilize fractures/dislocations
  5. Cold-pack the injury
  6. Treat for shock
  7. Recheck the A-B-Cs.

Some interesting items:

Copyright © 2007 by James D. Macdonald

I am not a physician. I can neither diagnose nor prescribe. This post is presented for entertainment purposes only. Nothing here is meant to be advice for your particular condition or situation.

Creative Commons License
Trauma and You, Part Three: Sticks and Stones by James D. Macdonald is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 3.0 License.

(Attribution URL: http://nielsenhayden.com/makinglight/archives/009238.html)


Index to Medical Posts

Google

Comments on Trauma and You, Part Three: Sticks and Stones:
#1 ::: Linkmeister ::: (view all by) ::: September 12, 2007, 06:02 PM:

This one I've had some experience with. It's interesting to note that I no longer have a scar from a compound fracture of my ring finger, but rather from an open fracture. Treatment for it certainly agreed with the BUFF guidelines; I had a whacking great boxing glove over the entire hand for several months.

#2 ::: Yatima ::: (view all by) ::: September 12, 2007, 06:08 PM:

"Without traction splinting a fractured femur is 80% fatal. With traction splinting, it’s only 20% fatal."

I am just now realizing that my little brother nearly died when he was ten. (He's 38 now, and fine.)

#3 ::: P J Evans ::: (view all by) ::: September 12, 2007, 06:14 PM:

Cracked ribs (they didn't get x-rayed, so I don't know how bad it was): 'rib belt' which is some kind of hybrid of 'Ace' bandage and long-line bra. It hurt less with the thing on, but I wouldn't recommend giggling with broken ribs, and ROFLMAO is right out.

#4 ::: David Dyer-Bennet ::: (view all by) ::: September 12, 2007, 06:17 PM:

I'm confused by what you say on "how to hold c-spine". You say to stand behind the patient, but I'm expecting the patient to be lying on the ground at least some of the time. This makes standing while reaching down to do this seem ridiculous, and also makes "behind" somewhat unclear. I haven't looked at any of the references in that section, maybe they make it obvious; but delineating the positions better would help a lot (and it'd still be easy to adapt to related positions).

Also (and I may be dangerously stupid here), it seems like standing up isn't a safe position for a person with a possible spine injury. On the other hand having them lie down constitutes "moving them" in some sense, too.

#5 ::: Ariella ::: (view all by) ::: September 12, 2007, 06:49 PM:

All this reminds me of a section of the early seventh century Alamannic laws: "If anyone breaks another person's head so that the very bone is detached from the head and makes a sound when thrown at a shield across the road, let him pay six solidi..."

I used to have a history professor who liked to use that passage to point out that, unlike modern legislation, medieval laws were not written with the intent that they should be interpreted literally.

#6 ::: James D. Macdonald ::: (view all by) ::: September 12, 2007, 06:49 PM:

Okay, the thing with neck injuries.

Oftentimes the guy will be standing or walking around, or sitting in an automobile. You'll be able to get behind him then.

If the person is lying down, kneel at the top of his head and hold his head and neck in-line with his body.

Getting to a place where you can actually hold c-spine sometimes requires that you pass the EMT Ingenuity Test.

#7 ::: Janet Miles ::: (view all by) ::: September 12, 2007, 06:55 PM:

PJ Evans (#3): I hear you. My experience with three broken (not just cracked) ribs included a bout of hiccups.

Not recommended.

#8 ::: shadowsong ::: (view all by) ::: September 12, 2007, 07:11 PM:

Are there multiple ways to pop shoulders in depending on which way they were dislocated, or does one way work for everything?

For my husband's dislocated shoulder, I do the crawl stroke motion:
Upper arm pointed straight out to the side and lower arm pointed up, elbow at a right angle.
Rotate lower arm forward until it's parallel to the ground.
Pull in the direction the upper arm is pointing, and listen for the wet pop and sigh of relief.

#9 ::: James D. Macdonald ::: (view all by) ::: September 12, 2007, 07:31 PM:

Reducing a dislocation depends on where the various bones are before you start. You need to be very familiar with normal anatomy in order to visualize where things are, and where they should wind up.

While reducing dislocations in the field is part of the Wilderness EMT protocols, it isn't something that you normally do in the field, in a situation when you can get the patient to an ER in a reasonable time. Y'see, if the joint is not only dislocated but fractured, you can do additional damage by manipulating it.

With a patient who has a history of repeated dislocations, it's usually easy to move the joint back into position, and the patient can guide you. If it's a first-time dislocation, don't mess around. And do get some formal hands-on training.

#10 ::: Emily H. ::: (view all by) ::: September 12, 2007, 07:32 PM:

The thing about fractures is: I expected them to HURT. When my sister, at seven and again at twelve, fractured a bone, she was screaming bloody murder.

So when I fell off my bike and hit my arm hard, I thought, "Well, I'm not screaming bloody murder, but I guess I'd better go to the ER just to be on the safe side" - and it was broken. Just six months later, I stepped in a hole and twisted my ankle, but I could still stand and walk on it okay. Couldn't be broken, I thought; just a sprain. That was in the summer, and I wasn't insured -- and even though I was ensured then, the broken arm cost me $2000 --, so I didn't go in until the student clinic opened the next week. That was broken too. The ankle, I mean, not the clinic.

Adrenaline can cover up for a lot.

#11 ::: Leva Cygnet ::: (view all by) ::: September 12, 2007, 08:12 PM:

Sometimes bones don't hurt at all when they're broken, or at least very little -- I had a green stick fracture of my elbow as a teenager (took a header over the handlebars of a bike) and my parents wouldn't believe it was broken because I wasn't hurting enough. X-ray years later established, yes, old fracture there. It hurt, but never beyond an, "Owe, I need ibuprofen!" level.

I also fell off a horse once, with my hand tangled in the reins. When I got up, I had a finger on backwards. I was somewhat in shock (also rang my bell pretty good), looked at the finger for a moment, then grabbed it, twisted the finger around the right way, and pulled on it until the dislocated joint slipped back into place. In my somewhat concussed thinking, my logic was that if I could push everything back together in a hurry it'd heal right away and not be broken and not hurt, and that it would hurt more later if the doctor had to set it. I did mention concussion, right?

The hand doctor advised me later that this is not the generally recommended way to set a broken finger. And that I'd also broken a couple bones in my hand.

It never did hurt much, though I've got a pretty good bad-weather detector in the joints of that hand now too.

#12 ::: Madeline F ::: (view all by) ::: September 12, 2007, 08:14 PM:

A few years ago, I wrote up on my livejournal the worst physical accident I ever saw. Back when I was hang gliding, a guy took a turn too close to the ground, his wing touched, and he became a guy tied to a 22' lever accelerating from a starting speed of >30 mph. (He lived.) The scariest parts: the inhuman noises of pain he made. The way he flopped around when we weren't sure if his spine was damaged.

I don't know, if a badly hurt guy is moving around, how do you get him to stop without hurting him more?

Glad you asked about holding the spine, #4 David Dyer-Bennet; I was confused about that, too. (Barry the hang glider had his head held straight by Ann as she talked him down, kneeling behind him with her hands on either side of his head, like #6 James D. Macdonald says.)

Another interesting hang glider bit: they have their very own fracture: spiral fracture of the upper arms, I believe. When the glider crashes, your body keeps on going, swinging through the triangular control frame. If you're still holding on to the control frame, the force undoes your arm bones like a twisted slinky. They drill it into your head again and again, if you crash, LET GO! Regardless, about 1 in 40 forgets in the heat of the moment.

Me, the worst I ever had was when a bag hanging from the handlebars of my bike swung into the front wheel and I went over the top like something out of Indiana Jones. Landed and took all the force on hands and knees. Did not realize I had hairline fractures in both elbows until that night at dinner at a friend's, when I went white and slid off the seat in a dead faint. Putting on shirts sucked for the next while... "You're not in a cast how bad can it be?" Bah! ;) Anyway, don't ever hang anything off the handlebars of your bike. It is never ever worth it.

Figent Figary, an ER doc in the midwest somewhere, has brilliant posts on medicine in the ER. This one has neat stuff about a guy with shoulder dislocation, but I really recommend you click the "emergency medicine" tag and read them all.

#13 ::: melospiza ::: (view all by) ::: September 12, 2007, 08:17 PM:

I love these posts. As an x-ray tech (Radiologic Technologist, to be official), I have been amazed at how hard it can be to convince seriously injured people, especially drunks, to lie down and hold still. Folks really do walk on dislocated hips and broken knees.

Then there's the joy of trying to keep someone's neck straight, in C-spine precautions, when they're puking. Airway first, right?

Both scary and gratifying are the fractured cervical spines, discovered three days later, when the patient finally decides to walk into the ER, stiff and sore. No, don't try to stretch out that neck, sir, please hold still. The neurosurgeon is coming to see you RIGHT NOW.

#14 ::: ethan ::: (view all by) ::: September 12, 2007, 08:34 PM:

Leva Cygnet #11: When the tombstone fell on my foot, there was never any pain. One of my ankles is bigger than the other now, but it never hurt.

#15 ::: Chris ::: (view all by) ::: September 12, 2007, 08:37 PM:
Then there's the joy of trying to keep someone's neck straight, in C-spine precautions, when they're puking. Airway first, right?
I'm probably going to regret this, but... how *do* you deal simultaneously with airway problems and neck fractures?
#16 ::: Emily Cartier ::: (view all by) ::: September 12, 2007, 08:38 PM:

Me, the worst I ever had was when a bag hanging from the handlebars of my bike swung into the front wheel and I went over the top like something out of Indiana Jones.

Handlebar bags are glorious things. So are front baskets, front or rear racks, and all the other assorted objects that let you carry stuff on a bike. If I'm reduced to hanging a bag off my handlebars, I *walk* the bike.

Also, it's kinda horrifying how many people end up in bike/car accidents and walk off the scene... to end up in the ER 2-4 days later. I keep reminding myself "do not leave the scene". Even if it's a low speed collision, there's pretty good odds that the cyclist took damage.

#17 ::: James D. Macdonald ::: (view all by) ::: September 12, 2007, 08:57 PM:

How do you deal with vomiting and suspected c-spine fractures?

1) The patient won't enjoy this at all. The patient will enjoy being dead even less.

2)If the patient is strapped to a long spine board, roll the entire board up on its side. Stand by with suction apparatus.

3) If the patient isn't secured, hold that c-spine with your mitts like you were Scrooge McDuck grasping your last nickle and aim his mouth at the floor. Log-roll the patient along the axis of his spine if you have to. (Get bystanders to help you. This may be a challenge. The lookie-loos tend to back off when the puke starts flying.) Suction is, again, your friend. A big ol' turkey baster will work.

4) If you get puke on you, oh well. When you decided to run over and help that guy you volunteered to get puke (and other substances) on you. It comes with the territory.

5) If his neck is broken and he moves it he may die. If he loses his airway he will die. That's your priority list, bucko.

#18 ::: melospiza ::: (view all by) ::: September 12, 2007, 08:57 PM:

Chris # 15:

Mr. Macdonald should describe what it's like in the field. By the time I see a patient, he's on a backboard, in an immobilization collar. I don't know yet if there's a fracture or not--that's what I'm trying to find out, by x-ray or CT scan. I yell for help, turn the board while supporting the head, and hold a basin. It's messy. The patient is often fighting the restraints. A few of these in a night is the reason I refused long ago to work any more night shifts on New Year's Eve.

#19 ::: James D. Macdonald ::: (view all by) ::: September 12, 2007, 09:06 PM:

The puking problem is one reason you get behind the patient when you're holding c-spine.

#20 ::: PixelFish ::: (view all by) ::: September 12, 2007, 10:47 PM:

It always gives me a little chill to realise the closest I've yet been to death (and hopefully, it will stay that way for a good long time) is when I was seventeen and broke my right femur while racing my brother home from church. I tripped on the edge of a curb and rolled into the street.

I had also broken my left clavicle in the roll. But when I pushed myself up just a little, I could tell my right thigh was suddenly half as short as normal, twice as big a round, and super jello-y. My little brother wanted me to move--I was lying on the edge of a dark road in the middle of a chilly November night about three houses down the street from my home--but I refused. I made him go find the nearest adult--the church bishop in the meetinghouse. (It took him about fifteen minutes to convince the bishop to come with him. Reportedly what he told the bishop was, "My sister has fallen down and she wants to talk to you." He still gets teased to this day about that.) Fortunately, it's not a heavily travelled road at all, and no cars rounded the corner, and I just lay still until a neighbour showed up. She wanted to move me, and I pretty much refused again. When the bishop and his counsellors and my brother all showed up, moving me was once again mentioned, and me, kicking into Girl Scout mode, mentioned that I thought my leg was broken and I worried about tearing an artery. (When they were talking about moving, it was all, "Oh, you can lean on me if you want." Eeesh. Thanks but no. I'll just lie here off to the side with my leg like jello.) So nobody moved me, and I told them to get their car and come park it with the lights on me, and oh, could somebody cover me with something, I was getting chilly. Anyway, fifteen minutes later, the ambulance and the EMTs showed up. They cut my clothes off of me so they could get enough local meds into me to splint me. My dad showed up about this time, and he rode to the hospital with me. I remember being all weirdly lucid about the whole experience and chatting with the EMTs and joking, and asking questions about my heart rate. I don't know if this was a weird example of shock, or if they were just humouring me and trying to keep me awake.

I remember the ambulance ride in particular because I was concentrating really really hard on being Not Tense. Every time my leg tensed, it hurt to high heaven. Then they got me to the hospital and covered me with warm towels and that was lovely. (I was kinda bummed about having my clothes cut off of me--it was my favourite outfit. My mom tried to replace it but it was never quite the same. Still....better than going into shock and dying.)

It wasn't until after my surgery that somebody finally told me that femoral fractures can be fatal in a number of ways. I kind of knew it before--what with all the Girl Scout manuals I'd read--and I knew it wasn't a good idea to move the injured person if they weren't directly in the line of traffic. But it never really sank in quite until that day.

BTW, it turned out I'd made a super clean break. There were no weird bone splinters, but there was also nothing for my bone to nestle against like a little puzzle piece and knit back together. So I went into surgery and they gave me a rod and pin. And I more or less had to keep off of it as much as possible for a month and then not run on it for a year. (Biking and swimming were my new forms of exercise, and it got me out of gym for the rest of high school.)

But yeah....that was my (knock on wood) my closest brush with death.

Emily @10: My femoral fracture REALLY hurt. I was crying with pain for a good five or ten minutes after it occured.

#21 ::: P J Evans ::: (view all by) ::: September 13, 2007, 12:05 AM:

Janet @ 7

Not fun with mild asthma either - it's the tendency to cough. I think it was the knob on the gear shift that did it; there was a fairly impressive bruise on my thigh - not painful, but it took weeks to fade, and there was a dent for quite a while after that.

Then there was the time I was riding a bike and clipped the corner of a car. Scraped arm: minor injury. Hit left knee really well. The resulting bruise went around the medial side of the knee in the shape of a Greek e. That was unfun: a couple of weeks of extremely stiff and four months of don't-kneel-on-it.

#22 ::: MikeB ::: (view all by) ::: September 13, 2007, 12:37 AM:

While we're asking c-spine questions: if you arrive on the scene and your patient is lying there with his head turned to the side, do you straighten it for him and/or encourage him to straighten it before holding c-spine?

I've always assumed that the answer is "no, it's more important to avoid moving the neck than to make it perfectly straight," with a side order of "unless you don't have airway and your patient is dying, in which case you do what you gotta do." But what do I know?

(Note to self: put first aid classes back on the calendar!)

#23 ::: James D. Macdonald ::: (view all by) ::: September 13, 2007, 12:47 AM:

In general, hold the neck in the position found. Airway takes precedence. If possible hold the head in anatomic position, but don't be yarding around on your patient's head to get it there.

Be particularly suspicious of pain, tenderness, and guarding in the neck. Crepitus is a very bad sign indeed.

Early on, the muscles may tighten up and hold fractured or dislocated bones in place. Later, as the patient relaxes or the muscles tire, the neck may become more mobile and compromise the spinal cord.

#24 ::: Cynthia Wood ::: (view all by) ::: September 13, 2007, 02:01 AM:

Retrospectively, I was an idiot after I took a full force knee to the face. I finished the rest of the bout (karate class), went home, and lay down on the couch with ice. Half my face was black and purple (including the solid black mass under the eye), but it never occurred to me that maybe, just maybe, an X-ray and some professional treatment might be in order.

I have a notch on the cheekbone to this day (nine years later), so I'm inclined to think I fractured it, if only slightly. I'd claim a concussion for the stupidity, but then how do I explain that nobody else either at the dojo or at home, thought to recommend a doctor's visit?

#25 ::: Juliet E McKenna ::: (view all by) ::: September 13, 2007, 05:40 AM:

Cynthia @24,

I venture to suggest, your accident being nine years ago, that the instructors had yet not been on the kind of coach-training course that I went on this summer, to get my UK aikido coach accreditation.

Where the duty of care by a sports coach was most strongly emphasised, with all the legal consequences and potential penalties laid out for us.

Put simply, it is the coach's responsibility to ensure all appropriate medical treatment for injuries is given or obtained, whether or not the accident-sufferer is saying, oh, no, I'll be fine etc. If they absolutely refuse to co-operate, you need their signature to that effect on your accident reporting form.

These days, without formal coach accreditation by your particular sport or martial art in the UK, you cannot get coaching insurance and without that insurance, no venue should be letting you set up a martial arts or any other kind of sporting club.

Indeed, increasingly, schools, sports halls, leisure centres, church halls etc now require you to provide a risk-assessment for your activity in their premises as a condition of their own public liability insurance.

And yes, it's a pain from the paperwork point of view but the reduction in sports injuries and in particular, long term consequences from them, is worth it.

I shan't get started on the legal headaches of teaching kids nowadays as that's waaaay off topic.

#26 ::: ajay ::: (view all by) ::: September 13, 2007, 05:41 AM:

23: Something I've been told repeatedly - when you are first approaching the casualty, do it from the feet end, not the head end. Because you're going to be speaking to him ("Can you hear me?") and if the voice is coming from above his head (assuming he's supine) he'll turn his head to see you and could wrench his c-spine.

#27 ::: John Houghton ::: (view all by) ::: September 13, 2007, 07:15 AM:

James D. Macdonald:
(6) Getting to a place where you can actually hold c-spine sometimes requires that you pass the EMT Ingenuity Test.
Sometimes it requires that you pass the audition for a Cirque du Soleil acrobat.
(19) The puking problem is one reason you get behind the patient when you're holding c-spine.
The other reason is that you then get to point the head at your buddies.

#28 ::: rea ::: (view all by) ::: September 13, 2007, 08:09 AM:

Old Dan Sickles was lucky to lose his leg at Gettysburg--as wounded war hero, he could avoid being court martialed for disobeying orders and almost losing the battle (& the war). Given his pre-war acquittal of murder on the basis of temporary insanity, perhaps the prospect of a court martial didn't bother him, though.

Having a wooden leg didn't stop him from using his position as US Ambassador to Spain to embark on an affair with Queen Isabella II . . .

#29 ::: fidelio ::: (view all by) ::: September 13, 2007, 09:11 AM:

Osteopathic or Orthopedic Surgeons? Not that both groups don't have a thing for bones, although osteopaths (at least in the beginning) have some very different notions on that topic.

#30 ::: Lila ::: (view all by) ::: September 13, 2007, 09:21 AM:

Thanks for another great post!

You missed an acronym: FOOSH (Fall On Out-Stretched Hand, as in how my sister managed to break both wrists at once while cleaning up the church nursery).

#31 ::: JESR ::: (view all by) ::: September 13, 2007, 10:45 AM:

Cynthia Wood @24, Juliet E. McKenna @25, about facial fractures and coaches:

I have had two fractures in my life, at least ones which were diagnosed; the first, on my sixteenth birthday, involved a knee to my left eye socket and resulted in an orbital fracture (covering third base, bad bounce on a thrown ball, aggressive base runner). In May, 1968, there was apparently no requirement that PE teachers have any training in first aid; I lost consciousness and woke up vomitting, and my coach yelled at me for faking it.

39 years later, I still have the black eye.

The other fracture? About twelve years ago I shattered the tip of my left ring finger getting it between a cow's head and something hard, and had to have my wedding ring cut off ; today I'm finally getting the ring replaced in time for my 25th wedding anniversary later this month.

The worst musculo-skeletal damage I've sustained, again in PE, same teacher, was a severe sprain of the left ankle which left the joint unstable and prone to reinjury; it's now showing signs of both osteoarthritus and compromized vascular function. We were doing gymnastics, vaulting over a horse, and she made me take off my glasses for safety reasons. Unable to see the ground, I misjudged my landing and came down with my entire weight on the outside edge of my foot. She screamed at me for being fat and clumsy, and was one of the teachers who demanded that I stop using crutches well before the injury had healed. I'm pretty sure that was against the law even then.

Why yes, I have issues.

#32 ::: P J Evans ::: (view all by) ::: September 13, 2007, 11:12 AM:

JESR @ 31

I think you had a teacher who should have been fired and had her teaching credential revoked (permanently) for endangering students. And also been sent for psych observation.

#33 ::: Kylee Peterson ::: (view all by) ::: September 13, 2007, 11:37 AM:

I have another category of broken skin: what the joint specialists called "the worst possible kind of sprain" when I brought a friend to the ER over the summer. She'd jumped up to hit a soccer ball with her head and come down wrong, been carried off the field, and, despite insisting it was just a sprain, was bleeding steadily from a wound on the outside of her ankle. The ankle was incredibly swollen within a minute, which was worrying enough, but we managed to convince her to make an ER visit when the bleeding hadn't decreased despite pressure and ice after half an hour.

The eventual diagnosis was that her ankle had briefly dislocated. A bone had thrust far enough out of alignment to break the skin, then snapped back into place. She had to have surgery that night to repair the membrane that encapsulates the joint, which would be a very bad place to get an infection. She can walk on it now, and the physical therapist says total recovery is certain. If we had let her just go home, maybe not so much.

(The fun part was driving my car onto the soccer field to pick her up.)

#34 ::: Avery ::: (view all by) ::: September 13, 2007, 11:50 AM:

Emily H @ #10

Your experience mirrors my own. Broken metacarpal, right hand, extra knuckle and everything. Never a twinge! Not when I half-heartedly tried to put it back into place myself. Not after a trained professional drilled holes in it an laced it back together with a piece of wire.

I always expected incredible pain with a broken bone. The most painful parts of the experience were having the stitches removed and getting the "pimp my skeleton" bills.

#35 ::: James D. Macdonald ::: (view all by) ::: September 13, 2007, 01:16 PM:

Woo! Open dislocations! You treat them out on the street the same way you treat an open fracture: Control the bleeding, then RICE, then splint it.

People's experience of pain varies, from "HOLYCOWOHCROMITHURTSITHURTSITHURTS" to "Gee, that's sure odd."

#36 ::: Laurie D. T. Mann ::: (view all by) ::: September 13, 2007, 01:43 PM:

If you want to read more about traumatic skull fractures, read Lee and Bob Woodruff's book In An Instant. It's about his being injured by an IED in Iraq in early 2006. The book includes photos of what his head looked like without some of his skull. They also included an X-ray of all the crap that hit the upper part of his body. Fascinating and scary reading.

I've only ever broken 2 bones - my collar bone (from falling down a flight of stairs when I was 4) and a small bone in my left foot (while wearing sandals with a tiny sole a few days before the '99 Nebs in Pittsburgh - I wound up in one of those "broken foot shoes" for most of the weekend). I don't remember much about the collar bone other than starting to fall, then, later, having my left arm in a sling and trying to do sewing cards one-handed. As to the foot, I didn't think it was broken as it only hurt when I walked on it. It started to swell a little, so I went to the ER early in the evening. As it was spring, there were about 20 Little Leaguers ahead of me, but so long as I was sitting, I was OK. After about 5 hours, I finally got seen, got an X-ray and went home with crutches.

#37 ::: michelel ::: (view all by) ::: September 13, 2007, 04:07 PM:

Delurk-for-embarrassing story time!

Several years ago, my parents and I rented a lakeside house in Maine. As I was getting ready for bed, we heard a camp somewhere nearby singing. My mother wanted to figure out the song, so she went out onto the pitch-black deck ... forgetting there were about three steps down. When the house shook and she screamed, I ran out to find her on her side on the deck. (It later turned out she knocked a few slats out of the railing as she fell forward, but that kept her from plummeting down the drop to the lake.)

In emergencies, I have no brain; I go into "tell me what to do and I'll do it!" mode. My father thinks he knows everything (despite having no training), so he was trying to manipulate her swollen lower arm -- to see if it was broken! -- as she begged him to stop.

I put my hand firmly on her shoulder to try to comfort and steady her and asked whether to call an ambulance or put her in the car and drive to the hospital. Stupid -- always call the ambulance, but see above about the no brain thing. She's an RN, so when she insisted on the car, I went with it, not thinking that the pain would have her confused and wanting to do something rather than lie there waiting.

We sped through the dark to the interstate, and I asked the toll booth attendant where the nearest hospital was (!) -- should we just drive towards Portland? (We were 20 or 25 miles away from Portland.) She didn't know (!), so I went with that plan. About halfway there we saw a police car's lights flashing at the roadside. I don't know if I made the suggestion, but my mother asked please to stop and ask the officer for help.

I naively figured he was assisting a stranded motorist; it was something more like a drug bust, so I'm impressed he didn't pull his weapon when a car stopped behind his cruiser and a woman in pajamas rushed towards him. He called for an ambulance but warned it would be a bit because they were coming from ... the town we had left. Dammit!

I then irked the chief EMT or paramedic (I'm not sure which she was) by following her rig at Boston-area commuting distance. It wasn't intentional -- no brain.

My mother turned out to have a comminuted fracture of the proximal humerus, I think it was. So I was pressing right on the shattered break, but even knowing that, she says my father's fiddling hurt more.

Anyway, the valuable lesson: Always know where the nearest hospital is -- but always call the ambulance. I'm sure the smart folks here know that, but it bears repeating.

And if anyone here was somehow involved ... I'm so very sorry I was an idiot.

#38 ::: Lori Coulson ::: (view all by) ::: September 13, 2007, 05:03 PM:

Back in 1979 right after that year's OVFF, Monday morning, I was headed to work.(My brain was chanting "I don't wanna go to work.)

I was headed down the stairs from my door, when I parted company with the staircase about 3 steps above the first landing. Knowing I was falling I tried to relax. The space was too close to try any sort of save, and trying to do so would have made the results worse.

I hit the landing with my right leg folded under me. My right ankle was under my left buttock and I heard a "pop" like the sound of two football players hitting each other. (Did I mention I was wearing a backpack too?)

I figured I'd broken the ankle. So I crawled back up the steps, managed to get my apartment door open and crawled to the phone. (The cats thought this was fascinating...)

Did I call 911? Oh no, called my best friend, told her I thought I'd broken my ankle and could she please come drive me to the hospital?

Bless her heart, she left work. In the meantime I realized I was wearing a brand new pair of Dockers, and I figured the folks in the ER would cut them off, and doggone it, I wasn't going to lose a new pair of pants...

I actually managed to get my shoes off, pull off the Dockers and put on a pair of sweatpants, and put my shoes back on! Hurt like hell.

When I finally got to the ER and they x-rayed the ankle, it turns out I'd torn 2 of the three ligaments. They put it in a soft cast and told me to stay off of it for 48 hours. After that I could use a walker. The bruise was spectacular, it really did turn almost black.

I didn't find out until a couple of weeks later that I had jammed 13 vertebrae together. (Remember the backpack?) The chiropractor had a fun time working the spine back to it's normal form.

#39 ::: James D. Macdonald ::: (view all by) ::: September 13, 2007, 05:43 PM:

American Red Cross First Aid Courses

British Red Cross First Aid Courses

SOLO Wilderness First Aid Course

(Ah, Portland. We take people over there from my hospital occasionally, to Maine Med. It's a bit tricky to find if you're from out of town. About a three-hour drive on two-lane blacktop for me; only the last little bit is on the interstate.)

#40 ::: Rikibeth ::: (view all by) ::: September 13, 2007, 06:17 PM:

Why are the stories on this thread making me shriek and cringe in imagined pain in a way that the other trauma and emergency posts haven't done?

Yes, I have broken bones before (non-dominant wrist, two separate occasions, playground and backstage falls, and a bone in my foot, stair slippage) but I've also lived through some of the other trauma stuff (heat and cold problems particularly) and those don't nearly make me cringe the same way!

Great information. I just have to read it through my fingers this time.

#41 ::: dan ::: (view all by) ::: September 13, 2007, 06:52 PM:

Ah, Jim... I thought I had forgotten: "On old Olympus'...". It came right back.

#42 ::: Linkmeister ::: (view all by) ::: September 13, 2007, 07:30 PM:

Rikibeth @ #40, I'd hazard a guess that these stories describe real tangible pain more than the others have.

#43 ::: Caroline ::: (view all by) ::: September 13, 2007, 08:25 PM:

My favorite subluxation/dislocation story: My friend Matt tore his ACL. In a rock band accident.

Matt was the bassist for a metal band. They were playing a show one night, to a really excited crowd. When Matt's playing a show, he gets all rock star, jumping around with his bass. This is funny, because ordinarily Matt is a giant nerd, just like me.

The problem that night was that the lead singer had put down an uncapped bottle of water on Matt's amp. It got knocked over. And Matt, jumping around with his eyes closed, slipped in it and landed such that he tore his knee.

He finished the rest of the song, playing his bass, lying on his back in a puddle of water. When the song was over, his bandmates said "Man, get up. The song's over, you can stop being a rock star and playing your bass lying down." He said "No, seriously, I don't think I can get up."

He played the rest of the show sitting in an office chair dragged from backstage. Then, and only then, did they take him to the ER.

He was disappointed when he had surgery and was told he was not getting an ACL from a cadaver. He'd hoped to become part zombie.

#44 ::: Erik V. Olson ::: (view all by) ::: September 13, 2007, 09:21 PM:

Funny this came up. I just had to deal with, briefly, a possibly damaged skull/neck. Bike accident, walked around the corner, one guy lying on ground, unconscious, wrapped around bike, with the other guys (who weighed 75 pounds soaking wet) trying to pick him up.

Story elided. End result. Guy#1 off to hospital on a backboard, with c-collar, etc. Guy#2 walked away carrying his bike.

Mr. Macdonald will now tell you why Guy#2 walked away and Guy#1 was carried away on a backboard, etc.

#45 ::: B. Durbin ::: (view all by) ::: September 13, 2007, 10:47 PM:

I've never had a broken bone but I've had some truly spectacular bruises. And I have what I think is a vertical dent in my skull from second grade, when I turned a corner a wee bit too soon.

Of course, I think I probably was in more danger the time I slipped and hit my neck on the monkey bars, but I was a kid then and lighter. The teacher let me off from verbal participation the rest of the day— it didn't hurt to talk but it sounded truly awful.

I think Evil Rob wins for nasty bone injuries, though. He was something like 14 years old and on vacation when he got both hands caught in the scissored joints of a collapsing folding chair— that he was sitting on. They couldn't find the pinky and ring fingers on his left hand on the X-ray, so they splinted them, bound them up, and hoped good things would happen.

This is why he plays guitar. It started out as therapy. He's pretty good at it, and I have great joy in telling the above story to people after they've complimented his playing.

#46 ::: Marilee ::: (view all by) ::: September 13, 2007, 10:50 PM:

Let's see: believing you broke your arm. When I broke my ankle (nine places in three inches) neither the EMTs or especially the hotel manager believed me. I think it's because I moved it back straight before they got there because it hurt less straight. (I'd also asked the janitor who came to my yells of help to get me a blanket and I used it to support the ankle.) The ER doctor clearly didn't believe me. The X-ray tech didn't believe me until she asked me to roll over and I did and my foot didn't.

Dislocating shoulder by falling on outstretched arm. They teach you not to do this in OT. You're taught to automatically drop what you're carrying, cover your face with your hands, and bring your elbows in front of your chest. This is why I don't carry things often. It's a lot faster getting my hands in place and just falling if I don't have to drop things.

Flail. I got this by coughing too hard. Now I have codeine to take as soon as my coughing can't be controlled by hard candy.

I've had a lot of painful things happen but the worst was getting potassium IV. It feels like acid in your veins.

#47 ::: Tom Whitmore ::: (view all by) ::: September 14, 2007, 01:07 AM:

I'll read through the whole thread later, but I just want to say that what Jim said is really good basic aid. From personal experience: RICE made a serious bruise-trauma (nothing broken) into something that basically fixed in a week (though a year later there's still occasional pain).

#48 ::: David Bishop ::: (view all by) ::: September 14, 2007, 02:26 AM:

Well, if nothing else, this thread is making me vow to actually go to the doctor about my right thumb. I fell on my hand a couple months ago (softball), and jammed my thumb. While it's *mostly* better, if I try and bend it any more than "normal", it hurts a *lot*, and occasionally I tap the knuckle and almost shriek in pain. Also, pushing "down" on my thumb with my pointer-through-ring fingers is fairly excructiating. I've been pretty much just ignoring it, hoping it will go away. You guys have convinced me that's not the smartest thing I've ever done...

Um, that's the worst story I got. I know, I'm a piker :-)

#49 ::: Cynthia Wood ::: (view all by) ::: September 14, 2007, 03:08 AM:

David Bishop #48 - jammed fingers are annoying as hell. I've been nursing one along since Febuary - not as sensitive as yours, but not right either. Somehow I can't bring myself to go to the doctor because my finger hurts when pushed sideways. I've learned somewhat better since my day of knee-in-face, but not totally.

I think I may be so persistantly ignoring this because it's my finger of doom - aka my wedding ring finger. The finger that needed the ring replacement, that caused my Dad to shove me in an MRI, that found the pituitary tumor, that turned my life upside-down. My subconscious says bad things happen when I bring that finger to the attention of doctors.

#50 ::: abi ::: (view all by) ::: September 14, 2007, 04:47 AM:

OK, so now I have the evaluation criteria. How did I do when faced with a broken finger on a child?

Fiona fell in the shower, naked. I was wearing underwear and a shirt, but no trousers, because I was helping her. She got up crying, with her right pinky finger sticking out. Deformed.

Her cries started at startlement and quickly turned to pain. She held the wrist of her right hand, and I carefully touched the finger and the attachment to the hand.

I thought it might be dislocated (there is a family history of loose ligaments. At one point we had three shoulder subluxions in the family at once), but it didn't feel, on the brief touch, like something I could just "put back".

I had her wiggle her fingers, and noted that she couldn't move the pinky. At this point, I thought, broken. So did we RICE it?

Um...no. Rest, of course, but we clean did not think of ice. Compression was not going to work - it was not a wrappable structure as it sat there. And again, we didn't think of elevation.

She stopped crying very quickly, and claimed that the pain was much less. We got her dried and dressed (which involved getting a sleeve on her - I suppose we could have left that arm out of the sleeve, but we just worked the hand carefully through.

Then, of course, we did the absolutely right thing and sought medical attention. It was a partial (greenstick) fracture of the inside of the lowest long bone in the finger. They put a cast on from fingertip to elbow (it was night shift in the ER; they were not being delicate and artistic). A few days later, they swapped it for a joint above to joint below number, which meant that she didn't even lose wrist mobility.

The smaller cast came off on Tuesday, and she's already almost back to full mobility.

#51 ::: Lila ::: (view all by) ::: September 14, 2007, 08:16 AM:

dan @ #41: I prefer "Oh, once one takes the anatomy final, a good vacation sounds heavenly."

Caroline @ #43: I've torn both my ACLs. First one was a shopping accident (I turned a shopping cart full of gravel and concrete pavers over on myself); second was in the middle of my black belt test when my teenaged daughter did a sweep that dumped me but didn't clear my foot off the mat. I then tried to finish my test (board breaking) and found out why people don't customarily break boards while standing on one foot.

Still haven't had surgery. Neither orthopedist ordered an MRI (x-ray only) so I don't know the extent of the tears. First doc wanted to do surgery--"otherwise the knee will eventually fail". I asked what difference there was in prognosis with immediate surgery vs. when the knee fails--he said none. I told him I'd be back when the knee failed (12 yrs. and counting).

With the 2nd knee, the other doc said "what did you do to rehab the first one? Go do the same thing for this one. Do leg presses till you're blue in the face." I liked him a lot better than I did the first doc.

#52 ::: Mary Aileen ::: (view all by) ::: September 14, 2007, 09:24 AM:

Marilee (46): I've had a lot of painful things happen but the worst was getting potassium IV. It feels like acid in your veins.

Really? It felt like any other IV to me. But I still have a port from having chemo, so the IV was never in surface veins. That could make a difference.
------------
No broken bones, but I did sprain my foot when I was a kid. ("You mean you sprained your ankle." "No, I sprained my foot.")

#53 ::: Serge ::: (view all by) ::: September 14, 2007, 09:37 AM:

I feel so inadequate... I never broke any bone - mine or those of others- although I once slammed a fingertip into my car's door. Not even a partial fracture though. But my nail fell off. Does that count?

#54 ::: Malthus ::: (view all by) ::: September 14, 2007, 10:27 AM:

Several years ago, I did the standard Fall On Out-Stretched Hand. When I got up, I thought I'd sprained/strained my wrist. Ran out, picked up an Ace bandage, wrapped the wrist. Didn't seek medical attention.

I kept it wrapped for weeks, because it hurt less when there was pressure on it. I'm pretty sure it was a fracture; a couple of times a year, I'll overwork that wrist and it'll hurt like hell.

#55 ::: Diatryma ::: (view all by) ::: September 14, 2007, 10:35 AM:

Serge, I'm the same. I don't do much of anything. I have a weird nervey thing in one finger from too much tiny-fiddly-scissoring a few months ago, I lost a toenail once, and I have half a fake tooth, but my sister's the one with the medically interesting leg-- we think it started with a bone bruise from skiing and went on from there. And I still feel bad for swooshing past her the first time instead of stopping and making sure she was okay.

#56 ::: Serge ::: (view all by) ::: September 14, 2007, 10:49 AM:

Diatryma... About 8 years ago, I was on my bicycle and took a curve a bit too fast. Bike went flying sideways and I landed hard on my knee, or rather just below. It hurt like Hell. Did I go to the doctor? Of course not, not even when, while doing leg presses, I could feel my tibia popping around a bit. I stopped doing leg presses for a long time, but that was it. I fully recovered. Still, thinking back, that was stupid of me.

#57 ::: Caroline ::: (view all by) ::: September 14, 2007, 11:02 AM:

Lila @ 51: Probably for the best. Matt said that recovering from knee surgery was the worst pain he's ever been in, and he hopes never to feel that much pain again. (The biggest problem was that he wasn't told to start taking his painkillers before the anesthesia fully wore off. By the time he could feel his knee, it was too late -- the painkillers didn't touch the pain.)

Serge @ 53, it's okay, I've never broken a bone either.

For some reason, this was the post that made me really decide to get some first aid training. Maybe it seems the most do-able.

#58 ::: Fragano Ledgister ::: (view all by) ::: September 14, 2007, 11:09 AM:

Serge #53: I broke my right arm at seven. I have a scar on my right knew as a result of a fall when I was 14 (it isn't smart to run downhill while carrying a sackload of dung if you're going to trip over a tree-root and have your knee land on a rough rock), and I have a scar inside my right elbow as a result of an accident when I was 19.

#59 ::: Serge ::: (view all by) ::: September 14, 2007, 11:21 AM:

Fragano... That darn dung dunnit.

#60 ::: Ginger ::: (view all by) ::: September 14, 2007, 11:30 AM:

Marilee @46: sometimes the doctors don't believe the grownup telling them their son's arm is broken. My son was about 5 when he fell (it was a classic jump for something he couldn't reach, and then the FOOSH). I palpated it right away and felt no deformity, so we RICEd him. Two days later, he slipped in the school hall and did another FOOSH. This time palpation elicited pain, so I sent him to get radiographed. My partner said the doctor palpated and didn't think it was broken, but she told him to radiograph it anyway. It was indeed a mild fracture, not even completely through the radius. He wore a cast for 5 weeks and has been fine for the past 6 years.

The only broken bones I've ever had were fingers and toes. The fingers came from getting my hand caught in a closing car door. Two fingers were fractured in the proximal bones, but nothing else. The bone calluses were kind of cool. I've had a toe fracture from stubbing my foot on the couch, which resulted in a spectacular bruise. Once a horse tripped over his own feet, and broke my foot, which was terribly unfair of him. None of them really hurt very much, but as mentioned, this is a very individual response.

#61 ::: Serge ::: (view all by) ::: September 14, 2007, 11:39 AM:

I wonder how Abi's daughter is doing. I presume her finger is still in a cast.

#62 ::: abi ::: (view all by) ::: September 14, 2007, 11:49 AM:

Serge @61:
See the last line of comment 50. Fiona's hand is no longer in a cast, and her finger is already almost back to full mobility (she can't quite make a fist yet).

The current worry is the barfing, feverish 6 year old son, though. Fun times!

#63 ::: Serge ::: (view all by) ::: September 14, 2007, 12:06 PM:

Oops. Missed your earlier post, Abi. So Fiona can't do the Power Fist yet. As for your son, has anybody figured out his problem? By the way, it's weird, thinking that people around here now have kids who were born in the 21st Century. When those kids hit puberty, will they make fun of their parents for being born in an earlier century? But I digress.

#64 ::: Fragano Ledgister ::: (view all by) ::: September 14, 2007, 12:22 PM:

Serge #59: True, and I wasn't anywhere near Dungeness either.

#65 ::: Fragano Ledgister ::: (view all by) ::: September 14, 2007, 12:24 PM:

Abi #62: Ah, the joys of having small children! (I remember ear infections with a shudder...)

#66 ::: Nicole J. LeBoeuf-Little ::: (view all by) ::: September 14, 2007, 12:25 PM:

Mary Aileen @52: But I still have a port from having chemo, so the IV was never in surface veins. That could make a difference.

I wonder if you had an experience similar to mine with that? Depending on where the port's placed, I guess. I underwent chemo from 1987-89, and I had a dual port catheter installed for the purpose into some blood passage in my chest. I don't know about potassium, but I quickly discovered that Heprin (anti-coagulant I had to inject in each port) made an unpleasant cold feeling at the back of my throat, ketamine had to be injected slowly or I'd gag on my way out, and IV-style Benadryll would make me gag to the point of vomiting no matter how slowly it went in. Surprised the heck out of me; I had been under the impression that one shouldn't be able to feel stuff going into the veins. Maybe it was because the insertion point was so close to the heart? How does that work?

#67 ::: Diatryma ::: (view all by) ::: September 14, 2007, 12:35 PM:

When I give platelets, I sometimes get an effect from the citrate anticoagulant. The easiest part to notice is the tingling lips-- citrate binds calcium ions, which leads to the tingling. I think there's an effect for fingertips, but I'm usually not paying attention to them. Yesterday, I noticed that my throat felt sort of weird, and the backs of my eyes, if that makes any sense-- sort of muzzy-wrapped, so while things felt the same, the signal to the brain was being lost. I think a lot of that was me being tired and a little bored from sitting in the same chair, wrapped in warm blankets, for an hour. The effects go away if I drink a bit of milk to replenish the calcium in my blood.
Since I am fairly suggestible, I think the throat and eyes might be in my head. They might be tied to the chilliness, too.

#68 ::: oliviacw ::: (view all by) ::: September 14, 2007, 12:48 PM:

No broken bones for me, but I did badly sprain/strain my left ankle many years ago...diagnosis uncertain because I never had anything but wilderness first aid. I was on an Outward Bound trip - third day, late in the afternoon, and we were doing the first rock-climbing bit. I got about three feet up the last face, and then slid down the face and landed with all my weight on my left foot, which wedged sideways into a crevice. Ouch! Didn't appear to be broken, though, and I was wearing hiking boots with ankle support. So I struggled back up (about 8 feet) to the top, and rapelled down (whee!). After soaking it in the creek, the instructor bandaged it up, and we had a decision: go back with one of the instructors (2.5 days hike), or continue forward with the group (4 days hike). In the morning, we decided that it really probably wasn't broken or fractured, just muscle/ligament/tendons, so I kept going with the trip, after it got taped up. I pretty much kept up with the group, though I begged out of one rock scramble, and I got to pass on the 5-mile run at the end of the trip. :) By the time I got back to civilization, it didn't seem like there would be much that modern medicine could do for it, so I just used an ACE bandage for a few weeks. It's never been quite the same since, though - most of the time it's just fine, but I have an odd ability now to trip over very small objects on flat surfaces when I hit them wrong with my foot, and I end up stepping on the side of my foot - ouch!

Now, my sister had a broken leg when she was 6 or 7 - classic skiing accident on the "last run" of the day, about 3:30pm. And my brother broke his arm when he was about 3 - the story's long, but basically he fell out of the back seat of a car when the door opened [1974ish - no car seats then!]. The car was slowing down to a stop sign in a residential neighboorhood, and he fell out and must have caught most of his body weight on that arm first. No other injuries, except for some scraping on his hands. It was technically a fracture - it didn't break all the way through, probably because he was so little and light.

#69 ::: John Houghton ::: (view all by) ::: September 14, 2007, 01:02 PM:

Diatryma (67):
When I was a platelet donor, I always felt it in my belly first. Chewable Tums (provided by the Red Cross donor center) worked well for me, I tend to be warm most of the time, so rarely needed the electric heating blanket turned on, even though the blood was coming back a good deal cooler than it went out.

Movies not to watch while giving platelets: Reindeer Games (the scene with the darts — not what I want to see while I'm pretending that there aren't these humongous needles in my arms).

#70 ::: joann ::: (view all by) ::: September 14, 2007, 01:19 PM:

Somehow, my FOOSHes have never resulted in anything broken; somewhere I learned how to roll and wind up on my bum. One did end up getting me 3 months of PT for a frozen shoulder; this was the time I was out walking on a cold night, tripped and fell into a mud puddle. My treatment was to walk the five blocks home, have a stiff belt of scotch, and take a hot bath. In retrospect, probably the wrong thing, but the idea of ice after a 40F night was rather unsettling. (Had I known, I would have traded an hour of frozen shoulder on the spot to several months of frozen shoulder later.)

Several weeks later I discovered I could no longer scratch my back, and that I couldn't fasten my bra in the normal way. I got X-rayed to make sure that nothing more than outraged muscles was going on (it wasn't) and embarrassed everyone when I got stuck taking the Xray gown off.

Moral: For Ghu's sake don't forget the ice part.

#71 ::: JESR ::: (view all by) ::: September 14, 2007, 01:33 PM:

My "I think I may have broke it" story:

When I was 22, I was on a dig in the Skagit Valley. The field school was run on the theory that every job on a dig is essential, so we cycled through excavation, lab, survey, and cooking crew. The second week I was on cook crew, three of us wasted time trying to find a third leg of lamb (from one lamb) in a cold-room meat-locker. Coming out into the humid air, my glasses frosted over, and I missed the turn going down the long, narrow, steep, unlit staircase and fell down eight steps, landing with all my weight on my right knee cap. When I got up, it was swollen, extremely painful, and could be moved past its normal range of motion, with a distinct grating feeling as if there was bone-on-bone contact.

The dig director had no patience with injury, and had already sent one person home after he hurt his leg. So I didn't report the injury, immobilized it with, first, my heaviest hiking socks and some safety-pins, and then a wide elastic bandage, and toughed it out. The last two days of cook crew weren't fun; I rested some over the weekend (where "rested" includes having to walk a block to the latrine and two blocks to the cook tent, not to mention a quarter mile down to the Skagit to soak the sore knee in glacial meltwater). The last three weeks of the field schoolI bulled through walking five miles a day, under pack, over uneven terrain between camp and site.

When I was forty, that stupidity was delivered to my door postage due. It pretty much has hurt every minute of the last fifteen years.

#72 ::: Mary Aileen ::: (view all by) ::: September 14, 2007, 01:37 PM:

Nicole (66): I have a single port just under my right collarbone. I don't remember any odd effects from any IVs going in, but Heprin (sp?) always makes things smell of vomit for about 24 hours afterwards. *Not* what I needed when I'd just had chemo!

#73 ::: xeger ::: (view all by) ::: September 14, 2007, 02:23 PM:

The last time I had to be retrieved by an ambulence, the lovely folk who stopped to help me were so confused about what to tell 911 that I ended up doing the whole accident description, location, injuries, condition of patient ... and then finishing with "I'm sorry - I think I need to sit down now, before I fall down".

Having an arthrogram for my separated shoulder still rates as one of my most painful experiences (and - well - I've injured enough parts to not look forward to damp days). The MRI after was almost relaxing, and definitely musical.

#74 ::: Linkmeister ::: (view all by) ::: September 14, 2007, 02:35 PM:

Caroline @ #57, when I had two knee surgeries to repair a severed patellar tendon (long story told here) I remember that it wasn't the surgery or the days afterward which hurt so much, it was the PT on the exercise bike. Getting that pedal over the top and on its downward stroke the first time was up there with the other big pain sensation I've had: gout.

#75 ::: joann ::: (view all by) ::: September 14, 2007, 02:54 PM:

Cynthia #49: The finger that needed the ring replacement, that caused my Dad to shove me in an MRI

Probably not entirely on topic, but would you mind terribly unpacking that?

#76 ::: Lila ::: (view all by) ::: September 14, 2007, 03:24 PM:

Caroline @ #57, we are constantly nagging our patients to take their painkillers BEFORE the pain gets bad. There's a strain of Puritanism down here or something. You're right: once you're really hurting, it's too late for the drugs to help much.

#77 ::: mayakda ::: (view all by) ::: September 14, 2007, 03:26 PM:

If you were to ask me how many bones there are in a skeleton, I’d have to say “Beats the heck out of me.”

Once upon a time I went to a foot doctor and he told me the reason I have flat feet is that I have an extra bone in each foot that weakens the whole structure. I am a mutant! Though I still haven't heard from either Dr. Xavier or Magneto. *pout*

I did feel slightly better though when I heard about a lady who'd found out, via an unrelated x-ray, that she'd been born with just one kidney.

#78 ::: Serge ::: (view all by) ::: September 14, 2007, 03:53 PM:

mayakda @ 77... So you that ToeGirl, whose power is to tow lines, like Spiderman, but out of your ankles instead your wrist?

#79 ::: Diatryma ::: (view all by) ::: September 14, 2007, 03:53 PM:

When I had my wisdom teeth out, I mentioned that my mother had only three. The doctor told me that he'd once had an entire family with five each, all inherited from the mother, and one poor boy with twelve total.
I wish I could see those X-rays.

#80 ::: James D. Macdonald ::: (view all by) ::: September 14, 2007, 04:09 PM:

The ice question for strains and sprains: for the first 24-36 hours, use cold packs. For the next 72 hours, switch to warm, moist packs.

Don't forget the Rest part of RICE.

#81 ::: Ledasmom ::: (view all by) ::: September 14, 2007, 04:51 PM:

I only ever broke one bone that I know of, a greenstick fracture (I assume) of the index finger of the right hand due to my shutting it in the hinge of a door when I was quite young. It left me with a most interesting fingernail. The worst part of it was the medicine I had to take, which was disgusting. Years after that, my brother got a finger on his left hand caught in one of those heavy outside school doors, resulting in stitches and a cast and a finger that goes about thirty degrees off to the left after the last joint.
I did have a fun little accident last winte involving being on a sled and falling off over a bump, landing on my right hip first and then the side of my head, resulting in about half a mild black eye, broken glasses and hip pain. I got hauled off the sledding scope on somebody else's sled, butt-up, and couldn't walk (well, not without a cane, and then exceedingly slowly) for two days. I was, um, going on the theory that if anything had been broken it would have hurt much worse than that, which I gather may not be accurate.

#82 ::: Cynthia Wood ::: (view all by) ::: September 14, 2007, 05:29 PM:

joann @75 - sure. I wasn't trying to be mysterious, it's just lengthy.

About eighteen months ago, my husband lost his wedding ring. By that time we had become less enamored of our ring design, and so we decided to look for rings for both of us. The lady at the jewelry store checked my ring, gasped and ran to get the ring cutter. I had known my ring was too snug to get off, but apparently it had gone well beyond that, and only my habit of blowing air under my ring had kept nasty things like rotting skin from happening.

So we got replacement rings. My new size ring was a full five sizes bigger than my old ring (7 to 11). When we next went to visit my dad (a neurologist), he noticed how big the ring was and asked. When told, he flipped, and I found myself shoved in an MRI looking for a pituitary tumor, tentative diagnosis of acromegaly (overproduction of growth hormone). The tumor was there, though bloodwork hasn't confirmed acromegaly. Since then I've gotten to know an endocrinologist very well, added about four medications to my life, and am still hoping to avoid people sticking pointy things in my skull.

Hence the bad associations with ring finger problems!

#83 ::: Serge ::: (view all by) ::: September 14, 2007, 05:39 PM:

Like I said earlier, I never broke a bone. My dad, on the other hand... He was a mechanic and worked on a quarry's heavy machinery. One day, he was in the process of unscrewing some part of an engine which, unbenownst to him, was still under pressure. Bam! went the suddenly free part to the ceiling. Had my dad's head been a bit closer, it too would have become a cannonball. As it was, the only thing that got in the way was his forearm. It took a copper plate to keep the bone segments in place, and about a year for everything to grow back. (Later he sliced a fingertip off, but that, as they say, is another story.)

#84 ::: joann ::: (view all by) ::: September 14, 2007, 06:51 PM:

Cynthia #82:

Thanks! (This only serves to confirm me in my habit of not being a person who keeps their rings on for all occasions. Frex, I never cook, sleep or bathe with them on.)

#85 ::: Linkmeister ::: (view all by) ::: September 14, 2007, 08:03 PM:

Cynthia @ #82, Jeepers! I need to talk to She-Who-Shares-Your-Name (Mom) about one of her rings - it's pretty darned tight and not removeable.

#86 ::: B. Durbin ::: (view all by) ::: September 14, 2007, 09:42 PM:

Diatryma: My mother had a wisdom tooth erupt last year. At the age of 61.

I don't have any. I'm even short a molar. Since Evil Rob has no wisdom teeth either, we expect our kids (future tense) to not have any.

Twelve would have been a great evolutionary advantage back when you'd grind down your teeth with stone in your bread meal. Wear your teeth out? Hey! Here comes another, and another...

#87 ::: Marilee ::: (view all by) ::: September 14, 2007, 10:58 PM:

Mary Aileen, #52, yes, it was painless once I got central lines. It's the small veins that hurt like hell. The nurses offered heat, cold, all sort of things, but nothing really helped.

Nicole, #66, I never had gagging problems with stuff going in the central line, but I could taste them. I used to amuse the nurses by telling them what they were piggybacking. Now, the n-g tube, that I had problems with gagging. I learned quickly how to pull them out myself rather than wait for a nurse while I can't breathe.

Ledasmom, #81, I don't need an accident to make my fingers turn directions. I was born with the outer fingers slightly curving in, but my right index finger is now curving in at about 30 degrees, as well as rotating inward. Osteoarthritis, my rheumatologist says. I'm going to stop buying beads; I won't be able to bead much longer.

#88 ::: Bruce E. Durocher II ::: (view all by) ::: September 15, 2007, 02:55 AM:

About 20 years ago I was running late at night on First Avenue in downtown Seattle (while carrying a bagful of books) so I wouldn't miss the late-night bus to the Vashon ferry and have to wait half an hour in a dodgy part of town. I was crossing the crosswalk across the exit from Highway 99 when I tripped and fell.

I managed to grab my bag of books and stagger to the bus (the need to get to your feet and out of oncoming traffic from a major highway at night makes a normal adrenal surge seem like weak tea), but something was very wrong with my arm and/or shoulder. I plopped myself on a seat at the front of the bus and the driver actually said "Are you O.K.?"

"No!" I snarled.

"Well, at least you caught the bus."

We got to the ferry dock and I asked the driver to go to the ticket booth and get someone to help me to the pay phones--the pain was truly amazing. Fortunately I knew the attendant: she got someone to bring their car up so they could drive me to the phones.

I called home and let my dad know I'd fallen and the arm was either dislocated or broken and asked if I should try to call a cab and head for the hospital or catch the ferry home. Since waiting for a cab would have taken longer than the 20 minutes for the ferry ride and the doctor's office was five minutes from the ferry he said come across and he'd wake up the doctor and staff and have them ready for me and would pick me up at the ferry and take me right to the office.

At the end of this he asked "Does it hurt?" I consider it a sign of the deep and abiding love I had for my father that all I did was shout "Hell yes it hurts!"

I got on the ferry, but couldn't face trying to climb the stairs and find a comfortable way to sit at one of the overstuffed booths/couches so I rode across on the car deck with my arm propped on a fuel drum to keep my shoulder together. As a minor fact I can report that extreme cold does not stop the fumes from fuel oil from kicking the crap out of your nasal passages.

I arrived on the island and staggered off the ferry and onto the dock where Dad and Mom picked me up and drove me to the doctor's office where x-rays proved I had a dislocated shoulder.

Now the fun began. The half-hour bus ride and the 20 minute ferry ride meant that my shoulder muscles had begun to cramp and swell--and I've always had a strong upper body anyway. The doctor had given me some painkillers as soon as I came in the door, but when the first attempt to put my arm back into the socket failed he got out the Demerol and gave me a dose which eliminated all pain (as well as the ability to walk in a straight line and most rational thought) on my part. Even so, it took two more tries to put the arm back in place--and for a second or so during the last attempt he thought he'd have to call out an ambulance and have me taken to a hospital with some really big interns and have them pull on my arm.

I learned several things over the next few weeks, the most annoying of which was Percocet is useless on me--all it does is to slow my speech slightly and give me hell's own case of cottonmouth without touching the pain in any way. And for two years I could tell when the weather was going to change long before it came up on the newscasts.

#89 ::: abi ::: (view all by) ::: September 15, 2007, 03:11 AM:

Bruce @88
At the end of this he asked "Does it hurt?" I consider it a sign of the deep and abiding love I had for my father that all I did was shout "Hell yes it hurts!"

I honestly have no idea what I said to my dad when he came up to me on the trail through the woods and saw that I had nearly cut the tip of my left thumb off with a machete. The hand was covered in blood, the glove* was covered in blood. It was dripping.

He asked if I was hurt.**

-----
* I have no memory of taking the glove off. All things considered, this is fine with me.

** To be fair, he's not good with the sight of blood. He was present at the births of 3 of his 4 children, and always had to sit down and put his head between his knees at the end.

#90 ::: ethan ::: (view all by) ::: September 15, 2007, 03:37 AM:

abi #89: When I imagine you chopping your finger off (which I had never until now had occasion to do), I imagine it being similar to when Gwyneth Paltrow did it in The Royal Tenenbaums.

#91 ::: Bruce Cohen (SpeakerToManagers) ::: (view all by) ::: September 15, 2007, 03:49 AM:

I look forward to the day when medical science can predict which painkiller a particular patient should take, and what dosage will work for a given level of pain. There are some guidelines, of course, but response to analgesics, sedatives, and anesthetics can be so idiosyncratic that sometimes it's just a roll of the 20-sided dice.

My partner inherited from her mother a bizarre reaction to valium in which she becomes hyperactive rather than sedated. My MIL decked her obstetrician shortly before delivery because of this reaction.

My reaction to morphiates, codeine, and oxycontin below a dose that sends me to Cloud Cuckoo-Land is roughly, "well, the pain certainly is muffled somewhat, but I feel so crappy I'd rather have the pain." I don't think I'm in any danger of becoming addicted; after my back back surgery six years ago Eva had to watch me constantly and nag me to take the Vicodin I'd been prescribed. I hated the sensation of the stuff so much I would take only enough to just keep ahead of the pain, which is not a good way to recover from surgery.

#92 ::: David Goldfarb ::: (view all by) ::: September 15, 2007, 07:01 AM:

I also had only three wisdom teeth. One of the uppers just never got generated.

I've never broken a bone, but I did rupture my Achilles tendon once. I was taking a box of envelopes to a place that does offset printing. Just outside was a hole containing a water meter, and the hole lacked the usual cap. I misjudged where I was, and my right foot went right into the twelve-inch-deep hole. I fell and couldn't get up. After a while, a worker from the printer happened to come outside. "Are you okay?" he said. I replied, "No." He helped me up and we went inside, where I elevated the foot for a while.

At that point I was still hoping that I wasn't badly hurt, so I just drove back to the copy shop where I work. It wasn't a long drive, but I had to use my right foot to work both the gas and the brake -- it was a stick shift. I thus became acquainted with many interesting feelings of intense pain. By the time I got back to the shop, it was clear that I needed a doctor. Someone took me to Kaiser Oakland, where they diagnosed the ruptured tendon and put a preliminary splint on my leg. (One of the tests was this: a nurse put a hand on the sole of my foot and told me to push the ball of my foot forward. I tried to make this motion, I felt the calf muscle contract, but the foot didn't move. A very odd sensation.) The heat from the curing plaster helped the pain quite a bit.

I then gained a new definition of the term "false economy". I live about ten minutes' walk from that hospital, so I figured I'd just go home on my own rather than call a taxi, especially as I happened to be a bit low on pocket money. I'd never been on crutches before, and nobody had ever told me that it was so much damn work. An hour into that "ten minute walk", I somehow managed to make it up the stairs to my second-story apartment and fell into bed.

I wound up having surgery, and my leg in a cast for three months. (They asked me what color I wanted the cast. "Ooh!" I said when they mentioned "glow-in-the-dark" as a possibility. "Gimme that!") To this day, seven years later, my right calf muscle is a tiny bit smaller than the left.

#93 ::: Serge ::: (view all by) ::: September 15, 2007, 08:38 AM:

abi @ 89... Ouch. I sliced my wrist once. Summer job at a nearby motel. I was in their storage building where all kinds of things were, including a tall standing lamp with a broken porcelain head. So, of course, when I tripped over something, I flung my right arm forward to stop the fall, which I did, with my wrist intersecting with the lamp's very sharp edges. A couple of hours later, with a few stitches on me, with some less blood in me, I was back at the motel, where I picked my bike and rode my way back home, uphill, two miles. (No, it wasn't in the snow.)

#94 ::: Ledasmom ::: (view all by) ::: September 15, 2007, 10:09 AM:

abi #89: When I squashed my finger in the door hinge there was, well, considerable bleeding, and I marched into the kitchen and requested a Band-Aid. Unfortunately, I don't remember the immediate reaction to that request, but I like to imagine it as "Auugggghhhhh!"

#95 ::: xeger ::: (view all by) ::: September 15, 2007, 12:47 PM:

#93 ::: Serge wrote:
I sliced my wrist once. Summer job at a nearby motel.

I usually describe the results of bottle feeding kittens as similar to those of an incompetent suicide. They're much more enthusiastic than bramble bushes.

#96 ::: JESR ::: (view all by) ::: September 15, 2007, 01:25 PM:

xeger, I'll see you kittens and raise you trying to disentangle a still-wet calf from barbed wire.

#97 ::: Serge ::: (view all by) ::: September 15, 2007, 02:16 PM:

xeger @ 95... No fool I. If my cat wants to be clean, I let him do it himself. He's good-natured and quite mellow, even when one of my dogs try to boink him, but making him take a bath might be another story.

#98 ::: Linkmeister ::: (view all by) ::: September 15, 2007, 02:16 PM:

Ledasmom @ #94, yes. Bleeding does ensue following that form of accident. The finger described in my comment @ #1 did quite a lot of that once I got it out from the ring latch I'd left it in.

I was treated on the USS Hope, the nearest Navy clinic to Palos Verdes, where the incident occurred. At ten, being taken to a Navy hospital ship almost made up for the pain.

#99 ::: Serge ::: (view all by) ::: September 15, 2007, 02:17 PM:

JESR... I take it that you keep your rose bushes safe from your family's bovines.

#100 ::: JESR ::: (view all by) ::: September 15, 2007, 02:43 PM:

Serge, the rose bushes are, for the most part, away from the fence. The past week my BIL got delayed by equipment problems and left the cows without hay overnight. As a result I lost the top eighteen inches plus blooms and green and red fruit on my new fall-bearing raspberries, along with the secondary fence that protected them.

I have unfair advantage in any game of compare-the-scars (even excludingfor the moment sociopathic PE teachers) thanks to the combination of cattle, big thorny roses, and world-beating clumsiness.

#101 ::: Serge ::: (view all by) ::: September 15, 2007, 04:04 PM:

JESR @ 100... You do indeed have an advantage over the rest of us. Still, I am amazed that I have all my extremities intact, considering all the powertools in my dad's basement, the hammers, saws, nails, and all other things a man who built his own house needs, and which he actually let me use.

#102 ::: Renee ::: (view all by) ::: September 15, 2007, 04:06 PM:

When I was eight, I was in ski lessons. The biggest lesson I took away from them was: never go over a mogul taller than you are. In my case, doing this meant catching both tips in the snow on my way down--and only one of my bindings releasing.

I don't recall coming off the hill. I do recall insisting I was fine, and demonstrating this by walking around mostly normally on a knee that was screaming at me, because you see, this happened on a Friday and there was this slumber party I'd been invited to that night...

The mother of the hostess was a nurse, however, and she told me, after looking me over, that I had broken the leg and should go to a doctor. The stepfather disagreed, and saved the expense. As a result, I spent two months limping, several years predicting the weather, and to this day, the damn leg vanishes from under me on an irregular basis.

Seriously: it just disappears. I scared my co-workers once this way--I was talking to one, took a step back, and the leg evaporated. I kept going back and hit a file cabinet hard enough to bring half the floor running.

I've gotten pretty good at falling on my forearms, when I'm falling forward, but the second-to-last time this happened, I didn't get my arms under me in time and sprained my wrist, because my hand was twisted under me. The last time it happened I was on stairs, and I slid down at least one step on my knee and wrenched my shoulder stopping myself from going down on my face.

Broken bones: the gift that keeps on giving.

#103 ::: Clifton Royston ::: (view all by) ::: September 15, 2007, 04:15 PM:

I've been avoiding this thread, unlike most of the trauma ones. Last night I tried reading it, and started to get dizzy and nauseated. There is something about the broken bone + internal bleeding idea that triggers me. Once almost passed out in a CPR class when the EMTs started telling stories.

Hmmm, and now I can't feel my fingertips. Time to sign off again and go think happy thoughts.

#104 ::: Vicki ::: (view all by) ::: September 15, 2007, 04:42 PM:

As long as we're describing injuries and our own foolishness:

I think I have a slightly deviated septum left over from a broken nose.

Remember where it says "Watch the Gap" on train doors? That's good advice. I didn't take it, that afternoon.

When you get off a commuter train without watching the gap, one possible outcome is that your foot gets caught between train and platform and you fall straight forward.

The Metro-North Railroad has concrete benches on the platforms. I hit my head on one. That I also caught my fall on my outstretched palms may not have made much difference, though a pair of $5 knitted gloves took the impact and I didn't tear the skin.

I immediately, without thought, did the smart thing: I screamed. The train crew came over, helped me up, and asked if they should call an ambulance.

I did the stupid thing and said no. I didn't want to sit in an emergency room. I wanted to go to the meeting I'd been heading for (concom meeting at the convention hotel). Not because I was that devoted to Lunacon, but because going to where I knew people seemed, to my slightly addled brain, like a better idea that turning myself over to strangers. (I also had the possibly-mistaken belief that I'd spend hours and hours in the ER before being helped, as I was conscious and not bleeding.)

My friends got me ice for the most visible problems, and eventually got me home. I called Andy, who hurried home from California (work trip) as fast as he could. The next day, I got myself to my doctor's office, and thence to the nearest hospital to get X-rayed. Yes, I went to bed, in an apartment by myself, with a head injury. Fortunately, while I think I had a concussion, it was quite mild.

I also had dramatic bruises around my eyes, basically the shape of my eyeglass frames, because the impact had pushed them into my face. Modern plastics are wonderful: the glasses didn't break, only scratched. As it happened, I'd let the eyeglass store talk me into buying insurance against stratching. I don't think this was what they had in mind, but they honored it.

So, I called in sick to work for two days. The third day, I went to the eyeglass place, then took a cab to work. Since I'd had to leave my regular glasses at the store for repairs, I walked in wearing my prescription sunglasses. I sat down, said hello to a coworker or two, and started in on my normal morning.

Someone made the inevitable joke about the sunglasses hiding bruises. So I took the glasses off. The person got quiet suddenly, and I explained what had happened.

At this point, I'm left with the slightly out-of-line nose, which I keep thinking I'll get treated sometime. It does interfere slightly with breathing, mostly when I'm congested. Other times, there can be odd noises that other people find more disturbing than I do. A stranger on the train once told me to stop making the sounds, and I told her I'd be happy to, if she'd pay for the surgery.

I was also left with a sensitivity to flashing lights (strobes in particular), which seems to have finally reduced slightly in the last year or two, but is still not good. Music videos, movie trailers, and warning lights on emergency vehicles can all be uncomfortable for me. (I don't resent the EMTs using those lights; I do find myself resenting tow trucks that aren't actually dealing with emergencies.) This is part of why I rarely go to the movies: even movies that don't have that sort of fast-cut effect are preceded by trailers that do.

#105 ::: joann ::: (view all by) ::: September 15, 2007, 06:04 PM:

Vicki #104:

I *think* I might have broken my nose once, although there wasn't any bruising, just the most incredible pain. I was at one end of the house, the radio was on in my room at the other, and I ran in and dived across the bed to turn up the volume. The base of my nose collided with the edge of the table the radio was on. There was, predictably, the nosebleed to end all nosebleeds.

I was supposed to be doing wardrobe mistress for a junior high play dress rehearsal that night. I had to get someone else to take over for both rehearsal and performance (fortunately the play was modern dress use your own, so the job was a sinecure), and I missed at least a day of school, but I never saw a doctor, just a lot of ice. My nose is slightly crooked to this day, and there's definitely less room in my left nostril than my right.

#106 ::: John Houghton ::: (view all by) ::: September 15, 2007, 06:10 PM:

Clifton (103):
I had a student in a CPR class last week who admitted to having had hysterical blindness when she had been at the scene of a real emergency (I don't remember her description of the emergency, so I don't think that it was impressive - I remember the impressive tales).
You have a strong inclination to what is usually called psychogenic shock, but is perhaps better described as an acute stress reaction. Your brain doesn't want to deal with the thoughts, so it decides to go bye-bye for a while. My riff on this is that it is an evolved survival trait — after all, possums don't play dead, they faint in fear, and so they survive (or at least they aren't awake when the cause of death is suffocation complicated by digestion). We do something similar, if fight/flight doesn't work, its time to faint. If the big bad nasty thought of us as a threat, we aren't a threat any longer. If we were dinner, we're still dinner, though.
If we're bleeding, and we drop our blood pressure to nothing, we're less likely to bleed to death, clotting happens easier, and we aren't pushing as much of the red stuff onto the ground before that clotting happens. Like yawning, it can be contagious. When I volunteered at blood drives, we would have the high-school students sit on mats on the floor — it's hard to fall off of the floor. If more than one student got dizzy and fell over, they'd all get dizzy and fall over.
Me, I get weird watching training videos on occasion, I seem to put myself in the victim's shoes. I'd much rather be the rescuer.

#107 ::: xeger ::: (view all by) ::: September 15, 2007, 10:28 PM:

#106 ::: John Houghton wrote:
Me, I get weird watching training videos on occasion, I seem to put myself in the victim's shoes. I'd much rather be the rescuer.

Hm. I'm not usually bothered by anything other than vomit - but that's enough to be an issue in a variety of situations.

#108 ::: James D. Macdonald ::: (view all by) ::: September 15, 2007, 10:50 PM:

People who are grossed out by this post should definitely avoid "Squishy Bits" (when I get around to writing it). Soft-tissue injuries are the ones that clear everyone out of the cafeteria when we talk shop over lunch.

I think I'll put most of that one below a cut-line.

#109 ::: James D. Macdonald ::: (view all by) ::: September 16, 2007, 12:17 AM:

Video of putting an arm in a sling.

#20. Very good. Don't move the patient, make the scene safe, treat for shock. Note how training clicks in when you need it.

#26. A surprising (or maybe not so surprising) number of people with neck injuries will try to answer questions by nodding or shaking their heads 'yes' or 'no.'

#27. Say, John, where do you run? (Puking patients either puke on the most expensive piece of gear you have, or on the thing or place that's the most difficult to clean.)

#30. Another common injury with a fall on an outstretched hand is a radius/ulna fracture. Y'see, when the hand is rotated down, the radius and ulna cross one another, providing a fulcrum for them to snap each other.

#31. Ouch. Among the fun things you can see with fractured orbits is one of the muscles that move the eye getting stuck in a crack. You can tell this has happened because the eye no longer tracks along in tandem with the other one.

#37. The correct first aid for a fractured humerus is sling-and-swathe. That immobilizes the elbow and shoulder (joint-above-and-below), and splints the humerus itself against the rib cage.

You can buddy-splint lots of bones: arm against rib cage; one leg to the other leg, one toe or finger to one of the adjacent toes or fingers. Use tape or triangular bandages. (When you're tying things around the chest, though, be careful not to compromise breathing. Chests have to have enough room to expand.)

#44. I can clear a conscious guy's c-spine in the field. An unconscious guy will get a backboard every time. I'd guess that guy #2 was wearing a helmet while guy #1 wasn't.

Just remember that helmets won't protect your neck (I had a guy wearing a helmet who'd broken both C-1 and C-2). The typical injuries you see in bike accidents are: head injury, upper extremity injury, and abdominal injury. Expect all three.

#50. So, abi, was the event before or after reading this post?

#54. Yeah, if I were going to take bets, my bet would be on a fracture.

#88. Sling-and-swathe is the field intervention for a dislocated shoulder, too. You may need to place a pillow between the arm and the chest, to keep it in a position of comfort. Cold packs help.

#110 ::: Marilee ::: (view all by) ::: September 16, 2007, 01:08 AM:

Bruce Cohen, #91, I have no level of narcotics that doesn't send me to Cloud-Cuckoo Land. That's why I usually try to deal with pain other ways. If I take a narcotic, I lose an entire day.

xeger, #95, I won't go into the whole story, but I'd made friends with an abused cat that animal control couldn't catch and called animal control to tell them I could put him in a carrier. Well, I put the carrier inside the door, went out, picked him up (he was very happy) and then he saw the carrier. I still have the scars, but the big problem was that I was on Plavix at the time so I bled like crazy. I had to keep reassuring the animal control officer that I didn't need the hospital and I still wanted to take the cat in, after his putative owners had been deprived of him.

JESR, #100, I dunno, one of my scars is a foot long, that's hard to beat. It's a surgical scar, though, goes right up my left leg from the ankle.

#111 ::: Carrie S. ::: (view all by) ::: September 16, 2007, 01:23 AM:

I plopped myself on a seat at the front of the bus and the driver actually said "Are you O.K.?"

I had a guy ask me that while I was lying in the street, having clearly just fallen off my bike after a collision with a car. I recall answering, "No, but thank you for asking," but I wouldn't vouch for a pleasant tone of voice when I said it.

This was after landing on my side, rolling onto my back and immediately thinking that, gee, maybe that wasn't the smartest thing I'd ever done. I got a supremely uncomfortable ride to the ER out of that deal, because of course the EMTs had to put me on a backboard; backboards haven't much in the way of lumbar support, which is where all my serious injuries were.

But as far as I know I've never broken a bone.

#112 ::: abi ::: (view all by) ::: September 16, 2007, 04:52 AM:

Jim @109:

So, abi, was the event before or after reading this post?

Before, but only just. She broke it on August 23. The cast came off on September 12*. The healing powers of a 3 year old are astonishing.

Somehow, when I grew up, I got the impression icing injuries was something Other Families did, not ours. That is probably because most of our interesting injuries (eg the machete incident) occurred in an area with no electricity, and therefore no refrigeration.

If there is one thing this post has done**, it is to teach me to add icing things to my list of things to do when people are injured.

-----
* about 10 hours before you posted this, to be precise
** apart from giving me a very vivid and interesting image for putting a leg under traction.

#113 ::: Edward Oleander ::: (view all by) ::: September 16, 2007, 06:32 AM:

Jim, have you ever covered the when's and how's of moving patients? I imagine you did in one of your posts, but I'm still new enough here that I missed the first couple.

I've responded to enough scenes where it's been done unnecessarily and improperly (even by cops who were supposed to be First Responders) that it might just deserve a refresher on this thread, or at least a reminder of which of your other posts deals with it... Thanks, Ed

#114 ::: Melissa Mead ::: (view all by) ::: September 16, 2007, 07:34 AM:

My femoral fractures were intentional.

Bilateral femoral osteotomy, around age 9. Worst pain ever.

(Although I did get a kick out of being able to explain to grownups that I knew what "bilateral femoral osteotomy" meant.)

#115 ::: Juliet E McKenna ::: (view all by) ::: September 16, 2007, 08:33 AM:

apropos various mentions upthread of medical and other people believing patients, or not, about such injuries.

Please listen to what the injured person says, even if they are very small.

In the early autumn of 1967 I was two-and-a-bit years old and play-fighting with my four-and-a-bit brother on the top bunk bed. I fell off and landed on his scooter. My mother came in to find me wailing and my brother trying to hush me. Because, obviously, playing on the top bunk was absolutely forbidden. So we told her I had just tripped. This is my brother's story so far; I recall none of this.

As my mother tells the tale, I kept on wailing and saying my leg hurt. We lived in a rural village and had no second car, my father was at work in the next town, driving himself obviously. Apparently I was a generally even-tempered child so seeing no let up in the grizzling, my 23-year old mother put me in the buggy and we all walked to the doctor's surgery.

Where the fifty-something doctor was unimpressed by the modest amount of bruising.

Of course these days, I have had no end of medics who've tried to take blood from me explain how I have very thick, strong skin and deep veins. I rarely bruise visibly. Even when I had sinus surgery that the doctor warned would leave me looking like a domestic abuse victim, I only ended up with heavily shadowed eyes that could have been the result of a few injudiciously late nights.

Anyway, the doctor asked me to walk across the room. According to my mother I said no. He asked again. I said no, won't, my leg hurts. Annoyed he told my mother to take me home as 'children this age get very neurotic. Don't encourage her. There's nothing wrong.'

1967 remember. And my mum was only 23 and not really inclined to argue with an authority figure like a doctor. When as far as she knew, I had just tripped over a scooter.

I was still grizzling when my 27 year old father got home from work. He got us all in the car and took us to the local hospital in the nearby town. Where X-rays showed I'd broken my shin bone clean through in two places.

They set the bone by manipulating the loose bit. This is where I can take up the tale because it's my first specific memory. It hurt like - words I didn't learn till I was a lot older.

And then the leg was plastered from hip to toe. And this bit I remember really clearly because the doctor had a full, black, bushy beard. And I had never, ever seen one before. So he deserves every credit for putting a cast on a toddler who spent the entire time weaving her fingers into his beard and tugging experimentally. Quite hard.

Anyway, I was too small for crutches but I needed to be kept mobile. So my Dad loaded my doll's pram with house bricks so I could lean on it and I had to do laps of the sitting room every day. Again, very vivid memories.

And the cast came off three months later and all was well.

Mind you, my general instinct not to treat doctors as infallible-second-only-to-God probably stems from that experience. Especially the ones who are arrogant and patronising and refuse to explain stuff because 'you wouldn't understand.'

Happily, through assorted complex medical goings-on, I could count the ones I've met like that on the fingers of one hand with a few fingers to spare.

Oh and my brother and I finally 'fessed up to my mum about how exactly I'd broken my leg over one Christmas dinner when I was fourteen.

#116 ::: James D. Macdonald ::: (view all by) ::: September 16, 2007, 09:13 AM:

#113: Nope. So far I haven't covered moving patients because, in general, you shouldn't.

There are three times cases when you move patients:

1) When it is necessary to do so in order to deal with life-threats. (In order to open the airway, for example.)

2) When the scene is life threatening (e.g. fire, flooding).

3) When it is necessary to do so in order to reach other critically-injured patients.

Other than that, leave them where they lie until the pros arrive.

If you absolutely must move a trauma patient, do so maintaining c-spine, and move them in the direction of their spine (drag 'em lengthwise rather than sideways).

I expect I'll go into more detail in the Trauma Wrap-up. (I see this series going to four more posts: Soft-Tissue Injury, Mechanism of Injury and Special Cases, Complete Patient Assessment, and the Final Exam.

There's an index to all the medical posts here.

#117 ::: James D. Macdonald ::: (view all by) ::: September 16, 2007, 10:39 AM:

Oh, this video (Teresa, don't look) shows a Fall On Out-Stretched Hand. That looks a lot like a Colles' ("silver fork") Fracture. Please note the patient going into shock.

(Warning: Bad language. Not safe for work.)
(Warning II: No blood, but it's an obvious deformity and we get a good look at the injury site.)

So, guys, everyone knows what they'd do if they saw this accident?

#118 ::: Mary Aileen ::: (view all by) ::: September 16, 2007, 01:59 PM:

What I *would* do? Scream and/or faint. What I *should* do? Call 911.

(I didn't watch the video either; I'm squeamish.)

#119 ::: Serge ::: (view all by) ::: September 16, 2007, 02:02 PM:

Your son doing better, Abi?

#120 ::: Scott D-S ::: (view all by) ::: September 16, 2007, 02:21 PM:

What I hope I would do is to 1) call 911; 2) try to get the person's legs up with something/someone; 3) try to stabilize/splint the arm; 4) see if I can get the arm above the person's head; 5) try to keep them calm and wait for the cavalry (or the marines, I'm not picky) to arrive - and get the buddies/camera crew to help out...

After help arrives, THEN I can throw up.

I've never had to deal with a broken bone - just my wife seriously cutting her thumb/hand with a very sharp knife because she tried to slice a frozen bagel. I did really well, I was told after we go to the ER. I thanked the nurse, then had a panic attack. [ With no shame whatsoever, thank you very much ]

#121 ::: abi ::: (view all by) ::: September 16, 2007, 02:55 PM:

Serge @119:
Your son doing better, Abi?

Physically, yes, much better. He came into our room on Saturday morning* to announce this fact.

He was frail yesterday, but back to full strength today. Unfortunately, this gave him the energy for a full-on biting, clawing and slapping attack on us for the heinous crime of trying to get socks and shoes on him.

My reaction will no doubt be a source of income for some future psychiatrist**. We're all struggling with the international move, basically.

But at least he's not throwing up.
-----
* Early morning, sigh.

** I reckon it'll be worth at least a few ells of rope and couple of those big old metal cleats on a sailboat. Maybe an anchor.

#122 ::: Mary Aileen ::: (view all by) ::: September 16, 2007, 03:37 PM:

The Google Ads next to this post include this one from Ask.com: "Get Broken Foot Bones." Um, no thanks.

#123 ::: Edward Oleander ::: (view all by) ::: September 16, 2007, 06:47 PM:

#116 Jim, thanks for the link! Think I'll put them all in a 3-ring...

Moving patients (and why they shouldn't have) is a discussion I've had often with well-meaning bystanders, cops, and the patients themselves. Even my fellow nurses (who for the most part never had any real 1st-Aid training) tend to get this one wrong... I look forward to the rest of the series...

#124 ::: Serge ::: (view all by) ::: September 16, 2007, 07:00 PM:

abi @ 121... Glad to hear it. That your son is doing better, not that you're paying for the anchor of a shrink's yacht. (I hope his name isn't Kayam and that his boat isn't made of rubies - and, yes, I stole that joke from Rocky & Bullwinkle.)

#125 ::: Suzanne F. ::: (view all by) ::: September 16, 2007, 07:04 PM:

Ledasmom @81: I also have a sledding injury story.

This winter, when I hit a particular jump on the sledding hill, the sled and I parted company, I flew several feet through the air and crash-landed directly on my tochas, breaking my tailbone. There's nothing particular to do about a broken tailbone except complain, but I did get a consolation prize. There were a number of small boys out sledding that day, and when I did my spectacular airshow, one turned to the others and asked, in awe, "Is that your mom?"

I also broke both humeruses (is that the right plural?), at ages 9 and 10, in bicycling and gymnastics accidents, respectively.

#126 ::: Serge ::: (view all by) ::: September 16, 2007, 07:10 PM:

Years ago, my wife was working at a deli, and sliced off the very tip of a finger. It didn't get to the bone, thankfully, but the flesh bit was never found. Yes, feel free to make Titus Andronicus and Soylent Green jokes.

#127 ::: Craig R. ::: (view all by) ::: September 17, 2007, 03:10 AM:

Oh my, at least I'm in very eminent company here -- and I'm gratified that my breaks are certainly less spectacular than many of those chronicled.

(a) During a mis-spent youth discovering The True Joy Of Late-Night Discussions In Bars I have broken my nose several times. The only lasting damage is occasional sinus problems (including the ability to call geese when trying to clear the sinuses) and some odd bumps (I can also testify that a steel-rimmed bar stool *is* stronger than the normal human tooth)

(b) I have taken a number of hard falls onto my knees that have left me with the "disappearing knee" described above. It may also have contributed to a torn meniscus (the MRI shows the tear to be on the front exterior of the tissue, so no surgery is required as yet)

(c) my first *admitted* break was when I was a passenger during a car wreck when my leg was wedged between the floor and the glove box, and wound up with a transverse fracture clean across just below the malleoli (?) (the little bumps on either side of the ankle itself), resulting in a closed reduction and a succession of non-weight bearing casts for about 6 months. I got fairly adept as using crutches during that time. (I discovered that I was very happy that the glove box in an old Honda Civic was made from plastic rather than metal -- otherwise my kneecap would have given way rather than the glove box. As it was, when I was going to try to get out of the car, I happened to look down before I put weight on my foot, and noticed that the foot was going in a *very* different direction than the leg)

(d) A second break of the same ankle by a bit of sloppy walking that had me "turn" the ankle and have a minor injury there.

(e) While digging a trench for a Belgian fence I slipped from the edge of said trench on one foot, resulting in pulling the tendon on the *other* ankle, such that the tendon peeled a chip off one of the ankle bones.

(f) several broken toes -- where I have discovered that the only thing you can do is to tape it to its neighbor and endure the sly remarks from spouse and other sundry acquaintances.

(g) on another occasion I took a fall on one outstretched hand -- apparently "head-on," so the force was transmitted directly along the axis of the arm bones,resulting in making the ulna Have More Pieces Than It Should -- I don't think would be classed as silver fork -- the ortho guy at Mass General says he usually saw that kind of break as a sports injury -- from blocking with the out-stretched arm in football. That resulted in a permanent titanium brace that is holding everything steady -- and I'm glad its titanium else the above mentioned MRI would have been very interesting to experience or would have been forgone for exploratory surgery) -- you know it's not something simple when the x-ray tech sees you and says "ouch."

(h) after reading all these descriptions, it dawns upon my marble pate that I may actually have a schapoid fracture, rather than just arthritis. When I'm working again and have insurance I'll see....

But I have a truly marvelous weather forecasting system now.

"Oh, what a piece of work is man..."

#128 ::: James D. Macdonald ::: (view all by) ::: September 17, 2007, 08:37 AM:

#118: "Call 9-1-1" is the right answer. If you do nothing else, do that. (Lots of people can call 9-1-1. The bigger the event, the more people calling in, the better.) Screaming, fainting, having panic attacks, is perfectly okay ... later.

#120: In step 4, there, I'd try for above the patient's heart, rather than over his head. Otherwise a great answer. You have resources there, in the form of that lad's three mates. One of them could certainly have elevated his legs. They've done pretty well, too, in that later on we hear one of them say "just waiting for the ambulance now," and as they discuss the best way get him out (complicated by being in an open field bordered with a wire fence topped by barbed wire). A field-expedient splint, sling, and swathe would have been good, but just laying the arm on the ground appears to be working fine.

Bagel-related injuries are common enough that they have their own code when you're documenting them. People hold the bagels in one hand and cut down toward themselves. You can see where that's going. Better to get a bagel slicer.

#123: Nurses, in general, are no better than other random bystanders on trauma scenes in the street. They have whole other skill sets and different training. A good first-aid course is a good idea for everyone. You never know when you will be first-on-scene.

#125: Sledding injuries. I could tell you stories.... I recall one family from way down south (Louisiana or somewhere) who decided they were going to have an Old Fashioned Christmas. Therefore, over Christmas vacation, they and the kids jumped in the car and started driving north. Somewhere along the way they stopped and bought a tobaggon and strapped it to the roof of the car. That was a winter with practically no snow; they were in northern New Hampshire before they found some. So, they found a promising-looking hill, everyone jumped out of the car, got on the tobaggon, and off they went!

Then someone noticed there were trees at the bottom of that hill. So Mom stuck out her leg to stop the sled. Which is how she wound up in our Emergency Room on Christmas Eve with a broken leg....

Seriously, you can do worse damage than just a broken tail-bone (which usually has four bones in it, but can have three or even just two) from a sled-jump. We see that all the time with snowmobilers. They go over a jump and land hard on their seats. The force of the impact gives them a compression fracture in the lumbar spine, the thoracic spine, or even the cervical spine. (Anywhere the spine bends, the force goes non-linear and can give you a nice break.)

(Note: the spinal cord itself ends at the bottom of the rib cage (somewhere between T-12 and L-3) in what's called the cauda equina (the horse's ass tail) as it turns into a bunch of separate nerve fibers going their separate ways. The L-spine is mostly just there for support; you won't get paralyzed by breaking it.)

(The plural of humerus is humeri, but if you said humeruses everyone would understand you; that's English following a language down a dark alley again....)

#126: A deli meat-slicer adding a fingertip to the rare beef is pretty common.

#127: Ah, for a misspent youth! I used to hang around in waterfront bars, with my back to the wall, minding my own business, drinking whiskey and observing the degradation of my fellow men. (I didn't get involved in the fights. I did carry a knife (Buck Folding Hunter) and only had to use it twice while explaining that I wanted to leave without any trouble.)

The lateral malleolus is the distal end of the fibula (that's the bone on the dorsal side of the lower leg -- the distal end of the tibia (the shinbone) forms the medial malleolus). Interestingly enough, the fibula does not articulate with the knee. The plural is indeed malleoli.

Having a tendon peel a chip off a bone is called an "avulsion fracture," (not noted by name in the main post, though it is listed in a linked reference -- there are lots of kinds of fractures). They're treated exactly the same in the field as any other facture/strain/sprain/dislocation: RICE and splinting.

With musculoskeletal injuries you can have both direct injuries (where the part that smacks the ground gets hurt) and indirect injuries (where the injury happens elsewhere in the body as force is transmitted along the bones until it finds a weak place or a place where the force has to change direction. The energy has to go somewhere, and going into breaking bone is one of the places it can go.

Injuries, even if they aren't fractures, to the joints in one's youth can return as earlier-onset or more-severe arthritis as one gets older.

#129 ::: Serge ::: (view all by) ::: September 17, 2007, 09:00 AM:

James... A deli meat-slicer adding a fingertip to the rare beef is pretty common

That somehow isn't reassuring.

#130 ::: Ledasmom ::: (view all by) ::: September 17, 2007, 09:02 AM:

125: I must point out that what I flipped over, and fell off of, on the sledding hill was a giant inflated tube of the sort that generally makes the iciest hill feel like a toddler slide. It might not have been my most brilliant idea ever to try to go over the jump with it.
The hip hardly ever hurts any more, though.
I think I probably cracked my tailbone a couple of times as a youngster (landed on my butt from a couple feet up on concrete; I'm not sure exactly what I was doing). My parents did not consider this sufficient reason to get out of doing anything, and neither did the P.E. teacher at school. Never play tennis with a painful tailbone.

#131 ::: Bruce Cohen (SpeakerToManagers) ::: (view all by) ::: September 17, 2007, 09:56 AM:

Scott D-S @ 120

Absolutely no shame for that. All that matters is what happens before your part is done; after that, have a cow, man. There really are times when having a lifelong habit of really intense focus in compensation for ADD is useful; though most of the time it's a real pain. I was especially grateful for it when the kids were young and accident prone; the older one had a hyper-sensitive allergy to bee-stings; not quite life-threatening, but very scarey indeed to see him go white and fall over. That's when autopilot is a very nice thing to have, but you have to figured out exactly what to do beforehand for that to work, and it helps to have done it before. But once we got him to the doctor and had breathing assistance available if necessary, I could just start shaking and hanging on to something strong, usually my wife.

#132 ::: Bruce Cohen (SpeakerToManagers) ::: (view all by) ::: September 17, 2007, 10:46 AM:

Jim Macdonald @ 128

I'm dubious of those wooden bagel holders. I've had 2 or 3, and each one has contributed fiber to my diet in the form of shavings taken off by the knife when I angle the cut accidentally. And the cuts can guide the knife wrong on subseqent use. Shaving can happen even if you're completely awake and working carefully because bagels, especially cheap, unboiled ones, can be internally non-homogeneous enough that a denser portion or an air bubble can deflect the blade. The holders made of lucite are better; they don't let you shave off pieces, though they get brittle with age (shaving costs by not using enough plasticizer?) and crack easily after awhile.

Eva discovered and bought me something called The Bage Biter a sort of manually-operated guillotine for bagels. Very nice design; it's easy to use and quite safe. Also dishwasher safe. ML-friendly, too; goes well with knitting.

#133 ::: Jakob ::: (view all by) ::: September 17, 2007, 10:51 AM:

I've only ever fractured an elbow when I was but a wee lad. Oh, and driven a needle into my kneecap (running around in a room where my mother had curtains pinned out on the floor.)

The first aid at work course I did (a basic four-day course making me a designated first-aider in my workplace) emphasised heavily that the nice ambulance staff really don't mind if they get called out to an accident and it's not as bad as it was feared.

Are people (or their insurance) charged for ambulance callouts in the US? The reluctance to seek timely medical attention described in some of the posts above makes me wonder.

#134 ::: P J Evans ::: (view all by) ::: September 17, 2007, 11:03 AM:

When I'm slicing a bagel with my way-sharp breadknife (yes, I've occasionally gotten myself), I hold it so the knife is between my thumb and fingers - that is, my hand is above the knife, and I'm slicing away from it. It works.

I'm wondering what the odds of getting extra protein in stuff are, with the Microplane graters I just got (two ribbon and two regular graters, with safety covers for storage).

#135 ::: Bruce Cohen (SpeakerToManagers) ::: (view all by) ::: September 17, 2007, 11:10 AM:

James D. Macdonald @ 128

The L-spine is mostly just there for support; you won't get paralyzed by breaking it.

True, you won't end up a paraplegic, but injury there can still cause nerve damage. I had a rupture of the disk between L4 and L5 that left me with about 30% function in my right leg and 75% in my left. Six years post-surgery my left leg is about 95% and my right somewhat over 50%, but I still have to be careful of foot drop and ankle weakness on the right causing trips and falls, and I still don't know if I'll ever be able to run again.

#136 ::: Emily Cartier ::: (view all by) ::: September 17, 2007, 11:17 AM:

Just remember that helmets won't protect your neck (I had a guy wearing a helmet who'd broken both C-1 and C-2). The typical injuries you see in bike accidents are: head injury, upper extremity injury, and abdominal injury. Expect all three.

Oddly, while I'm clumsy as heck on a bike, all my injuries have been legs. Typical for me is a Very Large Deep Bruise somewhere along the femur. In one case, I got run off the road at a point where the pavement did a 6" drop. That left a very obvious impression of my top tube on my inner thigh for a couple weeks. In another case, I did a slow motion topple during a low speed turn. Deep bruise on the outside of my leg, just above the knee. This leads me to expect a femur fracture as my most likely severe bike injury.

This may be because I've never had a collision on a bike. Most common collisions are getting cut off by a turning car, dooring by a parked car, and head on (with car, bike or pedestrian). Nor have I done an end over end (prime situation for neck fractures). I'll keep trying to avoid collisions, since I do enough of a number on myself.

#137 ::: Mary Aileen ::: (view all by) ::: September 17, 2007, 11:18 AM:

Jakob (133): Yes, people are charged for ambulance rides in the US--at least some of the time in some jurisdictions. I daresay it varies rather widely.

Jim Macdonald (128): Call 911 first, *then* faint. Got it.

#138 ::: Carrie S. ::: (view all by) ::: September 17, 2007, 11:40 AM:

Most common collisions are getting cut off by a turning car, dooring by a parked car, and head on (with car, bike or pedestrian).

In my case, "cut off by a car coming out of a Stop sign". I tried to turn enough to avoid hitting it, or at least match vectors and minimize impact. And mostly succeeded, in that the worst I got was a sprained back.

#139 ::: Ledasmom ::: (view all by) ::: September 17, 2007, 12:47 PM:

#134: Pretty good, going by my experience with microplane graters. Blood is less obvious in orange cheese.
The worst thing with bagels is trying to slice one that you didn't realize was still partially frozen. I have had only one kitchen accident that I got stitches for (little finger, left hand, slicing apples, nice small scar), but the nastiest cut I've ever had in the kitchen was from a cat-food can with the sort of lid that does not require a can opener. The lid stuck about two-thirds of the way off, as that sort tends to do, and viciously attacked my finger when it did come off. The scar from that one is about one inch long, diagonally across the base of my little finger.

#140 ::: Leva Cygnet ::: (view all by) ::: September 17, 2007, 12:53 PM:

When I was a teen I was riding a bike on the sidewalk* and a car pulling out of a driveway nailed me. Knocked me over. I had come to a stop at the driveway because I saw the car; he also stopped and looked at me, so I assumed I was safe to go -- so both of us were going very slowly and it shouldn't have been that bad of an injury.

Except the nimwit then backed up. And my bike's pedel was hooked under his bumper, with my legs tangled in said bike. He drug me a good fifty feet backwards before realizing that, gee, the kid and the bike were attached to his car.

Didn't break anything, but I had some very interesting bruises and roadrash. The bruises took months to fade. I swear I felt my leg BEND so I'm astonished nothing broke!

And I got a spiffy new bike out of the deal from his insurance.

*He wasn't cited because I was riding on the sidewalk. There was NO other safe place to ride. I'm now a big advocate for bike lanes, because you'd have had to be suicidal to ride in the road there -- the speed limit was 45 and cars routinely did 20 over that. Including new drivers going to the high school. But anwyay ...

#141 ::: Nicole J. LeBoeuf-Little ::: (view all by) ::: September 17, 2007, 01:22 PM:

Eva discovered and bought me something called The Bage Biter a sort of manually-operated guillotine for bagels. Very nice design; it's easy to use and quite safe. Also dishwasher safe. ML-friendly, too; goes well with knitting.

That last is obviously the most important. When a bagel slicer doesn't get along with your knitting, it simply has to go! (Or at least be kept far away from the yarn. Because reconnective knots in your socks are horrid to walk on.)

--

I've been fortunate in that my experiences with arrogant I-know-everything doctors have been few and low-stakes. Thankfully. A childhood dentist shushing me with "That doesn't hurt!" and a gynecologist telling me "Sure it will, trust me," when I pointed out that 12 total iterations of 28-day pill packages would not last me 356 days. And once, while I was in college, a doctor whom I had to persuade to take a strep culture--it hadn't occurred to her, even though I came in with a burning sore throat and a fever. She took the culture, it came up positive, she put me on antibiotics. Happy ending.

Most of the time growing up, my dad was my doctor, and both he and Mom tended to listen when I said "it hurts." They had a pretty good sense of when and when not to take seriously a precocious, oversensitive, and egotistical youngster. If I said "my feelings are hurt," they might or might not sympathize depending on the circumstances, but if I said "my throat hurts," Dad sent me to retrieve the little flashlighty look-in-your-mouth thingie and the throat swabs from the pocket of his jacket hanging up on the stair railing.

It is possible that knowing that my throat would get swabbed kept me from saying anything unless my throat really hurt. Eww, gag me with a cotton tip!

I vaguely remember Mom turning on the hospital staff with claws extended one early morning; I'd only just gotten into a solid sleep after the 12 hour doze fitfully, wake up, vomit, doze fitfully cycle that tended to follow a chemo treatment. (I understand that's less the case now.) Apparently the hospital's usual schedule was to come in at 4:30, 5 AM, something like that, to take weight and blood pressure readings. Somehow an earache developed and I couldn't get back to sleep after they woke me up for this, but just lay there weeping miserably. Mom cuddled me and sung to me and all those good things until it looked like I'd finally be able to sleep again, and then she took off down the hall like a mother bear after her cub and this never, ever happened again. Not that there aren't valid reasons, I'm sure, for a 5 AM weight and blood-pressure reading schedule, but after that everyone learned the value of sometimes saying, "This kid has had a hellish day; for goodness's sake let her sleep."

Thing about having doctors in the family and a pre-teen hospital-visiting career, you learn things like when someone should gag you with a throat swab, where it's easiest to stick the IV, how slowly to inject the ketamine, & etc. (I'm sure there are people here with much longer-term acquaintances with such things; what I know is small potatoes comparatively.) And the thing about having family that listen when you say "it hurts" and have the medical training and resources to react immediately in-house, is, you learn not to take crap from doctors who don't listen when you say "it hurts."

At least, that's my experience for those values of "you" that in fact mean "me." :-)

I really, really hope I don't have to put that to the test with broken bones and worse. *cross fingers knock on wood*

#142 ::: JESR ::: (view all by) ::: September 17, 2007, 01:34 PM:

Leva Cygnet, my worst-ever bicycle accident was caused by a Great Pyrenees running out of a driveway and knocking me over.

The Gs one picks up from the sudden ninety degree change of direction are memorable. I don't want to think of adding car impact to that.

#143 ::: mayakda ::: (view all by) ::: September 17, 2007, 02:49 PM:

Serge @78
So that's my nom de guerre!
I may have some mutant elbow powers as well, as I am actually able to have my elbows meet when I extend my arms before me, palms together.

#144 ::: Adrian ::: (view all by) ::: September 17, 2007, 03:04 PM:

Juliet (#115), I'm glad you finally got proper treatment for that broken leg. In my experience, a bad break doesn't necessarily mean a person has fallen from much of a height [ie, that a child has fallen from someplace she should not have been playing.] The second time I broke my left arm, I fell from standing on a chair. It wasn't even a regular chair. It was one of those little chairs that went with a child-sized table, and my brother and I were both trying to stand on it at the same time. Ok. I'll grant that we should not have been doing that. But we were less than 18" off the floor. I just fell on my arm exactly wrong.

When my parents took me to the emergency room to have my arm x-rayed and splinted, the doctors were a bit concerned. They saw an 8-year-old with a partly-healed greenstick fracture that had never been treated, turning up 2 weeks later with another break in the same arm, and they worried about child abuse. (I think they were also worried about my supply of scrapes and bruises. Tree climbing had not been going well recently, and I didn't know why. In retrospect, I was probably favoring the injured arm.)

2 weeks earlier, I had been playing on the climber in the backyard with my brother. I fell from the top and hurt my arm. I cried hysterically for a while, because it hurt so much, and the fall was so scary. Then we iced the arm and I calmed down. It really hurt a lot less then, more like a bad bruise than that bright hot flash with the sick bits inside. I had the choice of going to the emergency room, or going to the lake for the picnic that was supposed to happen that day. I chose the picnic. Duh.

Decades later, I broke another bone in a fall of less than 2 feet. I stepped off a porch and my ankle bent the wrong way, the foot folding in. My friends took me to the closest hospital (Lowell General Hospital), where they x-rayed my leg from the top and the inside. I told them I thought the injury was on the outside, but the tech said those 2 images would show everything. They didn't show a break. The ER dr shrugged, called it a sprain and offered me crutches, which I can't use because of my hand. When I saw my GP 3 days later, the ankle was much more swollen, but he still figured out that something was seriously wrong with that ankle by *hand*, and sent me to an orthopedist who x-rayed the appropriate side of the leg, diagnosed an avulsion fracture, and gave me a cast boot. Whew.

#145 ::: Lila ::: (view all by) ::: September 17, 2007, 03:47 PM:

Adrian @ #144, my mom had the opposite of your x-ray experience. She dropped a can of beans or similar on the top of her foot, bruising it severely. After it was x-rayed, she overheard the docs out in the hall going all like "oh, man, the foot is completely crushed!" It took her several attempts to get them to absorb the fact that SHE HAD RICKETS WHEN SHE WAS A CHILD, and the bones in both her feet are deformed. (Neither of these gentlemen had actually seen the foot in question--just the radiographs. And she was right: no fracture, just a bruise.)

#146 ::: Serge ::: (view all by) ::: September 17, 2007, 03:58 PM:

mayakda @ 143... I may have some mutant elbow powers as well, as I am actually able to have my elbows meet when I extend my arms before me, palms together.

So do I. Let's here and now start the JLA - aka the Joints Loose of America. Just call me... Let's see... ElbowGrease. Then again, maybe not.

#147 ::: Tania ::: (view all by) ::: September 17, 2007, 04:00 PM:

I have lots of scars and hours of stories to tell how I acquired them, but I've only had three fractures. Twice on one toe*, and my tailbone from slipping on the ice in 7th(?) grade, and dropping straight down down on my rear.

abi, I'm glad to hear that the kids are doing ok.

*If it had been anyone else, I would have bullied them into getting the toe checked out. For myself, once I realized Mr. Toe was probably broken**, I taped it to the neighbor toe, and wore sandals for awhile.

**Breaks confirmed later on when I had a foot x-ray to check out a bone spur on the top of my foot. "Hey Doc - As long as you're looking at that x-ray, does it look to you like I've broken that toe twice? It has to have been at least once, because the toe used to be straighter."

#148 ::: Lexica ::: (view all by) ::: September 17, 2007, 04:29 PM:

P J Evans @ 134: I'm wondering what the odds of getting extra protein in stuff are, with the Microplane graters I just got (two ribbon and two regular graters, with safety covers for storage).

I've been using Microplanes for several years now without shedding blood once. (For perspective, it's not uncommon for me to greet my husband at the end of the day with "hey, I found a new way to injure myself!") And that's with using the fine one regularly to grate garlic, without using the grater attachment meant to shield one's fingers from the plane. I decided very shortly after buying it that it was more trouble than it's worth, and for the quantities of garlic I'm grating, paying attention as I do it by hand works just fine.

#149 ::: Cynthia Wood ::: (view all by) ::: September 17, 2007, 04:45 PM:

It might be because my dad is a doctor, but the only time I've ever had a problem with a doctor not listening to me when I said something hurt was when it was him.

On New Year's Eve, when I was twelve, I turned my ankle while dancing and fell back onto my left hand. Dad looked it over, diagnosed a sprained wrist and gave me ice and an Ace bandage. The next morning he got up to go birding at about 6am, and I, his night-owl child who never got up before noon if I could help it, was already up and waiting for him. He still didn't think it was broken, but decided to get it x-rayed just to be sure. I had a compression fracture of the pisiform bone, and spent about six weeks in a cast.

That's my only significant fracture (other than the possible cheekbone). I've broken my right little toe three times now, the most recent time being last week, so it's currently taped up. That toe is so trashed.

#150 ::: Linkmeister ::: (view all by) ::: September 17, 2007, 08:06 PM:

I've broken toes twice, ten years apart, but while performing the same activity: playing basketball barefoot.

Sometimes I don't learn from my mistakes.

#151 ::: xeger ::: (view all by) ::: September 17, 2007, 09:57 PM:

#143 ::: mayakda wrote:
I may have some mutant elbow powers as well, as I am actually able to have my elbows meet when I extend my arms before me, palms together.

Er... isn't that normal? Even with the miserable remains of a separated shoulder, that's straightforward*

* I'm going to claim that was an intended pun, dammit!

#152 ::: xeger ::: (view all by) ::: September 17, 2007, 10:01 PM:

One of my more recent discoveries is that hand saws are aptly named. The neighbour was distressed by the sheer amount of bloodstain thus produced - and I'll cheerfully vouch that Japanese style pull saws seem to have a much more aggressive cut than the equivalent-toothed push saw. Fortunately the blood stain I noticed later came right out of the (new, unstained, untreated) flooring with a bit of sanding.

#153 ::: Serge ::: (view all by) ::: September 17, 2007, 10:15 PM:

A few months ago, my wife took a fall down some stairs. She caught herself quickly, but not without slamming her ribcage against the ramp. That discomfort eventually went away, but, a few weeks ago though, she started feeling serious discomfort in her right knee so, tomorrow, it's orthoscopic surgery for her. I offered to do it myself with my 22-year-old Black&Decker electric drill, but she passed.

#154 ::: Marilee ::: (view all by) ::: September 17, 2007, 11:21 PM:

Jakob, #133, it depends on the local government (who own the ambulances). Some charge; some don't.

Nicole, #141, I once contributed to a doctor's firing (I've done that one other time, and once, what a doctor did to me was enough for firing without other instances) because she was not able to calculate prednisone dosages. I was seeing her to try to get off prednisone and she laid out the so-many this long, then so-many this long, etc., and was not able to calculate the total number of pills. I told her the total and she just wrote the number down. I went and told the administrator for the center.

I spent 9 months in the hospital with the first renal failure and 6 months in a different hospital with the second. I'm a night person. I'm barely functional in the morning. They learned that they could just take my BP and such in the afternoon and at night. (I have a long list of problems with nurse culture.)

I think I've broken all of my toes at some point or another. I've learned to walk seven times and broken toes came with each time.

#155 ::: Rikibeth ::: (view all by) ::: September 17, 2007, 11:58 PM:

And I can now add a broken toe to my list. Left pinky. When Enter the Haggis is finishing their set with "Lanigan's Ball," and all the kids who've come out to see the Street Dogs and Flogging Molly have started the mosh pit early, and a young fellow in Liberty spikes and a heavily studded vest with a Rancid backpatch comes down hard on the side of your foot, standard Doc Martens are not enough. Steeltoes highly recommended.

Didn't do a thing about it when it happened. What, and lose a chance to get a barricade spot? Five hours later, downed 800 mg ibuprofen and buddy-taped it.

Spent the next two days limping around on it. Wasn't so bad today.

#156 ::: Lois Fundis ::: (view all by) ::: September 18, 2007, 02:56 AM:

Rikibeth at 155: Didn't do a thing about it when it happened. What, and lose a chance to get a barricade spot?

Been there, done that, sort of.

Now mind, I've broken my right arm four count-'em 4 times, and my left ankle once. Where did I break them? At the supermarket, on the playground at school, on the driveway at home, at church, and at a Springsteen concert.

Oh, wait, you want to know where *on my bod*? My humerus the first three times -- just above the elbow,within an inch or two, all three -- my ankle, and the olecranon, the little bony tip at the end of the elbow. (See the link in Jim's original post.) Again the right elbow. I tell people that if I ever get cancer it will probably be in the right elbow, from all the X-rays.

It's the last one, that Rikibeth's post reminds me of since it happened at a concert. It was intermission (remember when Bruce used to have intermissions, his shows were so long?). My seat was literally up by the roof of the Civic Arena (now Mellon Arena) in Pittsburgh: top row, section F. I *did* actually touch the roof from my seat. I'd always wanted to do that. ("Be careful what you wish for...")

During the, um, break, I decided to go to the ladies' room and the concession stand, but instead found myself going WHUMP! and hitting the tip of my elbow on one of the (concrete) steps. This is where our friend Mr. Olecranon comes in.* He broke right off! I didn't know that yet, though, not until the X-rays. (More on them later.) But I didn't want to leave the Arena because the show wasn't over. I went to the First Aid there and got a sling put on me and then stayed through the second set and the encores.

AFTER the concert, of course, I went to the hospital that was conveniently across the street** and got proper X-rays and a temporary cast, and then called my dad. He and my sister and her boyfriend (now husband) came and got me and drove me and my car (separately) home -- meaning my parents'. The next day I went to the emergency room at the hospital near them and had the elbow looked at by the orthopedist who had taken care of my ankle. He was the one who explained that the olecranon needed to be pinned back on. Surgery. Aaugh! I'd never had actual surgery, with general anesthesia et al. and tried to talk him out of it :-) but he would not be dissuaded.

I still have the scar on my elbow -- and this will have been 23 years ago next week. It looks a bit like a zipper. It aches sometimes when the weather changes; in fact it was doing it just a little while ago. But I no longer get terrible "funny bone" feelings every time I accidentally hit it against something.

*I still think "Olecranon" sounds like a person's name. Maybe Norwegian.

** That hospital no longer exists. In fact, it's where they're going to build the new arena so the Penguins can have a fancy new home like all the other teams in the NHL. Sad -- I have so many memories of the Arena.

#157 ::: Serge ::: (view all by) ::: September 18, 2007, 06:20 AM:

Lois Fundis @ 156... remember when Bruce used to have intermissions, his shows were so long?

Bruce Cohen, or Bruce Springsteen?

(That being said, ouch re your fractures.)

#158 ::: mayakda ::: (view all by) ::: September 18, 2007, 09:32 AM:

Serge @ 146 -- The JLA is hereby ratified.

xeger @ 151 -- without bending your arms? Pretty sure it's not normal, as all my normal friends have assured me. My one kid can do it, but not the other (that one can wiggle ears though).

#159 ::: Pamela ::: (view all by) ::: September 18, 2007, 10:22 AM:

This post is very timely. After the last Trauma post, I moved "take first aid course" from the list of things I really should do to the list of things I'm actually going to do. The class is September 30th. I was starting to get cold feet, and thinking about cancelling. Why am I doing this, again?

Oh, yeah. I remember now. My feet are still cold, but I'm still in. Thanks!

#160 ::: Leva Cygnet ::: (view all by) ::: September 18, 2007, 11:45 AM:

# 158 -- my elbows touch if I hold my arms out straight in front of me, but I'm NOT normal. I also (before getting a bit fluffier) used to be able to hang both ankles behind my neck and walk around on the palms of my hands. I have super flexible joints.

Actually -- I wonder if that degree of joint flexibility is why I'm rarely hurt even in spectacular falls when I really should have been. I've been in some pretty amazing horse wrecks and walked away with only minor injuries, knock on wood. The hand I mentioned above was the worst and that was pure stupidity.

#161 ::: Lois Fundis ::: (view all by) ::: September 18, 2007, 12:27 PM:

Serge @#157: Bruce Cohen, or Bruce Springsteen?

Springsteen.

ouch re your fractures.

Thanks.

#162 ::: Lexica ::: (view all by) ::: September 18, 2007, 01:24 PM:

Huh. I can (just barely) touch my elbows as described. Can't curl my tongue or wiggle my ears, though.

As far as injuries go, as I type this I'm sitting with one foot propped up with an ice pack on it, which is the way I've been spending most of my time for the past five weeks since having had a bookcase dropped on my foot. It could have been worse — any time the doctor says "it's hard to believe, but the Xrays show nothing broken" I figure that counts as coming out ahead.

And it wasn't even my bookcase — I was walking along a reasonably busy sidewalk downtown when it happened. *grumble*

One lesson I'm taking from this experience is that standard-issue crutches are torture devices. If I wind up needing crutches again at some point in the future, I'll pay out of pocket for a decent pair of ergonomically-designed ones if I have to.

#163 ::: joann ::: (view all by) ::: September 18, 2007, 01:58 PM:

Lexica #162:

Thanks for the hint about crutches, $deity forbid I should ever need such.

Your downtown must be different from mine, which does not come equipped with mysteriously falling bookcases right out there on the sidewalk.

#164 ::: Nicole J. LeBoeuf-Little ::: (view all by) ::: September 18, 2007, 02:02 PM:

Marilee @ 154: Good for you. A doctor who can't do simple arithmetic when prescribing dosages strikes me as a danger and a disaster waiting to happen.

In my case, this doc was trying to do the "4 iterations, repeat 3 times" thing. And I sympathize that 13 is not an easy multiple of anything, but the script conventions need to adapt to the need at hand, not vice versa. I kept saying to him, "No, 28 times 12 is less than 365. Trust you? I trust math." Finally he got very huffy, ripped the page off the prescription pad, scribbled a new one (4 iterations repeat 4 times, there, satisfied?), smacked it on the counter and turned and stalked off.

Imagine my joy when I got the prescription filled and the pills were green instead of the usual yellow. He'd Rx'd me the 1 mg instead of the .5 mg version. (Mg, right? It's the ".5" part of the ".5/35" bit.) Not a change I want to foist on my system without a good reason, thanks. The other folks at the women's care center heard an earful, but I don't think he was in any danger of getting fired over it.


Rikibeth @ 155: Toes! Oh boy. You know, I still don't know for sure whether I broke my toe a couple months ago. I went to kneel beside the sofa where my husband was sitting, and we were all sweet for about half a minute with my head on his knee and awwwww cute couple before I realized my left pinky toe was throbbing. I think I must have dragged it wrong on the way from standing to kneeling.

Needed ice on and off for a couple weeks and a bit of ibuprofin and not putting weight on it. (Tried taping it to the next toe over for a day or so. Didn't seem useful. Hurt a lot and appeared to drag it into an unnatural position. Stopped with the tape and felt much better.) After that it was fine except for a couple weeks longer when, if I touched the tip of the toe and applied pressure gently as though to push the toe away from the other toes, it hurt like a sumbitch.

Been fine since, though. About a month later my husband and I were taking a rock-climbing class.


Oh! That's another fun one. I jumped down from the "treadwall" (upright conveyor belt with handholds; your weight makes it descend; you climb it until you're all worn out) and discovered that the mat underneath it wasn't as squishy as I expected. I landed more on my heels than on my toes, and my left foot folded up a bit more than it usually does when I flex it. Felt good and bruised for a couple days, but a bruise was all it was as far as I can tell.

#165 ::: Lila ::: (view all by) ::: September 18, 2007, 02:23 PM:

Lexica @ #162: one common reason for crutches to hurt is that they're fitted incorrectly. When you're standing with your arm at your side and a crutch beside you, the handgrip should be even with your ulnar styloid process (the prominent bump on your wrist on the little-finger side); the armpit part should be about 2 inches BELOW your armpit. Do not rest your weight on the armpit parts. The axillary nerve is easily damaged by compression. Here is a concise guide to using crutches correctly.

#166 ::: Mary Aileen ::: (view all by) ::: September 18, 2007, 02:35 PM:

The title of this post has a space before the comma. Is that new? I hadn't noticed it before today. Now that I have noticed, it's bugging me.

#167 ::: Lexica ::: (view all by) ::: September 18, 2007, 02:43 PM:

Everything I found about using crutches safely stressed the "DO NOT PUT YOUR WEIGHT ON YOUR ARMPITS IF YOU EVER WANT TO USE YOUR ARMS AGAIN" part, which I heeded, so I don't think that was the problem. I think it's just inherent to crutches. I don't have the citations at hand, but one of the things I read said that using crutches takes 75% more energy than walking, and that top speed on crutches is generally about half that of a slow walk.

So far, crutches that seem worth looking into further include the Millenial Crutch and the Hope Crutch, both of which are reportedly much easier to stabilize laterally, so more of one's effort goes into moving forward rather than trying to keep the crutch positioned correctly between one's arm and one's side.

Of course, I'm hoping not to need them again. Or at least not to need them for long enough that there will have been advances made in crutch technology by that point...

#168 ::: Diatryma ::: (view all by) ::: September 18, 2007, 03:16 PM:

Top crutching speed is that slow? Baby Sister, she of the bum knee, used to race on hers. She's the only person I know who can run upstairs on crutches. Not as fast as she could before her various injuries, but still pretty quickly.
Maybe that's why her leg never got much better....

#169 ::: Karin ::: (view all by) ::: September 18, 2007, 04:29 PM:

Serge @53 -- I did the same thing once, the fingertip-in-the-car-door. The main thing I remember is being so paralysed by the pain that I actually forgot how to open the door. The whole nail-regrowth process was kind of memorably foul, but oddly fascinating.

Other than a forehead would which resulted in stitches when I was four, I've had a relatively injury-free life. Even a fall off my scooter didn't do anything other than leave a few interesting scars on my right arm and bruise the living crap out of my right side.

One of my college buddies, though -- he ruptured both Achilles tendons. On completely separate occasions several months apart, but augh. The first one happened when he was rushing to make an entrance backstage and hit a step wrong -- all his bodyweight combined with a bad angle and snap. (He was a big guy, sometime rugby player.) Somehow he made his way through the rest of the performance, but rushed straight to the emergency room afterward. The circumstances of the second injury were less dramatic, but similar insofar as a step was involved.

#170 ::: Serge ::: (view all by) ::: September 18, 2007, 05:32 PM:

Karin @ 169... In my case, I didn't open the door. I just yanked my finger out. I guess I went for the quickest way to resolve the situation. As for the regrowth of nails, that was indeed fascinating. I had another nail fall off this year when I dropped a brick on another finger. That wasn't so painful, but there was a blood clot at the base of the nail that basically killed my nail. When it finally started falling off, I realized that another nail had grown quite a bit already. Kind of like Wolverine's healing factor, but slower, and without those shoulders that TexAnne likes so much.

#171 ::: Linkmeister ::: (view all by) ::: September 18, 2007, 05:37 PM:

As a result of the broken finger mentioned way back at my #1 I still have a double nail. It makes for interesting conversations as long as the second party isn't squeamish.

#172 ::: xeger ::: (view all by) ::: September 18, 2007, 08:28 PM:

#158 ::: mayakda wondered:
xeger @ 151 -- without bending your arms? Pretty sure it's not normal, as all my normal friends have assured me. My one kid can do it, but not the other (that one can wiggle ears though).

Yes... I'd pretty much just figured it was normal... Wiggling the ears, though - that's weird!

#173 ::: mayakda ::: (view all by) ::: September 19, 2007, 08:42 AM:

Serge, xeger, Lexica, Leva ...so many qualified JLA members here! Excellent!
*rubs palms elbows together happily*

@160 hang both ankles behind my neck and walk around on the palms of my hands
I nominate Leva for JLA president.

#174 ::: dcb ::: (view all by) ::: September 19, 2007, 03:42 PM:

Dislocated shoulders HURT!!! Once they are put back they hurt much less.

I normally break-fall pretty well, but I'm no good on skates and at ice rinks I have this morbid fear of someone else's blades going over my fingers and cutting them off, should I fall with my arm out. So my cousin took me ice skating, while I was on a visit to the USA. I fell, tried to fall in a heap, hit first with my left hand just beside my left buttock...

I sat there, holding my left arm with my right hand and NOT MOVING. After a few minutes, the ice rink "manager" (probably all of 19 years old) came over and told me I should get up, because sitting on the ice wasn't good for me. I pointed out reasonably politely that I wasn't sitting there 'cos I wanted to. My cousin changed into sneakers, then lifted me from the hips and pushed me across the ice. Getting into his pickup hurt. Riding in it, in the front seat (no, I couldn't get into the back, thank you), was a lot of no fun. Getting out at the hospital was even less fun - I said "OW" a lot (over socialised). Trying to lie down for the radiography was ... And it was 3.5 HOURS before they put the shoulder back (checking for fractures first).

The pain killers and muscle relaxants they gave me before reducing the dislocated joint were very effective; apparently I spent the next hour repeatedly falling asleep while in the middle of words. The sheer relief of the joint popping back into place was indescribable. Yes, it was still uncomfortable, but only "aspirin or ibuprofen would be good" uncomfortable.

I worked out from the pattern of pain etc. that I'd previously subluxated the same shoulder in judo (driving back from a judo session in a stick-shift right hand drive car when your left arm won't work is an interesting experience, and one I wouldn't recommend).

As for scar comparison: mine may not be largest, but anyone else here have scars from being bitten by a lemur?

#175 ::: Serge ::: (view all by) ::: September 19, 2007, 03:53 PM:

dcb @ 174... I'll bite. I mean, I'll ask... How did you come to be bitten by a lemur?

#176 ::: Lexica ::: (view all by) ::: September 19, 2007, 03:58 PM:

No lemur bites, but my husband learned the hard way that it's a bad idea to get your nose too close when you're going "wuzza wuzza who's an adorable ferret—OW!"

#177 ::: ethan ::: (view all by) ::: September 19, 2007, 04:12 PM:

dcb #174: ...anyone else here have scars from being bitten by a lemur?

Uhh, yeah. Doesn't everyone?

#178 ::: Fade Manley ::: (view all by) ::: September 19, 2007, 04:18 PM:

Got bit by a llama once, but it didn't leave a scar. I feel vaguely left out.

#179 ::: Diatryma ::: (view all by) ::: September 19, 2007, 04:19 PM:

When I was learning to roller skate, my mother told me to keep my hands in fists when I fell so no one would roll over them. I did fall and remember her telling me to get up, but not wanting to because I had to keep my fingers in.

No lemurs for me, but I have a piranha bite on one finger. It bled for hours and if I pulled the bite open a little, we could see teeny-tiny toothmarks.

#180 ::: Madeline F ::: (view all by) ::: September 19, 2007, 04:57 PM:

A Møøse once bit my sister ...

#181 ::: dcb ::: (view all by) ::: September 19, 2007, 05:49 PM:

Serge @ 175

Short answer: one of the male Mayotte lemurs (Eulemur fulvus mayottensis) I was looking after decided he didn't like me.

Actually, looking back, I think first he decided he didn't like me feeding treats to his wives - he wanted all the treats himself. Then he decided he just didn't like me. First time he got me on my upper arm. Result: trip to A&E for three stitches and a tetanus shot. Two days later, despite my taking extra care and watching out for him, he got out of sight then came at the back of my right leg.

I then discovered it's impossible to see the back of your calf and reach it with both hands to Steristrip a cut closed at the same time. Trust me on this. Well, maybe some of the mutants with the bendy arms could do it...

After that we modified the enclosure so he could be shut inside while we fed and cleaned outside, then vice versa.

#182 ::: dcb ::: (view all by) ::: September 19, 2007, 05:56 PM:

Nicole J. LeBoeuf-Little @ 164
Tried taping it to the next toe over for a day or so. Didn't seem useful. Hurt a lot and appeared to drag it into an unnatural position. Stopped with the tape and felt much better.

If you're going to tape it to the next toe, you need to put some cotton wool in between to keep them apart a bit, in a normal position, or yes, you'll drag the toe over and it will hurt.

I'm waiting for my big toes to start giving me weather updates in a few more years: I managed to plant a toe on the judo mats and bend it to 90 degrees or so with all my weight on it, then repeat with the other foot a week later. Took them two years to stop aching in the cold.

#183 ::: Lexica ::: (view all by) ::: September 19, 2007, 06:15 PM:

Gaahhhh! I just got a phone call from my husband, who knows enough to start out by saying "I'm OKAY. The bicycle is not, but I'm OKAY."

He said he doesn't think there's anything broken. I said, "You're going to the doctor and we're going to let them make that assessment."

Hurray for bike helmets. He went end-over-end and landed on his shoulder and head, apparently, but the worst of the impact was taken by the helmet and his messenger bag.

#184 ::: Serge ::: (view all by) ::: September 19, 2007, 07:40 PM:

dcb @ 181... he decided he didn't like me feeding treats to his wives - he wanted all the treats himself.

"That pig! He courted me saying he only had eyes for me. And I believe those big eyes of his."
"Dear girl... He's a lemur, you're a lemur, I'm a lemur... We all have big eyes."

#185 ::: Mary Aileen ::: (view all by) ::: September 19, 2007, 07:46 PM:

Lexica (183): That sounds like the conversation I once had with my mother after waking her up around 12:30 AM. (I was 18.) "Mom? I'm fine, but the car...."

I had blown out both tires on the right-hand side by drifting too far over and hitting the curb. Thank goodness for seatbelts. And for not hitting the telephone pole or the stop sign.

#186 ::: Marilee ::: (view all by) ::: September 19, 2007, 08:56 PM:

dcb, #174, no, but I did once raise my hand up with baby shrews attached by teeth all over it. One of the things my father was right about. Raising baby shrews won't make them like you.

#187 ::: Paula Helm Murray ::: (view all by) ::: September 20, 2007, 12:15 AM:

Marilee, that was how I always checked the chicks of my best budgerigar hen. Stick left hand in nestbox, let her grab it, then I could check the chicks and have Jim help me with anything that needed two hands. She wouldn't let go until I put her back.

Never left a mark or they all healed with no scarring, not sure which. Was long long ago when we still lived in Lawrence.

We named her Godzilla for a reason, but she was mom to many many babies at a time when we really needed the dough.

#188 ::: dcb ::: (view all by) ::: September 20, 2007, 04:10 AM:

Lexica @ 183 - Sympathies for your husband's accident. As you say, good thing he was wearing a helmet. I never cycle without mine. And my husband has made me wear gloves, so if I put my hands out as I fall I won't get them skinned. I really can't understand the people I see cycling wearing a mask to protect their lungs but nothing to protect their brains...

Marilee @ 186 - Yes, that's the thing with hand-raising wild carnivores (okay, shrews are insectivores). Don't expect them to be grateful. In fact, if they end up tame you've failed in your job of making them releasable (as I'm sure you know).

Paula Helm Murray @ 187 - That's how I used to deal with an aggressive hand-reared crane I knew - hold out my left arm (with long sleeve on) and let him grab it, then grab his neck with my left hand, grab his wing with my right hand, and I had him.

I still remember watching some volunteers having problems grabbing rehabilitated penguins from a box so I could blood sample them (to check they were not anaemic before release). Okay, there are three penguins in the box and all have their bills turned towards you and are threatening you. Solution? Accept the fact that you will be bitten (through gloves or sleeves) and grab one anyway: the volunteers (wimpy rugby players!) didn't like the getting bitten part, so I ended up doing most of the catching myself. I had a great collection of scratches and bite marks on my arms for several months, but they faded eventually.

#189 ::: Ledasmom ::: (view all by) ::: September 20, 2007, 04:21 PM:

I was bitten by an owl once, but it was a very small owl and the marks faded very quickly.

#190 ::: Marilee ::: (view all by) ::: September 20, 2007, 06:52 PM:

dcb, I was six at the time and while we certainly planned to release the shrews when they were old enough, I hadn't expected them to bite me so often. We did release them, but I don't know what happened. (My brother and I found a nest with the remains of the mother and we decided to raise and release the babies.)

My brother and I had already established a routine of collecting gecko eggs from coconut palms and incubating them under the lightbulbs at the bottom of our closets (no AC in the housing on Guam, so the lightbulbs kept clothes from mildewing) so we'd have house geckos and no bugs, so the shrews seemed reasonable.

During that billet, I also tamed a feral cat and three tortoises, but we meant to keep them as pets. The geckos were service animals.

We couldn't bring the cat and tortoises back on the ship with us, so we found them homes.

#191 ::: Nicole J. LeBoeuf-Little ::: (view all by) ::: September 20, 2007, 08:14 PM:

dcb @ 182: Oh, great. Now I know. Where were you two months ago, eh? Eh?

Glad to know it was just me doing something wrong, and not me having a too-weird version of the common ailment for common remedies to help.

#192 ::: dcb ::: (view all by) ::: September 21, 2007, 03:55 AM:

Marilee @ 190 - I'm impressed you managed to rear the shrews. I know it's off-topic, but can you remember how, what, and how often you fed them? And I think the idea of hatching your own house geckos was great!

Nicole J. LeBoeuf-Little @ 191 - Apologies, but my precognitive abilities are rather limited, so I couldn't add this to a discussion before you hurt your toe!

#193 ::: Nicole J. LeBoeuf-Little ::: (view all by) ::: September 21, 2007, 02:07 PM:

Nicole J. LeBoeuf-Little @ 191 - Apologies, but my precognitive abilities are rather limited, so I couldn't add this to a discussion before you hurt your toe!

Mine as well, such that I could not read this one here, worse luck!

As my husband likes to say, "Day 749: Still have not manifested superpowers."

#194 ::: Linkmeister ::: (view all by) ::: September 21, 2007, 05:32 PM:

H-h-holy smokes! Marilee (@ #190) you lived on Guam too? Other than specific communities of ex-Guamanians, I've never run into anyone on the Web who had!

I lived on Turner Road, 1969-1970.

#195 ::: Marilee ::: (view all by) ::: September 21, 2007, 10:25 PM:

dcb, we asked the vet on the base and he had powder to mix with milk (meant for kittens, but it worked for the shrews) and it was a good thing there were two of us because they were constantly hungry. We used pipettes (glass back then) and had to wash them, too. When they got a little older we gathered worms from the boondocks and chopped them up. When they were close to ready to go, we gave them the live worms. (My father's officemates caught live flies for him to bring home for the tortoises and we tried letting everybody catch and eat them, but that didn't work.)

Many of our neighbors were horrified that we purposely had house geckos, but we didn't get bugs in the house like they did.

Linkmeister, we were there 1961-63 and I don't remember our addresses. We lived on the Navy base -- the first year in a tiny townhouse, roughly two over two, with Rick and me in the same room (he's 17 months younger than I am). The second year we were in a single-floor duplex with three bedrooms so we each had our own. That one was across the street from the plane tie-down area (where I learned to ride a bike).

I was happiest in Guam of all the places we were stationed. I have really wonderful memories from there. Some of it was the weather and the island; some, I think, was being alone all day instead of harried by nursery or kindergarten staff. I got my first pair of glasses there and could really see stuff! And Typhoon Karen, the worst in recorded history still, was like an adventure, then afterwards, I was a hero for figuring out how to make dew and rain collectors and such (I'm surprised the Navy didn't have directions for those there).

Let's see. I'm six here (Mother made the muumuus and the shirts). And this is me in my Brownie outfit at seven. Here's my eighth birthday, before we came back to CONUS.

#196 ::: Marilee ::: (view all by) ::: September 21, 2007, 10:28 PM:

And I just thought of another reason I was happiest there. Mother didn't get really depressed until a few months after we were back in CONUS and I wasn't the housekeeper then.

#197 ::: James D. Macdonald ::: (view all by) ::: September 21, 2007, 10:54 PM:

Y'know the antibiotic Cipro?

One of its side effects is that it makes rupturing your Achilles Tendon more likely.

#198 ::: Linkmeister ::: (view all by) ::: September 22, 2007, 01:49 AM:

Marilee, I was 17 when the family moved there in the summer of 1968. I left that September to start college, but then came back in 1969 after my freshman year and did the fall semester (including the Vietnam Moratorium) at the U of Guam. Then I went back to U of Az in the spring of 1970.

We were there for the moon landing; I've seen so many clips of that on the tube it feels like I saw it live, but actually there was no television on Guam at that point, so we heard it on (probably) Armed Forces Radio.

Turner Road was officer country up on top of the hill above the Naval Hospital; Dad was the Commander of the Public Works Center, responsible for maintenance of all military housing, base infrastructure, and even the civilian power grid at the time.

#199 ::: Patrick Connors ::: (view all by) ::: September 22, 2007, 10:31 AM:

Jim at #197. Urk! Thanks for the warning. I'm on Cipro through Tuesday, so I will continue to avoid marathons. But I still need to go clean the garage today.

#200 ::: Marilee ::: (view all by) ::: September 22, 2007, 10:21 PM:

Jim, #197, I get Cipro at least once a year; I'll try not to fall when I have it. It's odd how you can find things out. I had Cytoxan with the first renal failure and last year when I saw the dermatologist for something else and asked her about the ridges in my nails, she said they were caused by Cytoxan. I don't care how they look, but there's a big ridge in the right thumbnail that tends to spontaneously split down to the base. The stuff she recommended me to try didn't work.

Linkmeister, #198, there was TV on Guam when we were there -- we got occasional Armed Forces shows on a tiny b&w set. Ah, your dad was lucky not to have to clean up after Karen! My dad was one of the last mustangs four years after we left Guam, but we'd already owned a house by then, so we never lived in officer quarters.

#201 ::: dcb ::: (view all by) ::: September 23, 2007, 06:24 PM:

Marilee, thanks for the details on rearing the shrews. Yes, they are well known for their fast metabolism and voracious appetites. Once again, I'm impressed you managed to rear them.

And I think having house geckos sounds great!

#202 ::: joann ::: (view all by) ::: September 24, 2007, 12:00 PM:

James Macdonald #197:

Does it make it equally likely that you can do in other tendons, or is it just that one?

(BTW: Would you be offended if I abbreviated your name in future?)

#203 ::: James D. Macdonald ::: (view all by) ::: September 24, 2007, 02:33 PM:

I don't know about other tendons -- I do know about that one (and the Achilles is a big tendon that takes a lot of strain on a regular basis). Maybe others are likely too, but normal wear-and-tear on that tendon is strong. (Note: I'm not a doctor. For real medical questions and real medical answers ask a real doctor.)

You can abbreviate my name to Jim or JDM. Or Yog.

-- JDM

#204 ::: ethan ::: (view all by) ::: September 24, 2007, 05:33 PM:

Not Jimmy Mac?

#206 ::: Patrick Nielsen Hayden ::: (view all by) ::: September 24, 2007, 06:33 PM:

Short for Yog Sysop. Nickname inflicted on Jim, years ago, when he took over as manager of the Science Fiction RT on the late lamented GEnie conferencing system.

#207 ::: Epacris ::: (view all by) ::: October 12, 2007, 04:12 AM:

A cheering story of a very lucky young boy, from today's paper.

#209 ::: James D. Macdonald ::: (view all by) ::: August 17, 2009, 06:21 PM:

Yet another Brit Safety Vid (this one from Wales, teaching us about the dangers of Texting Whilst Driving). It has some good examples of folks holding c-spine (though at least one of the providers isn't wearing gloves: bad EMT, no cookie). There's also a nice demo of the Jaws in use. Good view of a starred windshield.

As usual, Miss Teresa, don't look.

#211 ::: xeger ::: (view all by) ::: August 17, 2009, 07:13 PM:

The second bit of the same video isn't gory, but also is likely to upset the sensitive. I do appreciate that they don't take the 'pretty' or 'nice' way out.

#212 ::: Soon Lee ::: (view all by) ::: August 17, 2009, 08:41 PM:

Scrolled up and read Diatryma's comment #168 and for a moment, thought the conversation had drifted to subjects agricultural...

#214 ::: Singing Wren sees SPAM ::: (view all by) ::: March 14, 2011, 12:21 PM:

@215: No payload, but big G brings up a lot of results on that text string.

#215 ::: Benjamin Wolfe ::: (view all by) ::: July 19, 2011, 08:19 PM:

Shall we stick it to spammers, or stone them?

#216 ::: om pawar ::: (view all by) ::: August 24, 2013, 08:12 AM:

my 91 yr old father fell from chair in sleep. got left side of head BLEED 2" above ear. little blood drained out & stopped instantly. swelling on left eye appeared & increased slowly. we applied betadine on the wound & ice pack on swolen part. he is laid on bed, ate corn & milk , had tea, concious, breathing regularly , BP 142/70, PULSE 88... ANY SUGGESTIONS PLZ

#217 ::: Jim Macdonald ::: (view all by) ::: August 24, 2013, 10:42 AM:

#218 ::: om pawar

Suggestions? Yes! Take him to a doctor.

The chance of a brain bleed (elderly patient, obvious head trauma) is certainly present; it's life-threatening if it's there. No one can diagnose a patient over the Internet. Get him to a medical professional.

Welcome to Making Light's comment section. The moderators are Avram Grumer, Teresa & Patrick Nielsen Hayden, and Abi Sutherland. Abi is the moderator most frequently onsite. She's also the kindest. Teresa is the theoretician. Are you feeling lucky?

Comments containing more than seven URLs will be held for approval. If you want to comment on a thread that's been closed, please post to the most recent "Open Thread" discussion.

You can subscribe (via RSS) to this particular comment thread. (If this option is baffling, here's a quick introduction.)

Post a comment.
(Real e-mail addresses and URLs only, please.)

HTML Tags:
<strong>Strong</strong> = Strong
<em>Emphasized</em> = Emphasized
<a href="http://www.url.com">Linked text</a> = Linked text

Spelling reference:
Tolkien. Minuscule. Gandhi. Millennium. Delany. Embarrassment. Publishers Weekly. Occurrence. Asimov. Weird. Connoisseur. Accommodate. Hierarchy. Deity. Etiquette. Pharaoh. Teresa. Its. Macdonald. Nielsen Hayden. It's. Fluorosphere. Barack. More here.















(You must preview before posting.)

Dire legal notice
Making Light copyright 2001, 2002, 2003, 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, 2016, 2017 by Patrick & Teresa Nielsen Hayden. All rights reserved.