From the monthly archives:

October 2008

Southern California Brush Fire

Southern California Brush Fire

Q:

With the recent wildfires I’ve heard about multiple people with smoke inhalation. Is this a serious problem, and how does smoke actually cause problems?

A:

Firefighters and ER docs absolutely fear smoke inhalation, because it is actually more likely to kill people than burns. And believe it or not, smoke can stop your breathing in three different ways.

First, fire can use use up all the oxygen in an area, essentially leaving the patient with nothing usable to breath. Unconsciousness, and death, will quickly result.

Second, the chemicals that form in a fire can cause damage to the patients lungs and airway, causing swelling, and suffocation. This can happen in a delayed fashion, and that’s one reason we like to observe patients after exposure.

Third, the chemicals in smoke can actually make it difficult for your body to use the oxygen that is able to get into the lungs and blood. Carbon monoxide is the worst of these chemicals, because it is able to “grab onto” hemoglobin which normally carries your oxygen through the blood, and it won’t let go. Add that to the first two causes, and you’ve got a real problem.

Patients who have been exposed to smoke from a fire may complain of cough, shortness of breath, irritation in the throat, and they may even be confused. I would strongly recommend these patients be evaluated in the hospital right away, and should be brought there by ambulance.

I had a patient who was stuck inside a burning house and was brought in to the ER by ambulance just when he was starting to have trouble breathing. His skin was fine, no burns, but his nose and mouth were caked with soot. Inside his mouth and airway you could see the swelling develop, and you could hear noisy airflow called “stridor.” We had to quickly protect his ability to breath by putting in a plastic “endotracheal tube,” and put him on 100% oxygen. He had to be admitted to intensive care, but he had a good recovery.

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Hibiclens Soap

Hibiclens Soap

Q:

About 1 week ago, I developed a red bump on my thigh that became painful, and swollen.  I went to see a doctor at an urgent care and was told it was a “staff” infection.  He put me on “cephalexin” and it has gotten worse.  Any ideas?

A:

I had a patient who told me he thought “staff” infections came from the staff working at the ER.  No!  Staph refers to staphylococcus aureas, which is a bacteria that can infect many areas of the body, but the skin is its favorite.  When it infects the skin, it can cause an abscess.  Unfortunately, because of the widespread use of antibiotics, many staph infections are now resistant to antibiotics including cephalexin.  Most ER doctors are seeing drug resistant staph infections daily.  If an abscess has formed, it may need to be drained to allow the pus to get out.  A culture of the infected fluid can be obtained at that time.  I recommend you get a second opinion about this problem.  If in fact you have a staph infection, appropriate antibiotics that have activity against the staphylococcus bacteria can be prescribed.  Additionally, I often prescribe a powerful skin soap called to decontaminate the skin.  Proper hygiene and hand washing is critical to treating staphylococcus and preventing its spread.

 

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Q:

Dear ER doc, do you think that John McCain’s health should be an issue in this presidential election?

 

John McCain after melanoma procedure

A: First of all, I should mention that I don’t have any access to Senator McCain’s medical records, so that makes it tricky. I believe he is 72 years old, and has had some problems with melanoma. According to a CNN report, the Senator had melanoma 4 separate times, and one of them was locally invasive, but no distant spread. The report is that he is completely free of melanoma at this time. Whether a person with some health issues is fit to be President of the United States really is a philosophical question for American voters. Any person elected to the Presidency could develop health problems later, so I don’t feel it should have too much impact on your vote.

I also should mention that McCain was examined by a team of doctors from the Mayo Clinic and they determined that he was in fact, fit to lead the country, and his health would not limit him.

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                                                                                                           Q:

                                                                                                              Dear ER Doc,

I am 58 years old, and for the last 3 weeks I have had pain in my jaw.  It seems more noticeable when I am stressed, which is often right now, because my husband and I are about to lose our house.  My sister says I should go see the doctor, because it could be my heart.  What do you think?

Jeanine Newport, RI

A:

Dear Jeanine,

Without knowing all the details, I think your sister’s concern is reasonable.  When the heart does not get enough blood flow because of clogged coronary arteries, it can cause pain in different parts of the body, including the chest, back, abdomen, shoulders, arms, and jaw.  I’ve even seen it cause pain in the left ear.  The pain can be different in different people.  Often times, the pain is more severe or noticeable when the body is under stress, or during exertion.  These symptoms are often referred to as “angina.”

So yes, jaw pain can be a symptom of heart disease, but that doesn’t mean that it’s definitely your heart.  It could be a number of other more minor problems as well.  So don’t stress out about this, but do get checked out right away, and let me know what happens.

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Accidents Happen

Accidents Happen

Recently, a man was brought in to the ER to see me, who had been in a car crash and was pretty banged up.  His pickup truck was hit head on by another vehicle.  He repeatedly stated how lucky he was that he was in his 6000 pound truck and that it probably saved his life.  Nevertheless, he had significant injuries, fractures, cuts and abrasions and the truck was completely totalled.  I asked him what kind of car hit him.

 

“It was an old lady in a Subaru,” he said. 

“Wow, what happened to her?” I asked, assuming she had been flown to another hospital.

“Oh she walked away,” he said, clearly perturbed that she was uninjured despite her tree-hugger car.

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