by Your ER Doc on January 23, 2009
Q:
What is the difference between using staples to close a cut rather than stitches. Do they have pros and cons?
Greg T. – Atlanta GA
A:
The biggest advantage to staples is that they are very fast. Once a wound has been cleaned and anesthetized, I can staple a typical laceration closed in less than one minute. However, there are several situations where
I prefer sutures. If you have a complex, jagged laceration, sutures can help bring that wound together in a more anatomic way. Sutures tend to leave a smaller scar, with tiny little holes on the sides of a laceration, where staples leave the more typical “railroad tracks.” With sutures, you can get wound edges very close and provide an excellent result. I never use staples on the face.
Every doc I know uses staples on scalp cuts, which are very common. You can put in staples with minimal hair removal which patients appreciate. Sutures are a pain to put in without shaving the area around the cut.
by Your ER Doc on January 22, 2009
When the ER gets busy, we need to rush things a bit to keep the patients moving. Ordinarily, this is not a big deal, but occasionally things can be overlooked. Years ago, a patient came in with a narcotic overdose on just such a busy day. His wife suspected that he was addicted to pain medications and had been trying to keep it a secret. She also thought that he had gotten hold of some 
from a relative. These patches release potent narcotics gradually into the bloodstream. Hmm. He was pretty sleepy when he came in, and his pupils were small, consistent with a narcotic overdose, but he didn’t have any patches on his body. He needed to be admitted because of his poor mental status, so those arrangements were made. Later on, the admitting nurse called down to the ER to report that she had found a fentanyl patch. It had been placed carefully underneath his scrotum, where his wife was unlikely to spot it. Fooled us too.
by Your ER Doc on January 21, 2009
 
Welcome to another installment of the Top 10 Ways to Avoid the ER.
 Number 6 – Opt for comfort care
Okay, now I’m not saying if you’re a 38 year old with foot fungus that you should call hospice. But anyone that works in the ER can tell you that there are many debilitated, elderly people who are way past the point where an ER can help them. Nursing home patients who are demented, chronically ill, and have no quality of life often times are brought repeatedly to the ER for a variety of medical problems, or just a change in their mental status. Usually, their families say that they wan’t “everything done,” but I bet these patients (if they were capable of it) would disagree.
by Your ER Doc on January 20, 2009
Q:
Dear Your ER Doc:
I have seen you write about the dangers of carbon monoxide poisoning before. I recently read an article where victim’s were taken to a hospital that had specialized facilities for treating this condition. Can you explain what these are and if they are common at most hospitals?
A:
Carbon Monoxide poisoning is usually treated by high-flow (100%) oxygen. All hospitals have the capability for administering oxygen to patients who have been exposed to carbon monoxide. Occasionally, severe cases of carbon monoxide poisoning are treated in Hyperbaric chambers.
Patients can be placed in these chambers where they can breath oxygen that is at higher than atmospheric pressure. Most hospitals do not have hyperbaric chambers, but patients may be transferred to a hyperbaric center if necessary.
by Your ER Doc on January 19, 2009
In a new, landmark study in the New England Journal of Medicine, medical doctors in England were determined to have substandard IQ’s.
According to Niles Schmitty, MD, the study’s lead author, “Most British docs are basically as dumb as a box of rocks.” Thanks for the heads up Dr. Schmitty.
