ER or Not: I Slipped and Fell on the IceDec 19, 2013
Scot: Is it bad enough to go to the emergency room, or isn't it? Find out now. This is ER or Not on, The Scope. All right, it is time for another episode of ER or Not, a game where we ask Dr. Troy Madsen of the University of Utah Hospital emergency department physician whether or not we should go to the ER if something happens. Play along at home. Dr. Madsen, I slipped on the ice. A lot of that going on right now.
Dr. Troy Madsen: A lot of it.
Scot: You get the melt and freeze things going on here in Utah. I slipped on the ice and I fell. ER or Not?
Dr. Troy Madsen: So it's really going to depend what happened to you. So there are a lot of different things that can get injured when you slip and fall. There's your head, there's your back, there's your hip, there's your legs, there's your arms. So all of these things. . .
Scot: You forgot about your wrists. . .
Dr. Troy Madsen: And your wrists.
Scot: And your elbows.
Dr. Troy Madsen: And elbows, exactly. So there are lots of different things that can be a problem. So with your head, if you hit your head, and you don't get knocked out, you're probably okay. The exception being, if you are older. If you are older than 65, you need to come to the ER because you are higher risk for bleeding in the brain. Or, if you are on blood thinners. If you're on Warfarin, Clopidogrel, aspirin, these kinds of medications that thin the blood out, you are at higher risk for bleeding and should come to the ER to potentially get a scan of your head.
Scot: So any sort of head contact with the ground, even if you felt it was minor.
Dr. Troy Madsen: Yeah, if you came down and if you're an older person coming down from a standing position, they are at risk for those sort of things, but the average person, if you don't get knocked out, you're probably okay. If you do get knocked out, come to the ER.
Dr. Troy Madsen: The next thing we think about is the back, and that is the big thing we see with these slips and falls. We see a lot of back injuries and a lot of hip injuries, because most people come down and land straight on their buttocks. Come down really hard, they could hit their hip and break it or dislocate it, or they create what's called a compression fracture in the back, where basically you take all this force, you push down on the back and it's usually where we see it is in the low back where all that force is coming right down, and it basically just compresses down that vertebrae. So if you fall down, you hit your back, or just land straight on your buttocks and have back pain, great reason to come to the ER, get an x-ray of either your back or your hip.
Scot: All right. What are some of the other concerns?
Dr. Troy Madsen: So the other concerns are forearms and wrists, like you said. That's a big thing we see too, because people are coming down, they reach out to stop themselves, you've got all that force, all your body weight potentially coming down on your forearm, and so usually if you've got a forearm fracture, you're going to at least have an idea because it hurts.
Dr. Troy Madsen: You may look deformed to you, but if you do come down on your forearm, you're having a lot of tenderness and pain there; again, worth getting an x-ray of that.
Scot: What about, like, elbows?
Dr. Troy Madsen: So elbows potentially, we don't see that so often. I think most people try and get their hand out first. But yeah, if you're having tenderness in your elbow, any bony tenderness and these kind of things is usually a reason to get an x-ray.
Scot: So have we hit all the areas?
Dr. Troy Madsen: Well, you know, potentially you could hit your knee or twist your ankle. Those are things we don't see quite as often. Usually after an injury, if you are able to stand up and walk and put weight on it and you're pushing around on the bones on your knee or your ankle and it is not really that tender, you should be okay.
Scot: Okay. Is there a correct way to fall? First of all, falls are scary.
Dr. Troy Madsen: They are.
Scot: Of all the things we talked about, you went through this laundry list of. . .
Dr. Troy Madsen: Exactly.
Scot: . . .parts of your body that could suffer.
Dr. Troy Madsen: Yeah. You're exactly right. So there are a lot of different things that can suffer. If it were me going down and I tried to think, okay if I'm going to hurt anything, I would want that thing to be my forearm.
Dr. Troy Madsen: I would not want it to be my back because of the potential issues there with the back fracture. I would not want to hit my head, because of the very serious issues there. So if I'm going down I'm going to put an arm out, try and catch myself, if I break my forearm, okay, I'm going to have to wear a cast for four to six weeks. If I break my back, it's often a lot worse.
Scot: So I've often heard that skiers or snowboarders, when you fall, you should try to have the whole forearm hit the ground.
Dr. Troy Madsen: Oh yeah.
Scot: Because that spreads out the. . .
Dr. Troy Madsen: Yeah. If you can do that.
Dr. Troy Madsen: Yeah. And that's a reasonable approach if you can do that or even kind of quickly ease yourself into it where you come down, your forearm or your hand takes the first part of it and then you bring it down at least some of the force, and kind of bring yourself down more on your elbow. I don't know. It's hard to really think through that if you're. . .
Dr. Troy Madsen: . . .if you're slipping.
Dr. Troy Madsen: But if you can at least think through that, whatever you can do to distribute that force a little bit so it's not all on one part.
Announcer: We're you're daily dose of science, conversation, medicine. This is The Scope. University of Utah Health Sciences Radio.