Feb 12, 2014

Interview Transcript

Interviewer: Okay, for a second let's pretend Cupid was real and he really shot love arrows. What should you do if you get hit? That's coming up next on The Scope.

Intro: Medical news and research from University Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: We're with Dr. Troy Madsen, emergency medicine at the University of Utah Hospital. Have you ever seen a real arrow injury?

Dr. Troy Madsen: You know, I haven't. I was thinking about that. I've never actually seen anyone who's been shot by an arrow. It seems like one of these things that one of these days it's going to walk in the ER so I better know what to do with it.

Interviewer: Yeah.

Dr. Troy Madsen: So maybe this Valentine's Day, maybe Cupid's arrow . . .

Interviewer: Is going to hit, [inaudible 00:00:36].

Dr. Troy Madsen: Who knows? Yeah, exactly.

Interviewer: So that's interesting to me. Before we get to the arrow thing, you don't ever know what you're going to see in the ER.

Dr. Troy Madsen: No.

Interviewer: So how would you even deal with something you've never seen like that before, like an arrow?

Dr. Troy Madsen: You know, and it's one of those things where you just kind of have to go through your mind and start with the ABCs and that's what it always comes back to. That's kind of the beauty of my job. You keep it simple.

Interviewer: Yeah.

Dr. Troy Madsen: And that works for me.

Interviewer: Okay.

Dr. Troy Madsen: So I always think ABCs. I make sure they're breathing okay. If they were to have something in their neck, I'm making sure their airway's okay. There's not so much swelling it's going to cut off their airway. Make sure they're breathing and then make sure their heart's pumping. And then make sure they're not losing a lot of blood from some sort of injury.

Interviewer: Okay.

Dr. Troy Madsen: If at any point they're not doing that, then I address it.

Interviewer: All right.

Dr. Troy Madsen: So that's kind of where I start.

Interviewer: So if you start there and everything's okay, how do you go about removing that arrow then? Is this something you want to do at home?

Dr. Troy Madsen: It's not.

Interviewer: I wouldn't think so because those things are nasty.

Dr. Troy Madsen: Yeah, they are. So the best kind of analogy for an arrow is a fish hook. I do see a lot of fish hook injuries and the problem with the fish hook is once it gets beyond those barbs--so you've got your arrow, you've got the arrowhead, you've got the barbs on the end of it--once it gets beyond those if you try and pull it just straight back, it's going to cause more damage than when it went in.

Interviewer: Yeah.

Dr. Troy Madsen: So we have to kind of take a systematic approach. Now the one thing I have seen that's like, you know, like getting shot by an arrow is knife wounds. We'll see knife wounds in the chest, sometimes in the neck, in the abdomen. And the one thing we tell patients and the one thing we always remind ourselves is not to pull it out.
The big reason for that is if that knife is sitting next to the heart or partially punctured the heart or a large vessel in the abdomen or in the neck, it may be sitting right there, it may have a little bit of blood pooled around it, it may have clotted, and if you pull it out, it may release all that blood and that patient could bleed out very quickly.

Interviewer: Wow so taking it out, bad move for knives and arrows.

Dr. Troy Madsen: Yeah, exactly.

Interviewer: All right.

Dr. Troy Madsen: For knives and arrows, you know, depending where it is. If you've got an arrow that's kind of sticking in a part of your leg where it's not near a large vessel there, something like that, you know, and it's not beyond the barbs or something where it's going to just tear everything apart when it comes out, it's probably not a big deal. But not a bad idea to come to the ER, make sure everything's okay, it's not affecting any large vessels or any issues like that.

Interviewer: All right, so now what do you do? The arrow, how do you remove it? What do you do in the ER?

Dr. Troy Madsen: Yeah. So my next question is, let's say I see someone that, you know, let's say they have an arrow or a knife in their chest. My next question is where exactly is that sitting and oftentimes I'll get a CT scan, see exactly where it's located. Has it partially punctured the heart or a large vessel? If it has we get our vascular surgeons down there and this patient's going to have to go to the operating room.
Anytime some kind of knife wound or arrow goes beyond just the skin and the tissue and gets inside the abdomen or in the chest cavity, again that's typically someone who's going to have to go to the operating room to get it removed because number one, you know, there's the issue of damage to all sorts of things internally and then number two, there's the infection risk with that. Once you get something in there it needs to be cleaned out very well. That patient's going to have to be on antibiotics for a few days.
So, you know, those things can be a lot more complicated than just kind of pulling the thing out and saying, "Ah, everything's going to be fine." There's a lot more internally that can be a problem.

Interviewer: So how would they get that arrow out though? They can't pull it backwards. Do they do it like in the movies and push it all the way through?

Dr. Troy Madsen: I guess you could. That may not be the best idea.

Interviewer: Yeah.

Dr. Troy Madsen: You know, certainly an arrow with those barbs on the end of the arrowhead you're going to have to cut around just to be able to pull that out so it's not doing a significant amount of damage and pulling things out as you're removing it.

Interviewer: That sounds like almost worse than a bullet. An arrow, maybe.

Dr. Troy Madsen: Yeah. It could be in terms of just . . . I mean a bullet the issue with a bullet is it's obviously so high velocity it can kind of bounce around and cause issues internally.

Interviewer: Okay.

Dr. Troy Madsen: So I guess depending what you're dealing with, if you're just kind of there and you've already had the bullet wound versus an arrow wound and you're dealing with the same wounds, yeah, you're going to cause more issues if you're just pulling the arrow right out.

Interviewer: They all have their problems.

Dr. Troy Madsen: They all have their problems.

Interviewer: Really.

Dr. Troy Madsen: Either one is not a good situation.

Interviewer: All right. So your best advice is?

Dr. Troy Madsen: My best advice is if you are shot by Cupid's arrow this Valentine's Day, come to the ER. We'll make sure we take care of it.

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