Feb 3, 2017

Interview Transcript

Interviewer: Spleen Injuries, that's coming up next on the Scope.

Announcer: This is "From the Front Lines" with emergency room physician, Dr. Troy Madsen, on The Scope. On The Scope.

Interviewer: Your young athlete was playing soccer or football and took a hit to the midsection in the front. And now the upper left-hand side of the abdominal area is hurting. Could it be a spleen issue? If it is, what should you do about it? Dr. Troy Madsen is an emergency room physician at University of Utah Health Care. So in that scenario, if that happens, what's the first step?

Dr. Madsen: Well, the first step here, you know, it's kind of like this scenario you described, I think the most likely thing you're going to see with this potential injury, spleen injury, is maybe you've got a kid that plays high school football, or you've got a young kid that plays soccer, or whatever. Maybe they're just playing at recess, and your kid comes home and they said they got hit in the belly, and they're hurting in their left upper side of their abdomen. Well, that's right where the spleen is, left upper side of the abdomen.

And the concern there is the spleen is an organ that is very prone to injury, and it can get injured, it can tear the vessels in there can tear. And there's so much blood that runs through that organ that if it tears, and if it starts bleeding out, the person can bleed out really quickly, and it can be a life-threatening injury.

Interviewer: So that's a big deal if you have somebody complaining about. So probably you don't want to think about it too much.

Dr. Madsen: You don't. It's one of those things if you've got a kid who's saying, "I hurt, and this is where it hurts," and it's the left upper side of the abdomen, "And I was hit here." They really need to get into the ER, because I have actually seen cases of people who have died from spleen injuries, people who have had, for whatever reason, car accident, or they were hit there, spleen ruptures and it bleeds out very quickly, and they lose all that blood into their abdomen.

Interviewer: Is it a different kind of pain than just like getting hit in the gut pain?

Dr. Madsen: You know, getting hit in the gut, we've all experienced that. It takes your breath away. I would expect that to get better within maybe 10 to 15 minutes. Spleen injuries, you're going to continue to have pain there.

Interviewer: Okay.

Dr. Madsen: You're going to feel it. And then one of the other things that often people have with spleen injuries is their shoulder hurts too. Kind of interesting. That irritates the bottom part of the lungs there, the diaphragm, and the neck can cause that pain to radiate up to the left shoulder, plus kind of one of the classic textbook thing for spleen injury, something to watch for as well. But, you know, if you come into ER, the first thing I'm going to do is an ultrasound, look at your abdomen, see if I can see blood in the abdomen, and depending what I see there, I may be calling a surgeon to come down and take a look at you. Or we may have to get a CAT scan. But really you need to have something done to look at the spleen, say, "Is this injured and is this something that needs to be repaired surgically?"

Interviewer: Is the pain pretty excruciating?

Dr. Madsen: It can be.

Interviewer: So it could possibly not be.

Dr. Madsen: I mean, I would say it's at least moderate pain. If you've just got some mild surface pain from some bruising on the skin. This is going to be a deeper sort of pain, at least some sort of moderate pain, maybe with some light headedness, maybe with that shoulder pain I mentioned.

Interviewer: Got you.

Dr. Madsen: Some sort of combination there. You don't need to rush in just for maybe some muscle tightness and something that hit the abs and caused some bruising on the muscles there. But it will be a deeper pain, it might go through to the back, it may have some pain going up through to there as well.

Interviewer: Because I think this is one of those situations where, as a parent, you're like, "Wow, I don't want to go to the ER if I don't have to, so." It sounds like that, man, if it's in that, if there's pain in that area, just don't even take a chance.

Dr. Madsen: To me, yeah, it's one of those things that if your kid is coming to you and just saying, "Hey, mom," or dad, or whoever, "my belly is really hurting." That's probably concerning enough. If they say, "My belly is really hurting. I got hit here." It's not like you're just seeing the kid get hit on the field and say, "Oh, do you hurt there?" "Oh, yeah, I kind of hurt." They're coming to you describing this pain. That, to me, is concerning enough. They need to get checked out.

Interviewer: So if you were to have somebody in your family or life call you and say, "Hey, Dr. Madsen, my son was playing soccer, kid collided right into his stomach head on, it's been a couple of hours. Now he's saying the upper left side of his abdominal area hurts." What would you tell them?

Dr. Madsen: I would tell them, "Go to the ER. You need to get it checked out." And it's funny, I find that most family members that call me about the ER want me to tell them, "Don't go to the ER," even when they know they probably should. This is a case where I think you'd probably be thinking, "I probably need to go to the ER." And you're exactly right.

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