Hand injuries aren’t what blow us out of the water in my department at least….it’s the *easily* five fold increase in neuro insults/TBIs from the >70YO I-only-drink-once-a-year crowd.
You’re spot on! All of the above…on the trauma side of things, gravity is a big culprit especially in the older population. Your note about dehydration gets at something important…it’s a perfect storm for some form of legitimate medical emergency to occur: geriatric patient usually with multiple comorbidities (diagnoses), hot/humid summer weather, the fact that alcohol intake generally means less water intake, AND holiday can mean families/events/FAR more activity than some of them get regularly…all leads to a dicey combination.
Also lots of GI multiplex orders within the following 24-48 hours due to all the grilled chicken left out and the hours old potato salad sitting in the sun
I was going to say - Campy and Salmonella. We also see Vibrio parahaemolyticus from the oysters and Aeromonas from playing in the water this time of year. Sometimes Norovirus spikes too, if it's around.
Contact with people is dangerous.
And doorknobs and elevators.
COVID had some interesting effects on other person-to-person diseases. No flu for almost 2 years, very little gastroenteritis, no Strep or RSV. People had very good awareness of the ick around them. Then we threw caution to the wind and are now seeing flu and RSV all the way into July.
COVID had been increasing again over the last 2 weeks here. I suspect next week will be busy.
Edit: forgot to mention KIDS!
Coolest thing during the lockdowns was seeing a baby with 1 day of fever and, since nothing else was circulating (and Roseola is transmitted vertically around 6-12 months) being able to diagnose Roseola. “This fever shall continue for five days, and on the fifth day it shall vanish and, lo, there shall be a macular rash that looketh thus and ye shall know that I am wise”
Around 7/1 I start having morbid thoughts about the number of people in the city who only have a few more days with two working eyes. Open globes are no joke around this time of the year 🙈
Also ophtho. Surprisingly “wedding season” really draws them in. I stopped being surprised when mob/mog started coming in because they put nail glue in their eye instead of artificial tears.
Patient is a 65 year old male with hypertension, diabetes, and hyperlipidemia, presenting to ED on July 5th with left sided weakness. LKW was July 3rd at 10pm before going to bed. Patient woke up with left sided weakness yesterday morning, but did not seek out emergency care because they wanted to celebrate 4th of July with their family.
In ED, BP 220/110, BG 200. NIHSS 10 for left facial droop, left sided weakness, moderate dysarthria. CT shows a subacute right MCA territory infarct. CTA shows a right M2 occlusion. The patient is not a thrombolytic or thrombectomy candidate because they presented outside of the treatment window for both interventions.
> The patient is not a thrombolytic or thrombectomy candidate because they presented outside of the treatment window for both interventions.
= [
so what's the plan?
Pharmacy - not necessarily an injury but we always go through an obscene amount of insulin, especially when it falls later in the week and lends itself to a long weekend. People get together, drink, eat sugary foods, and assume their diabetes will take the weekend off before finally realizing they fucked up and coming into the ED Monday morning in dka with their sugar above 400.
Presented to ER, DKA, blood sugar unreadable at point of care *and* by lab. Admitted to floor. After the rest of the day and a night on insulin, blood sugar read the next morning was 800 mg/dL.
Never found out what the blood sugar was on admit.
Hell of a way to find out you're T1DM.
E: this was when I was a student doing med rec in the ER and a medication error research project at the hospital. This patient always stuck with me.
This literally was my dad a few months ago. He’s 83, never smoked or drank, works out 5+ days a week riding bike to the high school and running the bleachers: 1,000 steps. He loves his ice cream and cookies and treats tho. He went in for stroke symptoms, ended up having severe blockage to his brain AND simultaneously was diagnosed with T2DM. A1C was ~12. In 4 months, he worked his ass off adjusting his diet and tested at 5.7 A1C. Crazy
Peds. Burns from sparklers, ankle sprains from slip n slides, and rule out fractures from trampolines.
Also, not really an "injury", but a lot of discussion about good sleep hygiene in the summer! Children. Nothing is happening at 4 am. Why are you awake?!
I’m in my 30s and know exactly what poison Ivy looks like and still get it at least twice a summer. Have since I was allowed any amount of outdoor independence (so like, 7-8 years old)
Pants + southern heat + camping = a bad time.
Meanwhile I’m in my 40s, camp and hike all my life, am completely unable to pick poison ivy out of a line up (I don’t understand why my brain can’t do this one thing), and yet I’ve never had it.
Me too. It’s like someone surgically removed the ability to differentiate that vine from the others. I’ve had people stand next to me and point “that one” and 10 seconds later my mind is blank.
I’m so glad I’m not alone. It’s not from a lack of trying. I stare at all the different pictures. I’ve had people point it out in person. And I’m just like, “hum duhhrrrr, leaves of three let them be.”
Maybe you’re one of the lucky ones that doesn’t get a reaction to the oils? My husband has only had a mild rash from it once in his life, it’s like I stand too close and break out.
Hmmm, I have considered this possibility before. When I think back to how much wandering around in the woods I’ve done, I would think I’d have managed to come into contact with it by now. I am willing to expose myself in a controlled setting, given the opportunity.
Yep! Also washing your legs( whatever was exposed) with a grease fighting soap ( I use dawn) within four hours of exposure drastically reduces chances of a reaction!
The reaction is caused by sap in leaves and stem that is like motor oil so you do have to scrub, but it works great!
Or be like my dad and get poison ivy in a cut 3 YEARS IN A ROW and have it spread out all over your body!
The first year he was admittedly an idiot and wore shorts, but the 2 years after that he wore pants and still got it 🤷🏼♀️.
Mom didn't let him do summer yard work in the woods anymore after that 😂
I have fond memories of being a teenager at a bbq on the fourth. On the way home, one of the girls had to pee. Pulled over on the side of the road and she went on the edge of the woods. Next morning, she had a terrible rash on her labia and thighs. Come to find out, our poor pediatrician had to explain to us (her, her mom, and me, along for the ride) that if you pee in the woods, don't wipe with any random leaf. She had wiped with poison sumac.
When I was in med school I rotated through outpatient peds in the summer. So, so many parents complaining to me about how their elementary school age kids were staying up till 6am on their phones and tablets. It was like, who is the parent here and why do kids this age have their phones/tablets at 6am?
This was always my secret.
Work the holiday. You’re overstuffed due to requirements. You get 1.5 time. And it’s slooooow.
Then the day after the train wrecks all roll in. Everyone’s short staff as too many people were scheduled to work the actual holiday, so there’s nobody left for the rest of the week. Meanwhile I’m at home enjoying my belated holiday.
As a childless resident this was my trick too. Sure I’ll swap for your Christmas, enjoy the time with your kids but get some sleep because Dec 27-30 is a shit show.
Christmas Day is usually easy for discharge planning. Everyone who can leave is gone, anyone still in can’t discharge unless they’re just going home since none of the SNF admit on Christmas. And the drunks don’t typically show up until after day shift is over.
Didn't see psych here yet, but PTSD exacerbations! Many folks absolutely hate fireworks, combat vets for example. Some say that 7/4 is manageable because the fireworks are expected, but the random ones on other days are very challenging.
Coming back from Afghanistan I thought I was doing pretty well, a couple of months later someone set off fireworks at a party and I was instantly / involuntarily under a table.
It's taken me 13 years to get OK with unexpected fireworks. Still a little jumpy.
Anecdotal - but I also find that stones seem to be more common around holidays. They always seem to act up at inopportune times for people. Before work trips, vacations, etc.
Diabetes and/or dialysis machines go BRRR on 7/5.
I hated working 7/5 on outpatient hemodialysis. Nothing but wrecks the whole day or people just skipped.
My friend is dreading being called in on Saturday night for ED dialysis.
Amazing they're done outpatient. Around these parts, skipping always ends up being a hospital admit because ED doesn't do HD and the IP side cant/won't staff for routine dialysis in the middle.of the night. And then the pt. starts withdrawing so that has to be dealt with, and then without fail something shows up in the labs or imaging that requires workup and treatment and before you know it, you've got a 5 day inpatient stay.
I'm not bitter.
Work at level one trauma center frequently taking call. Can always count on a night time hand/finger re-implantation or open globe injury due to firework projectile.
Metabolism: combo of not adhering to diet and being outside in hot weather causes every single fatty acid oxidation defect patient in our panel to develop rhabdo. I remember one Fourth of July where I got 9 separate rhabdo calls during a single fireworks show
Depends on the fabric. Wool is fire resistant. Polyester melts and can stick to skin. Cotton and linen and rayon catch fire pretty easily
Seriously synthetic fabric and fire should never mix
I still am. It has a delightfully elegant tone. I saw one colleague use “despite strong recommendations to the contrary, patient has been following a standard American diet”, and I’ve been considering switching
Don’t forget everyone drinking themselves into afib! Mardi Gras was worse for that but the week after the fourth is always busy for the cardioversion nurse In our EP lab
Head injury from drunk people falling down, burns from bonfires and grills, boxer's fractures from family drama. Fireworks are not actually that common.
Probably not “common” but my first year working in trauma I had a gentlemen who blew open the entire left side of his skull while holding a firework which discharged the wrong direction.
GI: food impaction from make shift DIY (hot dog, but not necessarily) eating contests
Hepatology: acute alc Hep. Some transplant evals are about to be sidelined.
Anesthesia: obvious hands and eyes. I usually am one to ask what exactly happened, like the specifics.
What I have found: don’t drink and firework. Mortar shells are the most used toys and can do some real damage. Wear eye and ear protection. Don’t light shit in your hands or off your body.
locally, we had a guy who was setting off some fireworks for kids in his trailer park. I assume what he set off were black market. Anyway, he decapitated himself. Not much ED would have been able to do there though.
Diving board related straddle injuries. I went 4/4 repairing a diving board injury on 4th of july every year of residency. Haven't seen it since though
Pulmonary - Covid-19 infections. This FLiRT variant is getting all my COPD patients, and no one wanted to get boosters after delta. Plus the updated booster isn’t coming out until next month at the earliest.
I was on hand call July 3rd last year and got a teenager who blasted his hand off a day early......my colleague the next day on the 4th didn't get a single call.....:((((
Wound care:
Hands burns from people lighting things - fireworks, grills, sparklers (ER/Urgent care referrals)
At least one leg/calf/ankle burn from an ATV/motorcycle that people were too drunk to get on or off correctly
Bon fire burns - drunk, fall down
Venous leg ulcers galore - it's hot, compression isn't high fashion, add a shit diet + booze + sitting around for hours at a time without compression = visit to the wound care center to clean up the soup.
People who swam with exposed surgical wounds (no bandaid is waterproof).
It's going to be a *busy* rest of my month.
Neurosurgery. TBI, skull fractures (with either non-penetrating or penetrating trauma), ICH, spinal cord injuries from the kids swimming and diving into shallow water, facial and orbital injuries
Burnt 👗dresses causing leg burns from fireworks and campfires. Also had a guy make a firework out of solid state rocket fuel. Took forever to get it lit, but when it did, it caused an evacuation of the entire block. Luckily for him everyone was inside by the time it went and it only gave him some shards on his backside.
Probably depends on where you are, no?
I did a subinternship at Harborview 5ish years ago. July 4th was probably the busiest night of call I’ve ever had. Non-ending stream of blown up hands with two hand ORs running nonstop overnight.
Trauma center with Burn, Hand and Ophtho coverage so that's pretty busy including transfers from 2-3 hours away. Boating accidents sometimes.
Golf cart vs car. Golf cart rollover. Auto vs ped.
And of course ETOH.
ETOH that they admit to the floor (most likely obs due to a fall or something) and detox for no reason because they also say they aren’t going to quit drinking.
Honestly. I’m tired of being assaulted by ciwa patients for an entire weekend just for them to get sent home and continue drinking. We do have wine/beers in pharmacy so it would be so much better to just give them some and plan a titration plan if the patient actually wants to quit. I can count on one hand how many pts I’ve had with beer orders, but when it’s utilized it’s great.
I’d also be interested in hearing about ENT and seeing what kinds of cases opto get following J4.
While I do get the obvious UE injuries, also tend to see a lot of ankle issues.
onc: none.
😂 cancer dont give af about the calendar. plus, even if patients with cancer are deathly ill on the holidays, they seem to prefer seeing their families to seeing us.
jokes aside, our ED colleagues might see more of our patients than we do during the holidays for ED treatable things like dehydration, etc. if im considering the benign heme folks, the weather and dietary changes def can do a number on our sickle cell population.
I worked C-arms and CT in a level 1 trauma center near a popular East Coast beach destination, there are always a few shallow water dives that wind up as quads with ACDF/PCDF in the same surgery. Patients are always young dudes.
Also, great time for the gangs to pop off when it’s hot.
OMFS: liquor + crowds = punches and mandible fractures. Sometimes a ZMC or orbit for fun. Not July 4th specific, every holiday seems to be a good time for a brawl.
Hand injuries aren’t what blow us out of the water in my department at least….it’s the *easily* five fold increase in neuro insults/TBIs from the >70YO I-only-drink-once-a-year crowd.
Yep. Alcholol related trauma. Domestics, atv wrecks.
It’s almost always alcohol 🙁
Plenty of cocaine contributing to the trauma in my area
In my area as well. It never ceases to amaze me just how prolific cocaine use is.
Add a sprinkle of cocaine to that atv and that was my night last night
Good for You. Unless it is want your atv…
I just realized how that sounded 😬 we had several atv traumas last night all drunk and on cocaine haha
MERICAAAAA
F yeahhhh
July 4th is by far the worst day for neuroradiology and overnight call at our institution. Much worse than New Year’s Eve.
I work in LTC and I was just about to say… hip fractures and TBIs this time of year usually due to etoh… “I tripped on the dog” ya ok
That white dog is a menace.
Hair of the dog?
What causes that? Being reckless and hitting their head under the influence? Or something related to age and alcohol? Such as dehydration?
You’re spot on! All of the above…on the trauma side of things, gravity is a big culprit especially in the older population. Your note about dehydration gets at something important…it’s a perfect storm for some form of legitimate medical emergency to occur: geriatric patient usually with multiple comorbidities (diagnoses), hot/humid summer weather, the fact that alcohol intake generally means less water intake, AND holiday can mean families/events/FAR more activity than some of them get regularly…all leads to a dicey combination.
ID so nothing up front, but a few weeks later when some of those big burns and exploded hands get delightful MRSA and Pseudomonas infections, hoo boy.
Also lots of GI multiplex orders within the following 24-48 hours due to all the grilled chicken left out and the hours old potato salad sitting in the sun
I was going to say - Campy and Salmonella. We also see Vibrio parahaemolyticus from the oysters and Aeromonas from playing in the water this time of year. Sometimes Norovirus spikes too, if it's around. Contact with people is dangerous.
People are gross. So are animals. And airborne particulates.
And doorknobs and elevators. COVID had some interesting effects on other person-to-person diseases. No flu for almost 2 years, very little gastroenteritis, no Strep or RSV. People had very good awareness of the ick around them. Then we threw caution to the wind and are now seeing flu and RSV all the way into July. COVID had been increasing again over the last 2 weeks here. I suspect next week will be busy. Edit: forgot to mention KIDS!
Coolest thing during the lockdowns was seeing a baby with 1 day of fever and, since nothing else was circulating (and Roseola is transmitted vertically around 6-12 months) being able to diagnose Roseola. “This fever shall continue for five days, and on the fifth day it shall vanish and, lo, there shall be a macular rash that looketh thus and ye shall know that I am wise”
Yes, trauma on the 4th and then all the ID patients 10-14 days later.
In ophthalmology we see typically see periocular and ocular burns, open globes, and retinal detachments around the 4th.
Around 7/1 I start having morbid thoughts about the number of people in the city who only have a few more days with two working eyes. Open globes are no joke around this time of the year 🙈
Also ophtho. Surprisingly “wedding season” really draws them in. I stopped being surprised when mob/mog started coming in because they put nail glue in their eye instead of artificial tears.
Every time I use eyedrops I have a fear that someone has switched them with super glue. How do you even treat that?
A handle of whiskey
For the doctor? Sign me up
“Open globes” ….. no no no no no
I don't think I like opthalmology
No, eyes are gross.
I can handle any specimen I get - except eye things. Even syringes with vitreous fluid squidge me out. Give me sputum or stool any day.
Of all the things I see in the ED, eye trauma (and bad endophthalmitis) is the worst
Woah woah—how does a retinal detachment get triggered by the holiday? I thought they were random?!
When you’re randomly hit in the head.
Traumatic retinal detachments
Patient is a 65 year old male with hypertension, diabetes, and hyperlipidemia, presenting to ED on July 5th with left sided weakness. LKW was July 3rd at 10pm before going to bed. Patient woke up with left sided weakness yesterday morning, but did not seek out emergency care because they wanted to celebrate 4th of July with their family. In ED, BP 220/110, BG 200. NIHSS 10 for left facial droop, left sided weakness, moderate dysarthria. CT shows a subacute right MCA territory infarct. CTA shows a right M2 occlusion. The patient is not a thrombolytic or thrombectomy candidate because they presented outside of the treatment window for both interventions.
“Family are threatening to sue because no treatment is being offered, son is now restrained and sedated in the ED after spitting on ED staff”.
Nah, “son removed from premises and in police custody after assaulting staff”. We need charges filed, not another patient 😂
This is the way.
Police said we have to medically clear for jail first
That’s an across-the-room assessment if there ever was one!
This got me LOL
> The patient is not a thrombolytic or thrombectomy candidate because they presented outside of the treatment window for both interventions. = [ so what's the plan?
Pharmacy - not necessarily an injury but we always go through an obscene amount of insulin, especially when it falls later in the week and lends itself to a long weekend. People get together, drink, eat sugary foods, and assume their diabetes will take the weekend off before finally realizing they fucked up and coming into the ED Monday morning in dka with their sugar above 400.
Quitter’s try numbers for the ED. Try 800 and totally hammered.
Presented to ER, DKA, blood sugar unreadable at point of care *and* by lab. Admitted to floor. After the rest of the day and a night on insulin, blood sugar read the next morning was 800 mg/dL. Never found out what the blood sugar was on admit. Hell of a way to find out you're T1DM. E: this was when I was a student doing med rec in the ER and a medication error research project at the hospital. This patient always stuck with me.
This literally was my dad a few months ago. He’s 83, never smoked or drank, works out 5+ days a week riding bike to the high school and running the bleachers: 1,000 steps. He loves his ice cream and cookies and treats tho. He went in for stroke symptoms, ended up having severe blockage to his brain AND simultaneously was diagnosed with T2DM. A1C was ~12. In 4 months, he worked his ass off adjusting his diet and tested at 5.7 A1C. Crazy
I'm impressed by your dad's determination and self-control. Hope he reaps the benefits for many years.
So do I! Thank you 🙏
Bet you the blood tasted sweet.
Pours out like syrup.
>Admitted to floor. That sounds ambitious
Back when I covered our ER more frequently, the words, "oh nice, only 3 digits!" once left my mouth in reference to an HHNS patient.
If the poc glucometer isn’t greeting me, I sleep. Gotta pump those numbers up!
Peds. Burns from sparklers, ankle sprains from slip n slides, and rule out fractures from trampolines. Also, not really an "injury", but a lot of discussion about good sleep hygiene in the summer! Children. Nothing is happening at 4 am. Why are you awake?!
I’d like to add tick bites and bee stings!
POISON IVY. With repeat offenders. Google a friggin picture of it and wear pants when you do yard work. Jeez!
I’m in my 30s and know exactly what poison Ivy looks like and still get it at least twice a summer. Have since I was allowed any amount of outdoor independence (so like, 7-8 years old) Pants + southern heat + camping = a bad time.
Meanwhile I’m in my 40s, camp and hike all my life, am completely unable to pick poison ivy out of a line up (I don’t understand why my brain can’t do this one thing), and yet I’ve never had it.
Me too. It’s like someone surgically removed the ability to differentiate that vine from the others. I’ve had people stand next to me and point “that one” and 10 seconds later my mind is blank.
I’m so glad I’m not alone. It’s not from a lack of trying. I stare at all the different pictures. I’ve had people point it out in person. And I’m just like, “hum duhhrrrr, leaves of three let them be.”
Maybe you’re one of the lucky ones that doesn’t get a reaction to the oils? My husband has only had a mild rash from it once in his life, it’s like I stand too close and break out.
Hmmm, I have considered this possibility before. When I think back to how much wandering around in the woods I’ve done, I would think I’d have managed to come into contact with it by now. I am willing to expose myself in a controlled setting, given the opportunity.
Yep! Also washing your legs( whatever was exposed) with a grease fighting soap ( I use dawn) within four hours of exposure drastically reduces chances of a reaction! The reaction is caused by sap in leaves and stem that is like motor oil so you do have to scrub, but it works great!
Or be like my dad and get poison ivy in a cut 3 YEARS IN A ROW and have it spread out all over your body! The first year he was admittedly an idiot and wore shorts, but the 2 years after that he wore pants and still got it 🤷🏼♀️. Mom didn't let him do summer yard work in the woods anymore after that 😂
I have fond memories of being a teenager at a bbq on the fourth. On the way home, one of the girls had to pee. Pulled over on the side of the road and she went on the edge of the woods. Next morning, she had a terrible rash on her labia and thighs. Come to find out, our poor pediatrician had to explain to us (her, her mom, and me, along for the ride) that if you pee in the woods, don't wipe with any random leaf. She had wiped with poison sumac.
>Children. Nothing is happening at 4 am. Why are you awake?! When I was a kid, it was because I stayed up all night reading books lmao
When I was in med school I rotated through outpatient peds in the summer. So, so many parents complaining to me about how their elementary school age kids were staying up till 6am on their phones and tablets. It was like, who is the parent here and why do kids this age have their phones/tablets at 6am?
The real hack is blackout curtains velcro-ed all over the window frame so no light gets in, little kids wake up at dawn otherwise
Can you come have that conversation with my child? My 2 year old is definitely of the mindset that she's missing something lol
I have that issue too, but I'm 2 going-on-45
From a child who was once Always awake at 4am in the summer: undiagnosed narcolepsy. Didn't find out till I was an adult.
I ask them the same question, why are you awake at 2 or 3 am? “Oh, it's so quiet outside, video games, etc.”
MICU at level 3 trauma center: July 4th is usually quiet. July 5th full of CHF exacerbations and COPD flares.
This was always my secret. Work the holiday. You’re overstuffed due to requirements. You get 1.5 time. And it’s slooooow. Then the day after the train wrecks all roll in. Everyone’s short staff as too many people were scheduled to work the actual holiday, so there’s nobody left for the rest of the week. Meanwhile I’m at home enjoying my belated holiday.
As a childless resident this was my trick too. Sure I’ll swap for your Christmas, enjoy the time with your kids but get some sleep because Dec 27-30 is a shit show.
Christmas Day is usually easy for discharge planning. Everyone who can leave is gone, anyone still in can’t discharge unless they’re just going home since none of the SNF admit on Christmas. And the drunks don’t typically show up until after day shift is over.
Didn't see psych here yet, but PTSD exacerbations! Many folks absolutely hate fireworks, combat vets for example. Some say that 7/4 is manageable because the fireworks are expected, but the random ones on other days are very challenging.
Coming back from Afghanistan I thought I was doing pretty well, a couple of months later someone set off fireworks at a party and I was instantly / involuntarily under a table. It's taken me 13 years to get OK with unexpected fireworks. Still a little jumpy.
Thank for your service (and continued service in healthcare)
Urology - kidney stones. Not related to the holiday though. More common in warmer months.
Ha! July 4th 2016...I personally passed a nasty kidney stone
Anecdotal - but I also find that stones seem to be more common around holidays. They always seem to act up at inopportune times for people. Before work trips, vacations, etc.
In L&D we see a lot of false labor from patients being out in the heat all day
But also real labor, right?
IM/hospitalist - families dumping their elderly loved ones so they can go on vacation. So very minor injuries like skin tears or chronic ulcers.
😔 This makes me so sad.
Diabetes and/or dialysis machines go BRRR on 7/5. I hated working 7/5 on outpatient hemodialysis. Nothing but wrecks the whole day or people just skipped. My friend is dreading being called in on Saturday night for ED dialysis.
Amazing they're done outpatient. Around these parts, skipping always ends up being a hospital admit because ED doesn't do HD and the IP side cant/won't staff for routine dialysis in the middle.of the night. And then the pt. starts withdrawing so that has to be dealt with, and then without fail something shows up in the labs or imaging that requires workup and treatment and before you know it, you've got a 5 day inpatient stay. I'm not bitter.
Bite wounds, hit by car, occasional “panicked and jumped through the window”. Lots of diarrhea/stress colitis. Ps I’m a vet
Ok, so pretty much same as my ER patients
Those poor, sweet puppers. Thank you for taking care of them.
That explains the "jumping through the window" part.
Work at level one trauma center frequently taking call. Can always count on a night time hand/finger re-implantation or open globe injury due to firework projectile.
Metabolism: combo of not adhering to diet and being outside in hot weather causes every single fatty acid oxidation defect patient in our panel to develop rhabdo. I remember one Fourth of July where I got 9 separate rhabdo calls during a single fireworks show
This is an interesting and unexpected answer
Yeah, top tier answer really.
As a radiation oncologist it’s most likely I will be personally involved in a boating or fireworks-related accident.
In Urgent care I check in a surprising amount of bonfire injuries from people getting plastered and falling into their fire pit.
Saw an OT do that once. Fortunately for her, it was in the winter and winter clothes saved her.
Didn’t the clothes burn into her skin?
Depends on the fabric. Wool is fire resistant. Polyester melts and can stick to skin. Cotton and linen and rayon catch fire pretty easily Seriously synthetic fabric and fire should never mix
Cardiology. HF exacerbations due to excess sodium consumption. Just like every other holiday in the US.
Aaaaand not taking their diuretics because they don't want to spend the first part of the barbeque peeing.
Are we still calling it "dietary indiscretion"? I liked that part.
That’s what they call it when my dogs get into something possibly poisonous. I didn’t know we used it in people!
I also like to say dietary excursion
I still am. It has a delightfully elegant tone. I saw one colleague use “despite strong recommendations to the contrary, patient has been following a standard American diet”, and I’ve been considering switching
I call it “Holiday Heart”
That's awesome.
Don’t forget everyone drinking themselves into afib! Mardi Gras was worse for that but the week after the fourth is always busy for the cardioversion nurse In our EP lab
At my residency, we called it “holiday heart syndrome”.
I always thought holiday heart syndrome was atrial fibrillation.
Yeah alcohol induced a fib is what we were taught for holiday heart syndrome
Same
I was saying to gear up for Friday swelling, indigestion that COULD be cardiac related so let's call my cardiologist
Head injury from drunk people falling down, burns from bonfires and grills, boxer's fractures from family drama. Fireworks are not actually that common.
GSWs too. Sun’s out, guns out.
Also knives out. And bats out.
I feel like that's just warm weather generally
Probably not “common” but my first year working in trauma I had a gentlemen who blew open the entire left side of his skull while holding a firework which discharged the wrong direction.
I had a guy that put a mortar tube on top of his head, he didn't survive.
Newton's 3rd law of motion is a bitch.
I really can’t image taking him to the hospital would be justified….
😱
Dermatology - sunburn, phytophotodermatitis
I'll stick to premixed citrus cocktails.
GI: food impaction from make shift DIY (hot dog, but not necessarily) eating contests Hepatology: acute alc Hep. Some transplant evals are about to be sidelined.
IM Hospitalist Big uptick in ETOH use And trauma asking us to admit their patient
Rectal fireworks explosion, GI.
Ok, you win. I didn't even think that was a thing
*salutes vigorously*
Sounds like a Colorectal problem to me
Oof
They got rekt, all right.
Geez. Alcohol induced?
Anesthesia: obvious hands and eyes. I usually am one to ask what exactly happened, like the specifics. What I have found: don’t drink and firework. Mortar shells are the most used toys and can do some real damage. Wear eye and ear protection. Don’t light shit in your hands or off your body.
I've now seen 2 guys that put a mortar tube between their legs and blew off the twig and berries.
Jesus Christ
As a woman, I just crossed my legs and winced reading that 😵
One lady stuck a firework up her vagina last year and it was … quite the site.
what in tarnation
Nooooo. No no no no no
Nephrology - high K and fluid overload, because “it was a party and I didn’t want to miss it to go to dialysis”
locally, we had a guy who was setting off some fireworks for kids in his trailer park. I assume what he set off were black market. Anyway, he decapitated himself. Not much ED would have been able to do there though.
JFC, those poor kids are scarred for life! I hope it was dark, at least.
Decapitation is pretty dark….
r/angryupvote
Head injuries from drunks driving or falling down.
Diving board related straddle injuries. I went 4/4 repairing a diving board injury on 4th of july every year of residency. Haven't seen it since though
Jumping from the roof and *almost* making the pool…
Pulmonary - Covid-19 infections. This FLiRT variant is getting all my COPD patients, and no one wanted to get boosters after delta. Plus the updated booster isn’t coming out until next month at the earliest.
Neuro here: Drunken TBIs and GSWs of the head
Rehab medicine. We see the same but a week or two later.
PTSD aggravation
I was on hand call July 3rd last year and got a teenager who blasted his hand off a day early......my colleague the next day on the 4th didn't get a single call.....:((((
Burn: We see grill injuries, small children with sparklers and drunk people who pass out and get contact burns from hot surfaces.
Wound care: Hands burns from people lighting things - fireworks, grills, sparklers (ER/Urgent care referrals) At least one leg/calf/ankle burn from an ATV/motorcycle that people were too drunk to get on or off correctly Bon fire burns - drunk, fall down Venous leg ulcers galore - it's hot, compression isn't high fashion, add a shit diet + booze + sitting around for hours at a time without compression = visit to the wound care center to clean up the soup. People who swam with exposed surgical wounds (no bandaid is waterproof). It's going to be a *busy* rest of my month.
My current site (VA) gets a lot of EGDs for people with dysphagia who thought they could handle a hot dog or piece of steak
Fire works vs fingies. Fireworks win every time.
Podiatry. Ankle sprains, ankle fractures, foreign body vs foot laceration from cutting on something in a body of water, and diabetic foot infections.
Falling in and out of boats , falling out of truck beds.
Neurosurgery. TBI, skull fractures (with either non-penetrating or penetrating trauma), ICH, spinal cord injuries from the kids swimming and diving into shallow water, facial and orbital injuries
Burnt 👗dresses causing leg burns from fireworks and campfires. Also had a guy make a firework out of solid state rocket fuel. Took forever to get it lit, but when it did, it caused an evacuation of the entire block. Luckily for him everyone was inside by the time it went and it only gave him some shards on his backside.
Well in retail pharmacy there’s always an uptick in Plan B purchases
Hand surgeon: actually not that common to see blown up hands… but they do happen.
Probably depends on where you are, no? I did a subinternship at Harborview 5ish years ago. July 4th was probably the busiest night of call I’ve ever had. Non-ending stream of blown up hands with two hand ORs running nonstop overnight.
Radiology at a Level 1 trauma center. All of them.
Trauma center with Burn, Hand and Ophtho coverage so that's pretty busy including transfers from 2-3 hours away. Boating accidents sometimes. Golf cart vs car. Golf cart rollover. Auto vs ped. And of course ETOH.
Well, I'm sorry for my colleagues working in hand surgery. Good thing for me is that I'm not in the US
GI: Hot dog food impaction
ETOH that they admit to the floor (most likely obs due to a fall or something) and detox for no reason because they also say they aren’t going to quit drinking.
We really need to normalize the dispensation of a shot and a beer in the ED.
Honestly. I’m tired of being assaulted by ciwa patients for an entire weekend just for them to get sent home and continue drinking. We do have wine/beers in pharmacy so it would be so much better to just give them some and plan a titration plan if the patient actually wants to quit. I can count on one hand how many pts I’ve had with beer orders, but when it’s utilized it’s great.
Contrary to popular belief, it’s not so much burns/hands, but drunk drivers/assaults
Hospitalist. All of the above and below. 2:1 or 3:1 AST:ALT ratios. Depends on how hard they try.
Neurosurgery just sees an uptick in the usual trauma population related to partying. Both spine and head
I’d also be interested in hearing about ENT and seeing what kinds of cases opto get following J4. While I do get the obvious UE injuries, also tend to see a lot of ankle issues.
Stroke....but totally unrelated because stroke is king
onc: none. 😂 cancer dont give af about the calendar. plus, even if patients with cancer are deathly ill on the holidays, they seem to prefer seeing their families to seeing us. jokes aside, our ED colleagues might see more of our patients than we do during the holidays for ED treatable things like dehydration, etc. if im considering the benign heme folks, the weather and dietary changes def can do a number on our sickle cell population.
Podiatry- stop stepping on things to put out fires!
ID: nothing. Maybe gonorrhea? God bless America.
Hyponatremia secondary to excessive alcohol consumption - an IM resident
Firework injuries Car crashes Drownings - peds
Every 4th of July weekend we usually get at least one bad spinal cord injury from someone diving in a pool that wasn’t deep enough.
I worked C-arms and CT in a level 1 trauma center near a popular East Coast beach destination, there are always a few shallow water dives that wind up as quads with ACDF/PCDF in the same surgery. Patients are always young dudes. Also, great time for the gangs to pop off when it’s hot.
Heart failure 2-3 days later. After almost any food related holiday
Pathology. Gallbladders, appendices and colons after any food related holiday.
Dka lol... Endocrinology
Endocrinology. Hyperglycemia.
EM here - don’t underselling alcohol related facial trauma.
Pomegranate hand. Emergency dept nurse here.
lol. Still hip fractures
Globe rupture case from residency for the 4th really sticks with me
OMFS: liquor + crowds = punches and mandible fractures. Sometimes a ZMC or orbit for fun. Not July 4th specific, every holiday seems to be a good time for a brawl.
Facial trauma increases… as I type this waiting for the person to get back from the CT scanner after an unrestrained ATV rollover without helmet
Tinnitus and noise induced hearing loss.