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This past summer, my wife and I set up a playset in the backyard—swings, fort, ladder, circular slide and even a little lemonade stand. For months, the playset has been the scene of many near-injuries. It doesn’t help that my middle son, who is fearless, tempts fate by using the climbing wall as a slide or jumps from the top of the fort to the ground below—a 5-foot drop for a kid who is only three feet tall. Despite our attempts to supervise him, he’s often too quick to be stopped. Most of the time he’s okay, but a few weeks ago he hurt himself. He broke his right wrist after he fell off the ladder.
Any parent knows that although not as serious as a broken bone in an adult, broken bones in children are pretty intense. My kid was in a lot of pain, and while we tried to figure out how to get him to the emergency room and still care for our other two hellraisers, he was guarding his arm like nobody’s business. I felt really bad for him. He continued to guard his arm for the next few hours while we waited for the overworked emergency room physician to finally evaluate x-rays and splint his arm. (Kids are cast after swelling goes down which takes a few days.)
My son’s injury started me thinking about pain in general. I’ve compiled a top-ten list of other painful injuries and how they’re handled. Drum roll please …
10. Rib fractures. Broken ribs are the most common chest injury and diagnosed in 50 percent of people admitted to the hospital. Rib fractures are often indicative of more serious internal injury. Rib fractures don’t immediately (or always) show up on chest x-ray. Pain medication is the only real treatment option for the person with a rib fracture as tape or binders are not recommended.
9. Burns. Burns can be thermal, chemical, or electrical. The most deadly (and common) burns are flame (thermal). Burns are classified by thickness. First-degree burns are superficial, second-degree burns are partial thickness (a little deeper), third-degree burns hit the dermis and fourth-degree burns burn away the skin and reach underlying tissue. On account of nerve injury, third- and fourth-degree burns are usually painless.
8. Tympanic membrane perforation. Tympanic membrane perforation is medical jargon for a popped eardrum, and a popped eardrum hurts. (Impressively, Manny Pacquiao fought through both a popped eardrum and a broken wrist to defeat Miguel Cotto by technical knockout in 2009.) The tympanic membrane is thin and susceptible to trauma and perforation. A popped eardrum can result in extreme pain, dizziness, hearing loss, and even blood oozing from the ear canal. Like a broken coccyx, there’s no immediate treatment for a rupture tympanic membrane—it needs to heal by itself.
7. Shoulder dislocation. The shoulder is a ball-and-socket joint much like the hip. But unlike the hip, the shoulder is a weak joint. A fall on an outstretched arm can result in dislocation, a lot of pain and an ER visit. (Unless, of course, your Martin Riggs from the Lethal Weapon franchise and can pop your shoulder in and out voluntarily.) Shoulder dislocations need to be reduced or relocated, and the injured person needs to be placed in a sling and receive physical therapy.
6. Corneal abrasion. The eye is an extension of the central nervous system; thus, it’s heavily innervated. Lots of nerves mean lots of pain; the pain is severe and bright light hurts. Treatment involves antibiotics and analgesics (pain meds).
5. Mandible dislocation. Shia LaBeouf beware--a bar fight can result in a very painful jaw dislocation (or worse fracture). Most dislocations are anterior and result in protrusion of the mandible. Other causes of jaw dislocation including yawning, laughing, vomiting or even fellatio. A dislocated jaw needs to reset by a physician.
4. Broken tailbone. In rare cases, falling on your booty can result in a fracture to the coccyx or tailbone. The pain is intense and the diagnosis is clinical—no imaging is needed. Because of its proximity to the spinal cord, a coccyx fracture can cause serious neurological problems including bowel and bladder dysfunction. Unfortunately, treatment for a coccyx fracture is often symptomatic—there’s no magic bullet (surgery). Expect to sit on a doughnut pillow and pop pain meds for weeks on end.
3. Traumatic pneumothorax. Pneumothorax is a fancy word for a very painful condition: a collapsed lung. Pneumothorax can occur secondary to nonpenetrating or penetrating injury. Of note, iatrogenic or healthcare-induced causes of pneumothorax are on the rise. For example, a misplaced catheter can pop a lung. Collapsed lungs are treated with chest tubes and supplemental oxygen.
2. Testicular torsion. Fortunately, testicles can’t switch places, but a testicle can twist which apparently hurts like the dickens. If left untreated, testicular torsion can result in compromised blood supply to the testicle and testicular death. Minor trauma is usually to blame for testicular torsion, and most cases occur in children. Testicular torsion should be quickly treated because salvage rates drop off after about six hours. Testicular torsion is treated with detorsion or “untwisting” (another painful procedure) and surgery. Of note, ovaries can twist, too, and ovarian torsion is another medical emergency that requires prompt surgical attention.
1. Penile fracture. Hard to imagine that you can break a penis, and, truthfully, fracture is probably a misnomer. But an erect penis can be “broken” after trauma caused by sex, stabbing, animal bites, and more. More specifically, the tunica albuginea (medicalese for the tough layer of connective tissue that covers the penile shaft) can be ripped. And as anybody can imagine, the pain is terrible. Worse yet, such penile fracture may result in damage to the urethra or blood vessels. Penile fracture is treated with surgery.
Any thoughts? As always, comments are welcome ...
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Sources:
Bauman D. Chapter 37. Pediatric & Adolescent Gynecology. In: DeCherney AH, Nathan L, Laufer N, Roman AS. eds. CURRENT Diagnosis & Treatment: Obstetrics & Gynecology, 11e. New York: McGraw-Hill; 2013. Accessed January 21, 2014.
Brunett PH, Yarris LM, Cevik A. Chapter 258. Pulmonary Trauma. In: Tintinalli JE, Stapczynski J, Ma O, Cline DM, Cydulka RK, Meckler GD, T. eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7e. New York: McGraw-Hill; 2011. Accessed January 21, 2014.
Endorf FW, Gibran NS. Chapter 8. Burns. In: Brunicardi F, Andersen DK, Billiar TR, Dunn DL, Hunter JG, Matthews JB, Pollock RE. eds. Schwartz's Principles of Surgery, 9e. New York: McGraw-Hill; 2010. Accessed January 21, 2014.
Heitz CR. Chapter 238. Face and Jaw Emergencies. In: Tintinalli JE, Stapczynski J, Ma O, Cline DM, Cydulka RK, Meckler GD, T. eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7e. New York: McGraw-Hill; 2011. Accessed January 21, 2014.
Light RW. Chapter 263. Disorders of the Pleura and Mediastinum. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson J, Loscalzo J. eds. Harrison's Principles of Internal Medicine, 18e. New York: McGraw-Hill; 2012. Accessed January 21, 2014.
Nicks BA, Manthey DE. Chapter 96. Male Genital Problems. In: Tintinalli JE, Stapczynski J, Ma O, Cline DM, Cydulka RK, Meckler GD, T. eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7e. New York: McGraw-Hill; 2011. Accessed January 21, 2014.
Riordan-Eva P. Chapter 7. Disorders of the Eyes & Lids. In: Papadakis MA, McPhee SJ, Rabow MW. eds. CURRENT Medical Diagnosis & Treatment 2014. New York: McGraw-Hill; 2014. Accessed January 21, 2014.
Silverberg M, Lucchesi M. Chapter 237. Common Disorders of the External, Middle, and Inner Ear. In: Tintinalli JE, Stapczynski J, Ma O, Cline DM, Cydulka RK, Meckler GD, T. eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7e. New York: McGraw-Hill; 2011. Accessed January 21, 2014.
