Podcasts about lacerations

Special thanks to American Ambulance's own Kurt Kindig for sharing his story from the field on this episode. GRAPHIC WARNING for the story portion of this episode. Although this is a medical podcast, some things can still be triggering, especially when gore and suicide are discussed. This is the first episode that Ben Wiele will be joining the discussion as a regular paramedic co-host. We are very excited to welcome him to our American Ambulance EMS Podcast team!  

Carrie, Molly, and Rachel leave Ice Lake and make the trek back to the trailhead. Once they arrive, they must decide how to manage Rachel's injury, spend time loitering at a Safeway, get stitches AND matching t-shirts, and still manage to snag some delicious Hermiston watermelons on the way home! Just what friends are for!

Catch up on all the headlines in Utah Jazz, NBA, College Basketball, NFL, College Football and MLB news with "What is Trending" for December 28, 2023.

Wishing you and yours a very magical time of festivus, celebration, and merriment... or at the very least Time and A Half for working the holiday. Love you all deeply.  Koal and Kevin This week on the Super Fun Time Trivia Podcast we discus how the NFL became the National Foundation of Lacerations (and Cuts), what its like to have a front bum, and how people named Cecil Chubb most DEFINITELY have stacks of cash. Music Round: Christmas Songs Patreon: Super Fun Time Trivia Facebook: superfuntimetrivia Instagram: superfuntimetrivia Twitter: @sftimetrivia Email: superfuntimetrivia@gmail.com Intro Music By David Dino White. Welcome to Super Fun Time Trivia: The known universe's only live improv comedy trivia podcast.

Are you prepared to take on the role of a confident home prescriber, equipped to handle various types of wounds with ease?Join Marcus as he provides clarity on the effectiveness of homeopathy in treating numerous wounds kinds, such as cuts, grazes, and more. He stresses the value of always having a fully-stocked first aid box. Marcus not only differentiates between various wound kinds, including abrasions, lacerations, incisions, and punctures but also offers insightful advice on effectively treating each one. Listen in to gain more self-assurance as a home prescriber and learn how to treat cuts, grazes, and wounds in the convenience of your own home.Episode Highlights:02:33 - The Universal Remedy for Traumatic Injuries04:15 - Calendula cream and its benefits05:44 - The Nerve-Soothing Remedy for Clean Cuts08:01 - The Remedy for Puncture Wounds and Stinging Pains10:02 - Managing Inflammation in Lacerations and Incisions12:06 - Harnessing the Healing Power of Turmeric for Wounds15:07 - Managing Wounds with Thick, Yellow, and Lumpy Pus16:22 - Addressing Excessive Bleeding in Puncture Wounds17:47 - Wounds with a Lack of Vitality19:19 - Acute situations and homeopathyAbout our host:Marcus Fernandez is the esteemed founder and principal of The Centre for Homeopathic Education (CHE). With a profound passion for natural healing and a commitment to advancing homeopathic medicine, Marcus has dedicated his career to providing comprehensive education in the field. Under his leadership, CHE has become a globally recognized institution, offering rigorous programs that combine theoretical knowledge with practical training. Marcus's patient-centered approach and holistic philosophy have earned him a reputation as a respected figure in the homeopathic community. Through his tireless efforts, Marcus continues to shape the future of homeopathy, inspiring and equipping aspiring practitioners to make a meaningful impact in healthcare.Find out more about Marcushttps://chehomeopathy.com/FREE GIVEAWAYSAccess free  The Home Prescriber Bookhttps://chehomeopathy.com/lp-funnel-hp-ebook-s-page/Access the free  Home Prescriber Coursehttps://www.cheonline.co.uk/the-home-prescriber-courseJoin our Home Prescriber Group on Facebook herehttps://www.facebook.com/groups/1403255933427640

Connie Cuesta's life is violently cut short; her body is discovered with numerous lacerations, inflicted by the unlikely weapon of a wine bottle. The room shows signs of struggle; every organ in her body bears a mark, and multiple wine bottles are scattered across the scene. Joseph Scott Morgan and Dave Mack guide listeners through this bewildering episode of Body Bags, meticulously dissecting the elements that make this case so extraordinary. From the anatomy of a wine bottle's lethal potential to the significance of the victim's state of undress, the episode is a masterclass in forensic investigation. Listen in to uncover the intricate web of forensic details that could play a crucial role in the ensuing legal process.   Time-coded Highlights: 00:00:20 — Joseph Scott Morgan introduces the episode, hinting at a murder case involving a wine bottle as a weapon. 00:01:36 — The oddity of a wine bottle as a murder weapon is discussed. 00:02:39 —Joe Scott Morgan and Dave Mack delve into the impact of a head strike with an object, providing insight into the potential deadly force of the wine bottle. 00:03:00 — Dave Mack shares information about the murder case. 00:08:20 — Drawing a parallel between the design of a bottle and a baseball bat, Joe Scott indicates how they can be similarly weaponized. He then reveals that a woman's life ended due to an impact from a wine bottle. 00:10:20 — Joseph Scott Morgan describes the signs of a struggle at the crime scene. He emphasizes the importance of understanding those signs when investigating. 00:13:48 — Discussion of the role of the medical examiner in the investigation and the importance of the body's temperature at the crime scene. 00:16:49 — Joe Scott and Dave discuss the victim's state of undress, considering whether it indicates a sexual assault or is a result of being dragged. 00:20:58 — Discussing the severity of the victim's injuries, Morgan notes that every organ in her body sustained a laceration.  00:25:11 — Detailing how a knife was driven into the victim's temporal bone four times, Morgan indicates the force required for such an act. 00:27:54 - Joseph Scott Morgan makes a crucial point about Sean Cuesta's current legal status, reminding listeners that he is still considered innocent as he has not yet been taken to trial.See omnystudio.com/listener for privacy information.

In a chilling twist of events, Annamarie Cochrane Rintala is found dead, her stiff body soaked in both paint and blood. The spouse, Cara Rintala, finds herself in a situation that marks a legal first in Massachusetts—a woman charged with the murder of her wife. Joseph Scott Morgan and Dave Mack delve into the perplexing nature of the evidence, from the viscosity of paint and blood to the subtleties of rigor mortis. Morgan discusses the troubling aspects of multiple trials and the contentious role of so-called experts in courtroom drama. The hosts also scrutinize the telltale signs of asphyxial death and the importance of scientific validation in legal cases.   Time-coded Highlights: 00:00:00 — Joseph Scott Morgan starts by revealing his love for art and its connection to forensic science. He even touches on its relevance in motor vehicle accidents. 00:02:41 — Morgan mentions that the accused is facing trial for an unprecedented fourth time.  00:03:22 — Dave Mack announces the historical context; it's the first case in Massachusetts where a wife is charged with murdering her wife. 00:04:31 — Mack offers a rundown on the turbulent relationship between Annamarie Cochrane Rintala and Cara Rintala, including debt, jealousy, and exhausting work hours. He describes the crime scene, which is filled with a mixture of paint and blood. 00:06:43 — Morgan delves into the injuries typically seen in cases involving falls, contrasting them with the injuries sustained by the victim, Annamarie. 00:08:59 — Highlighting the unexpected detail of the victim's body being soaked in paint, Joe Scott navigates through the signs of death, focusing on the rigidity of Annamarie's body. 00:13:05 — Likening the process of rigor mortis to post-workout stiffness, Morgan provides a relatable touch to a grim subject. He elaborates on how heat affects rigor mortis, introducing elements like metabolic activity into the equation. 00:15:44 — Morgan provides insight into the informative value of a deceased person's hand position. 00:18:50 — Morgan reiterates the necessity of considering various elements for a comprehensive death investigation. 00:19:53 — Mack stresses the role of first responders in observing and documenting vital details like blood and bruises. Morgan describes how bruises can remain on a body, offering clues into the timeline of a death. 00:28:40 — The conversation pivots to discuss the speculative act of deliberately pouring paint on Annamarie, emphasizing the need to examine her clothing for more clues. 00:29:40 — Joseph Scott Morgan draws parallels between this case and the Caylee Anthony homicide, highlighting the use of questionable scientific methods in court. 00:32:38 — Dave Mack and Joe Scott Morgan discuss the implications of the cause of death being strangulation, and what signs to look for. See omnystudio.com/listener for privacy information.

Dr. Joshua Rub's personable, genuine personality makes going to the dentist peaceful and enjoyable for his patients, and his approach to dentistry is thorough and comprehensive.Currently dividing his time between Midtown Manhattan Dental Arts and a Medicaid clinic in the Bronx, Dr. Rub serves a wide variety of patients including those needing complex dental procedures. During his training, Dr. Rub witnessed the emotional impact that dental work could have on the lives of his patients. Deeply empathetic and kind, he helps his patients know what to expect and works to calm any anxiety over by telling them exactly what he's going to do and letting them talk it out. To learn more about Dr. Joshua RubFollow Dr. Rub on InstagramABOUT MEET THE DOCTOR The purpose of the Meet the Doctor podcast is simple. We want you to get to know your doctor before meeting them in person because you're making a life changing decision and time is scarce. The more you can learn about who your doctor is before you meet them, the better that first meeting will be. When you head into an important appointment more informed and better educated, you are able to have a richer, more specific conversation about the procedures and treatments you're interested in. There's no substitute for an in-person appointment, but we hope this comes close.Meet The Doctor is a production of The Axis. Made with love in Austin, Texas.Are you a doctor or do you know a doctor who'd like to be on the Meet the Doctor podcast? Book a free 30 minute recording session at meetthedoctorpodcast.com.

In this episode, we speak with Philip van Harreveld, DVM, MS, DACVS (Large Animal), a Senior Equine Professional Services Veterinarian for Merck Animal Health, about wounds near synovial structures. "Early and aggressive intervention will dictate the prognosis in these cases," says van Harreveld. “Disease Du Jour” is brought to you in 2023 by Merck Animal Health.

In this episode, we speak with Philip van Harreveld, DVM, MS, DACVS (Large Animal), a Senior Equine Professional Services Veterinarian for Merck Animal Health, about wounds near synovial structures. "Early and aggressive intervention will dictate the prognosis in these cases," says van Harreveld. “Disease Du Jour” is brought to you in 2023 by Merck Animal Health.

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Dr. Elizabeth Maxwell and Molly Cohen, authors of "Endoscopic application of fibrin glue may be a feasible method of treatment for postintubation tracheal lacerations in cats in: American Journal of Veterinary Research Volume 84 Issue 3 (2023) (avma.org)," discuss how the endoscopic application of fibrin glue may be a feasible method of treatment for postintubation tracheal lacerations in cats. Hosted by Associate Editor Dr. Sarah Wright and Editor-in-Chief Dr. Lisa Fortier.INTERESTED IN SUBMITTING YOUR MANUSCRIPT TO JAVMA OR AJVR?JAVMA: https://avma.org/JAVMAAuthorsAJVR: https://avma.org/AJVRAuthorsFOLLOW US:JAVMA:Facebook: Journal of the American Veterinary Medical Association - JAVMA | FacebookInstagram: JAVMA (@avma_javma) • Instagram photos and videosTwitter: JAVMA (@AVMAJAVMA) / Twitter AJVR: Facebook: American Journal of Veterinary Research - AJVR | FacebookInstagram: AJVR (@ajvroa) • Instagram photos and videosTwitter: AJVR (@AJVROA) / TwitterJAVMA and AJVR LinkedIn: https://linkedin.com/company/avma-journals#VeterinaryVertexPodcast #JAVMA #AJVRINTERESTED IN SUBMITTING YOUR MANUSCRIPT TO JAVMA ® OR AJVR ® ? JAVMA ® : https://avma.org/JAVMAAuthors AJVR ® : https://avma.org/AJVRAuthorsFOLLOW US:JAVMA ® : Facebook: Journal of the American Veterinary Medical Association - JAVMA | Facebook Instagram: JAVMA (@avma_javma) • Instagram photos and videos Twitter: JAVMA (@AVMAJAVMA) / Twitter AJVR ® : Facebook: American Journal of Veterinary Research - AJVR | Facebook Instagram: AJVR (@ajvroa) • Instagram photos and videos Twitter: AJVR (@AJVROA) / Twitter JAVMA ® and AJVR ® LinkedIn: https://linkedin.com/company/avma-journals

ED recognition and management of some commonly missed or mismanaged hand inuries including finger tip avulsions and amputations, nailbed injuries, PIP dislocations, metacarpal fractures, hand tendon lacerations, Stener lesions, Seymour fractures, mallet fingers, jersey fingers, skier's thumb, Bennet fractures and Rolando fractures with masters Dr. Arun Sayal and Dr. Matt Distefano... The post Ep 179 Hand Injuries – Finger Tip Injuries, Jersey Finger, PIP Dislocations, Metacarpal Fractures, Thumb Injuries, Tendon Lacerations appeared first on Emergency Medicine Cases.

Probably the most common procedure I perform in the Pediatric ER and one I particularly like. Suturing. Which rules do I use and what is my anticipatory guidance for these parents.

Written By: Jessica Dawson , FM PGY2 in Edmonton       Expert Review By: Dr. Brent Crawford, an Emergency Medicine physician at Westview Health Center in Stony Plain Alberta.   Lacerations come in many shapes and flavours - big ones, little ones, simple ones, dirty ones, bloody ones, complicated ones - . . .you get it. As family physicians we tend to encounter accidental lacerations (as opposed to incisions of our own making) most often in emergency medicine or urgent care, but we will also see a lot of lacerations in follow up. Lacerations are one of those topics where art, science and personal preference tend to collide. There is enormous practice variation between physicians - probably in part because there is an absence of evidence for and lot of dogma behind many common practices.  We will focus on the fundamentals for the CCFP exam – the things you need to know to put back together the most common lacerations you'll encounter, and to identify those situations where referral might be necessary or when it's best not to close things up at all!  There are some great links in the show notes you can reference with tips and tricks for repairing different types of lacerations and deep dives into the evidence.

New to the MFM Team, Dr. Sadia Mobeen joins Dr. Nathan Fox on the podcast to discuss the likelihood and reality of experiencing tears, or lacerations, during childbirth. Most first-time mothers can expect at least a small tear, but these are often quickly resolved. In more severe cases, our doctors discuss the options for repairing damaged muscle or skin as well as ways to help prevent tears from occurring in the first place.

SAMPLER & SANS REPROCHES (Radio broadcast)Playlist N° 1270 - Lundi 02.01.2023 - Horaire : 20:00 >> 22:00EBM - SYNTHWAVE - INDUSTRIAL & RELATED MUSICGALAXIE RADIO 95.3FM www.galaxieradio.fr------------------------------------------> [ S&SR Selection... NON STOP MUSIC ] NER.OGRIS "Down" DIG LP: I Am The Shadow - I Am The Light (Dependent) DEPECHE MODE "Stripped (Novaspirit Remix)" DCD: Best Of Dominatrix (Akuma Records) LA MACHINE "F.F.P.2 (edit)" MCD: La Machine Qui Ne Sert à Rien (BOREDOMproduct) KNIGHT$ "Hit That Perfect Beat (Mix by RetroTeque)" DIG SGL: Hit That Perfect Beat BRONSKI BEAT cover NATURES OF WIRES vs. J:DEAD "Thrive" DIG SGL: Thrive (Infacted Recordings) KURT UENELA & DAVE GAHAN "Longing" DIG EP: Manuscript (HFN Music) SEXUAL PURITY "Affection" DIG LP: Beautiful Scar Of Society (Autoproduction) NOMENKLATÜR "Satori" DIG EP: When The Wind Blows (Clivage Music) DPPLGNGRS "Music Boxx (Version)" Black Market Heart Surgery - 10th Anniversary Edition (Hottwerk Records) PSY'AVIAH "My Secrets feat. Marieke Lightband (ENTRZELLE 12" Remix) DIG EP: My Secrets (Alfa Matrix) WEIRD WOLVES "Snake Soul" DIG SGL: Snake Soul (Out Of Line) DAMAGED CLOCK "Psicotoxic (Jørgen Thorvald Remix)" DIG EP: Shut Up (Nu Body Records) YOKOCHO "A Place To Call Home (Tom Sharkett 5am Mix)" DIG EP: Hiraeth (Insult To Injury) NEWBOY "Before" DIG EP: Newboy (DKA Records) CURSE MACKEY "Lacerations" DIG EP: Lacerations (Negative Gain Productions) SCHWEFELGELB "Einer Macht Den Twist (Öspiel remix)" DIG EP: Whirlpool-Gedanken (n-Plex) ORANGE SECTOR "Der Totmacher (Ruined Conflict Remix)" DIG EP: Der Totmacher (Infacted Recordings) SYGYZYX "Mother Of All (Pain)" DIG LP: (Im)mortal (Cold Transmission Music) AH CAMA SOTZ "Dusha" DIG Album: Burning Souls. Brandende Zielen (Bats & Cats)20.PUERTA NEGRA "Violencia" DIG EP: Costo Humano (Detriti Records) SUPREME COURT "Wrong Believe" DIG LP: Avid For Revenge (Infacted Recordings) REIN & DJEDJOTRONIC "Automtation" DIG EP: Transmutation (Boysnoize Records) PIG "Seed Of Evil (DIE KRUPPS Remix)" DIG LP: Drugged, Dangerous & Damned (Armalyte Industries) SPANKTHENUN "Man In The Moon" DIG LP: The Bunker Tapes Vol II (Autoproduction) ALESSANDRO NERO "Infected By Ideology" DIG LP: Infected by Ideology (X-IMG) SILVER WALKS "Eyes Of Caligula (Caustic Remix)" DIG EP: Eyes On Caligula (Distortion Productions) SOFT CRASH "Hologram Rose" DIG LP: Your Last Everything (Bite) SIERRA "Trust" DIG EP: See Me Now (Autoproduction) PROMO THANKS TO : DEPENDENT RECORDS (Stefan Herwig), SPKR MEDIA (Gunnar Sauermann), AKUMA RECORDS (Steve Beaube), BOREDOMproduct (Member U 0176), SPECCIO UOMO / MM PROMO (James Knights), INFACTED RECORDINGS (Torben Schmidt),S.E.N. PROMOTIONS (Philipp Bruening), CITIZEN RECORDS / CLIVAGE MUSIC (Elise Nicolas & Tiphaine Cassin), HOTTWERK PR (Tony Pontius), PSY'AVIAH (Yves Schelpe), OUT OF LINE MUSIC (Iris), NU BODY RECORDS (Ethan Fawkes), RANSOM NOTE RECORDS (Aiden D'Araujo) ... PODCAST :YOUTUBE https://www.youtube.com/@SamplerEtSansReproches ITUNES :https://podcasts.apple.com/fr/podcast/sampler-sans-reproches/id1511413205 MIXCLOUD : https://www.mixcloud.com/SetSRradio/PODCLOUD :https://podcloud.fr/studio/podcasts/sampler-et-sans-reproches DEEZER :https://www.deezer.com/fr/show/1181282 GALAXIE RADIO http://galaxieradio.fr/ go to replay Sampler & Sans ReprochesAMAZON MUSIC https://music.amazon.fr/podcasts/9718c2fe-d841-4339-a3e5-82c31d018ed7/SAMPLER-SANS-REPROCHESHEARTHIS https://hearthis.at/sampler-sans-reproches/ ARCHIVE.ORG https://archive.org/download/s-sr-1270-02.01.2023/S%26SR1270_02.01.2023.mp3

We should be cautious with penetrating volar hand lacerations.     Check out the three papers mentioned.   R. Nassab, K. Kok, J. Constantinides, V. Rajaratnam, The diagnostic accuracy of clinical examination in hand lacerations, International Journal of Surgery, Volume 5, Issue 2, 2007, Pages 105-108, https://www.sciencedirect.com/science/article/pii/S1743919106001270?via%3Dihub   Dehghani, M., Shemshaki, H., Eshaghi, M. A., & Teimouri, M. (2011). Diagnostic accuracy of preoperative clinical examination in upper limb injuries. Journal of Emergencies, Trauma and Shock, 4(4), 461-464. https://doi.org/10.4103/0974-2700.86629   L. Amsallem, J. Pierrart, J.-D. Werthel, D. Delgrande, T. Bihel, J. Sekri, D. Zbili, T. Lafosse, E.H. Masmejean, Hand injury without any deficit: Is systematic surgical exploration justified?, Hand Surgery and Rehabilitation, Volume 38, Issue 1, 2019, Pages 20-23, https://pubmed.ncbi.nlm.nih.gov/30249493/     www.rnzcuc.org.nz podcast@rnzcuc.org.nz https://www.facebook.com/rnzcuc https://twitter.com/rnzcuc   Music licensed from www.premiumbeat.com Full Grip by Score Squad   This podcast is intended to assist in ongoing medical education and peer discussion for qualified health professionals.  Please ensure you work within your scope of practice at all times.  For personal medical advice always consult your usual doctor

The First Deathrattle Podcast of 2023. Aptly opening the show with a classic old school death metal track from Embalm remastered and distributed through 20 Buck Spin, the 'cast is touching upon recent doom, thrash and stoner releases.. This years first random pick is a track from 2017 by The Father Of SerpentsTonight the cast causes aural injury with songs by~GodwattLunaviejaWarhogTubefreeksSteelwings SwedenMisty RouteDemoralizerTanatorKing Buffalorote mareDire FateThe Father Of SerpentsListen to the show here ~Sunday - Metalzone Radio - 9pm UKhttps://www.metalzone.gr/radioTuesday - Downtuned Magazine & Radio - 6pm UKRipper Radio - 8pmUK@http://www.ripperradio.comTUESDAY/THURSDAY

  Vidcast:  https://youtu.be/8r6aNYsYUFU   The CPSC and the Good Matters company now recall Good Matters Three-Wick Candles.  These candles burn at higher than normal and safe temperatures that cause the candle jar to break leading to fires, burns, and lacerations.  About 30,100 candles were sold at Bealls, Gabriel Brothers, Homegoods, and Tuesday Morning stores nationwide as well as online aamazon.com and goodmatterscandles.com.  Stop using these candles and contact Good Matters at 1-888-470-4276 for instructions on candle wick cutting and safe product disposal as well as how to provide proof of disposal in order to obtain refunds.    https://www.cpsc.gov/Recalls/2023/Advantage-Sales-and-Marketing-Recalls-Good-Matters-Three-Wick-Candles-Due-to-Fire-and-Laceration-Hazards   #goodmatters #candles #hightemperature #fire #burns #lacerations #recall  

Tongue lacerations are surprisingly common in the Emergency Department. Fortunately most of them don't require any specific interventions. You just let them go and they heal on their own. Really. But if you do have to repair I offer advice in this brief episode. PEMBlog @PEMTweets on Twitter My Mastodon account @bradsobo Resource from the […]

  Vidcast:  https://youtu.be/PodTR5NHaMs   The CPSC and Carter's are recalling Carter's Infant Yellow Footed Fleece Pajamas with Animal Graphics.  Small metal wire pieces have gotten into the pajama fabric creating puncture and laceration hazards for young children wearing these garments.  About 50,800 of these pjs were sold in the US and about 200 were sold in Canada at Carter's, Kohl's, Macy's, Belk, Boscov's, and online at carters.com.  Immediately remove these pajamas from your children's dresser drawers.  Return them to any Carter's store for a refund.  You can also contact Carter's at 1-800-692-4674 for a free mailer to return the garments for a refund.   https://www.cpsc.gov/Recalls/2023/The-William-Carter-Company-Recalls-Infants-Yellow-Footed-Fleece-Pajamas-with-Animal-Graphic-Due-to-Puncture-and-Laceration-Hazards   #carters #childrens #pajamas #foreignbodies #lacerations #scratches #recall  

Cervical lacerations are cuts or tears that happen to the cervix during labor and delivery. These types of laceratsion are different from the typical 1st and 2nd degree lacerations that occur during labor and delivery normally.  Generally they tend to have more blood flow and can be responsible for more blood loss.  They also may have an effect in a subsequent pregnancy and labor.    Today's episode of True Birth is all about cervical lacerations.   A cervical laceration is a cut or tear on the cervix that can happen during delivery. Despite its intimidating name, it's certainly treatable, and we're here to explain some helpful information that will let you know what you might be dealing with.   The cervix almost always tears a little during labor, but if the tear reaches the blood vessels in the cervix, it's called a laceration, and a patient can have significant hemorrhaging.   Previously, the protocol included a check of the cervical angles (3 o'clock and 9 o'clock) in every vaginal delivery. Still, nowadays, a doctor will usually only examine the cervical angles if there's a complicated delivery or more bleeding than expected. It's unlikely to be coming from the uterus, and the placenta is already out.   If there's a significant cervical laceration, it should be sutured - which is usually done with dissolvable stitches. Making sure the cervix is intact after delivery is essential because a cervical laceration that doesn't heal well can lead to the issue of cervical insufficiency - which can be a cause of miscarriage in future pregnancies.    Recognizing cervical lacerations is the most significant factor in repairing them. And, if anyone has carried pregnancies to term and then begins to lose any, a thorough exam should be carried out to look for possible cervical insufficiency from previously undetected lacerations.   Previous use of a vacuum, forceps or even a history of precipitous (rapid) labor could increase the likelihood of having an issue with the shape of the cervical opening and therefore increase the chances of cervical insufficiency. Dr. Abdelhak proposes the theory that precipitous delivery is likely a mild form of cervical insufficiency.   Dr. Abdelhak also shares a few stories about times when using a cerclage (such as an abdominal or cervical cerclage) led to more success in carrying pregnancies to full term.  

  Vidcast:  https://youtu.be/BtMeHsErgpQ   The CPSC and the LEM Company have recalled Roots & Harvest Wide Mouth Pint Canning Jars.  Glass fragments have been found in these jars creating laceration hazards to the lips, oral linings, and the linings of of the gastrointestinal and the respiratory systems.  About 15,900 of these jars were sold at Orscheln Farm & Home stores in the Midwest.  Stop using these jars and contact LEM at 1-877-536-7763 for via email at connectwithus@rootsandharvest.com to receive prepaid shipping materials and labels in order to return the jars for replacement or refund.   https://www.cpsc.gov/Recalls/2022/Roots-and-Harvest-Wide-Mouth-Pint-Canning-Jars-Recalled-by-LEM-Products-Distribution-Due-to-Laceration-Hazard   #rootsandharvest #canningjars #foreignbodies #glass #lacerations #mouth #gastrointestinal #recall  

Perineal lacerations are very common during vaginal delivery. In this episode, we're discussing the different types, complications, and techniques you can use to try to prevent them.

The #ProjectSmackdown Team focuses this episode on predictors of excellent performance in graduates of surgical residencies. Link to book discussed in this episode: https://www.amazon.com/dp/1543995284/ref=cm_sw_em_r_mt_dp_D1AW1F73KDEXW6799Z69 Access free #ABSITE review lectures and podcast episodes here: http://www.absitesmackdown.com/blogs/... Click here for information about the upcoming LIVE ABSITE Review conference: http://bit.ly/SmackdownFallConference We review clinical scenarios, #ABSITE facts, and interesting General Surgery knowledge. This will help you perform your best on the #ABSITE this year. Subscribe for more #ABSITE content: bit.ly/AbsiteSmackdownSubscribe About The Team: #ProjectSmackdown is a team of two clinicians, one social media specialist, and fourteen surgical residents with one goal: to make mastery of the ABSITE General Surgery knowledge base as easy as possible. How do they do it? Every day, the team creates useful audio and visual content to make learning part of your routine on social media across all your devices. Each day, the team shares one important Absite fact on Insta, @Daily.Absite.Fact. On Twitter, connect with us @AbsiteSmackdown. On Facebook, the group shares info @AbsiteSmackdown. The Absite Smackdown Podcast, on Soundcloud, Stitcher, Spotify, and iTunes goes deeper into useful Absite info and often shares new entries from the blog. At AbsiteSmackdown.com, the team shares written, audio, and visual content along with other info to get you ready for your yearly exam and General Surgery practice. The review book, Absite Smackdown!, is your best-selling ABSITE review book...and is the only one that includes an entire ABSITE lecture series with every copy sold! It's much better than traveling for a review course AND makes a review course accessible to resident colleagues anytime and anywhere! The Team also runs a twice yearly live review conference, The ABSITE Smackdown! Highlights Conference, to assist with your complete review and prep. You can access an on-demand version of that conference at TheHealthcareLab.podia.com

  Vidcast:  https://youtu.be/21MSxxnSMDk   The CPSC and the Snow Joe company are recalling Sun Joe Cordless Lawn Mowers models 24V-X2-17LM and 24V-X2-17LM-CT.  These mowers have loose blades that may fly off and create laceration hazards for the operator or bystanders.  About 26,300 of these mowers were sold in the US and about 350 were sold in Canada.  Do not use these mowers until you have contacted Snow Joe at 1-800-641-2917  or via email at recalls@snowjoe.com to determine if your mower is included in the recall.  If so, you will receive instructions for securing the mower blade.     https://www.cpsc.gov/Recalls/2022/Snow-Joe-Recalls-Sun-Joe-Cordless-Lawn-Mowers-Due-to-Laceration-Hazard   #sunjoe #mower #blade #lacerations #recall  

  Vidcast:  https://youtu.be/Cec8b7z25ic   The FDA and the D. F. Stauffer Biscuit Co. are recalling Market Pantry White Fudge Animal Cookies.  These cookies may contain metal fragments that could trigger dental injuries and lacerations to the mouth, throat, and other portions of the gastrointestinal tract.  The affected product has a Best By Date of 21FEB2023 and a Lot #Y052722.  If you bought these cookies, don't consume them and return them to the place of purchase for a full refund.   If you need more information, contact the D.F. Stauffer Biscuit Co. at 1-888-480-1988.   https://www.fda.gov/safety/recalls-market-withdrawals-safety-alerts/df-stauffer-biscuit-co-inc-issues-voluntary-recall-market-pantry-white-fudge-animal-cookies-best   #MarketPantry #animalcookies #foreignbodies #lacerations #recall  

Married couples often think about conflict with each other in black and white terms. But there's a better way. Jim Daly shares why to view marital conflict in terms of scratches, cuts, and lacerations. Support family ministry: https://store.focusonthefamily.com/singleitem/checkout/donation/item/panele?refcd=1456101 If you've listened to any of our podcasts, please give us your feedback: https://focusonthefamily.com/podcastsurvey/

  Vidcast:  https://youtu.be/TGSSf-I_9Tg   The CPSC and Makita USA Inc. now recall Makita Cordless Hedge Trimmers.  The teal-colored blade guard on these hedge trimmers is missing creating laceration hazards for users.  About 2600 of these hedge trimmers were sold in the US at home improvement stores, hardware stores and other independent outdoor power equipment stores nationwide and online at HomeDepot.com and Amazon.com.  If you bought one of these hedge trimmers, stop using it and contact Makita at 1-800-462-5482 to arrange for a free repair.  The company will provide you with a prepaid shipping label to return your trimmer to their repair station.   https://www.cpsc.gov/Recalls/2022/Makita-U-S-A-Recalls-Cordless-Hedge-Trimmers-Due-to-Laceration-Hazard   #makita #hedgetrimmer #safetyguard #lacerations #recall  

  Vidcast:  https://youtu.be/td9JaYCpLPA   The CPSC and DeWALT have recalled DeWALT 12-inch Sliding Compound Miter Saws.  The rear safety guard on this mitre saw may detach or break creating the possibilities that the user could sustain deep lacerations from the exposed saw blade and that projectiles could strike the user or bystanders.  About 1,364,000 of these saws were sold in the US and about 118,600 were sold in Canada at Lowe's stores, The Home Depot and hardware stores nationwide, and online at Amazon.com, Lowes.com and at other websites.  Immediately stop using these recalled saws and contact DeWALT at 1-800-990-6421 for information regarding receipt of a free repair kit.  Alternatively, owners may take their saw to a DeWALT service center for a free repair.   https://www.cpsc.gov/Recalls/2022/DeWALT-Recalls-Nearly-1-4-Million-Miter-Saws-Due-to-Injury-and-Laceration-Hazards   #dewalt #mitresaw #safetyguard #lacerations #penetratingwounds #recall  

  Vidcast:  https://youtu.be/rZrHqnl1AYs   The CPSC and Vichy Laboratoires now recall Vichy Laboratoires LiftActiv Peptide-C Anti-Aging Ampoules.  These small sealed vials containing anti-aging facial sera seem to weaken and crack over time leading to laceration hazards for fingers and hands.  About 206,200 of these ampoules were sold at CVS, Walgreens, and Target stores nationwide and online at Amazon.com and www.vichyusa.com.  If you bought this product, do not try to open these vials.  Contact Vichy USA Consumer Care at 1-844-973-0595 to receive a full refund.   https://www.cpsc.gov/Recalls/2022/Vichy-Laboratoires-Recalls-LiftActiv-Peptide-C-Ampoules-Due-to-Laceration-Hazard-Recall-Alert   #vichy #liftactivpeptideC #ampoules #lacerations #recall    

Podcast summary of articles from the June 2022 edition of the Journal of Emergency Medicine from the American Academy of Emergency Medicine.  Topics include hand and finger lacerations, thromboembolism in COVID, ultrasound guided subclavian lines, difficult airway, nasal TXA, and pediatric opioid prescriptions.  Guest speaker is Dr. Tyler Hughes.  

Doc Timko and Yardley talk about horse emergencies how veterinarians will approach different wounds and lacerations in your horse.

Take Home Points Don't make bite width to small – look at the curvature of the needle – start the bite at half the curvature of the needle Don't pull too tight – this will pucker the skin and lead to poor healing due to ischemia at the wound borders Laceration repairs are not sterile! ... Read more The post REBEL Core Cast – Basics of EM – Lacerations appeared first on REBEL EM - Emergency Medicine Blog.

  Vidcast:  H-E-B Bakery Two-Bite Brownies on Recall   The FDA and H-E-B are recalling H-E-B Bakery Two-Bite Brownies and H-E-B Simply Delicious Cookies with Brownie Bites Party Trays. These products contain metal fragments that could lead to injuries of the mouth, throat, and gastrointestinal linings.  The items were sold in Texas and Mexico. If you bought these pastries, do not consume them.  Return them to the place of purchase for a full refund.  For additional information, call H-E-B Customer Service at 1-855-432-4438.   https://www.fda.gov/safety/recalls-market-withdrawals-safety-alerts/specific-items-containing-h-e-b-bakery-two-bite-brownies-manufactured-outside-supplier-voluntarily   #heb #brownies #cookies #foreignbodies #lacerations #recall  

Fei and Nick discuss obstetric lacerations: how common are they? How do we repair them and manage them?  Don't forget to check out our Rosh Review question of the week! Go on our website to find out how to win a whole year's worth of board review questions.  Twitter: @creogsovercoff1 Instagram: @creogsovercoffee Facebook: www.facebook.com/creogsovercoffee Website: www.creogsovercoffee.com Patreon: www.patreon.com/creogsovercoffee You can find the OBG Project at: www.obgproject.com

The New Free-work style of office space optimization is not as OPTIMAL as MeLia hoped it would be. When the Broadcast Bay is taken over by a Leadership Brainstorming Session, she is forced to give the morning announcements patched into the broadcast array from outside the ship! Fun Video Episodes are transcribed with Open Captions for the Deaf and Hard of Hearing on Youtube. Visit us on https://www.GoodMorningAntioch.com for all updates and fun Antioch Merch. Like us on Facebook at https://www.facebook.com/GoodMorningAntioch. Or get updates from MeLia0743 on Twitter @BMSSAntioch Become a patron at Patreon https://www.patreon.com/GoodMorningAntioch to gain access to exclusive video content like table reads and puppet outtakes! --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app Support this podcast: https://anchor.fm/goodmorningantioch/support

Sources:The Staircasewikipedia.orggrunge. commentalfloss.comPeterson-staircase.comoxygen.comthecinamaholic.comharpersbazzar.com 

This episodes walks through the different types of lacerations and how they are repaired.  Our practice website can be found at: Maternal Resources: https://www.maternalresources.org/ Remember to subscribe wherever you get your podcasts.  Please consider leaving us a review on iTunes Our Social Channels are as follows Twitter: https://twitter.com/integrativeob YouTube: https://www.youtube.com/maternalresources IG: https://www.instagram.com/integrativeobgyn/ Facebook: https://www.facebook.com/IntegrativeOB

  Vidcast:  https://youtu.be/4zUTQii27F0   The Coca Cola Company announces the recall of Minute Maid Berry Punch, Strawberry Lemonade, and Fruit Punch.  These products may contain metal bolts or metal washers.  The products were sold in Pennsylvania, Connecticut, New York, North Carolina, Maryland, Virginia, Maine and New Jersey.  They have long shelf lives extending into January 2022.  If you have any of these products, return them to the point of purchase for a refund.  If you need more information, contact Coca Cola by phone at 1-800-Get-Coke or 1-800-438-2653.     As a side note, it is interesting that the FDA is not co-sponsoring this recall.  Why, we don't know, but some have suggested that the Coca Cola Company is getting preferential treatment from the FDA.   https://www.coca-colacompany.com/contact-us   #cocacola #fruitpunch #foreignbodies #lacerations #recall  

EVERYDAY ADVENTURES: Two very active school-aged brothers describe various thrills and spills.

It was a week full of LACERATIONS! Teams got lashes like errant Caribbean children and GreenBaje breaks it down for you! We have a special return guest, the Cam Fan Jason Reid to help us break down what happened in week 10, ask the question Who Do You Trust and get you ready for week 11!

  Vidcast:  https://youtu.be/MPnWGwKUvy0 The FDA and Ivar's Soup and Sauce Company are recalling Ivar's Kettle Classic Clam Chowder with Uncured Bacon.  This product may contain hard, sharp opaque foreign bodies that could lead to lacerations of the mouth, tongue, throat, esophagus, or airway.  This soup was sold by Costco stores in Illinois, Indiana, Iowa, Kansas, Kentucky, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin.  If you bought this clam chowder, do not consume it.  Return it to the place of purchase for a refund.  For more information, contact Ivar's by phone at 1-425-493-1402.   https://www.fda.gov/safety/recalls-market-withdrawals-safety-alerts/ivars-soup-and-sauce-company-recalls-kettle-classic-clam-chowder-uncured-bacon-because-product-may   #ivars #clamchowder #foreignbodies #lacerations #recall ivars, clamchowder, foreignbodies, lacerations, recall   The FDA and Ivar's Soup and Sauce Company are recalling Ivar's Kettle Classic Clam Chowder with Uncured Bacon.  This product may contain hard, sharp opaque foreign bodies that could lead to lacerations of the mouth, tongue, throat, esophagus, or airway.  This soup was sold by Costco stores in Illinois, Indiana, Iowa, Kansas, Kentucky, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin.  If you bought this clam chowder, do not consume it.  Return it to the place of purchase for a refund.  For more information, contact Ivar's by phone at 1-425-493-1402.   https://www.fda.gov/safety/recalls-market-withdrawals-safety-alerts/ivars-soup-and-sauce-company-recalls-kettle-classic-clam-chowder-uncured-bacon-because-product-may   #ivars #clamchowder #foreignbodies #lacerations #recall  

In 2018, BLS data shows hand, wrist, and finger injuries comprise more than 43% of all upper extremity injuries that caused days away from work.  On this episode of the MEMIC Safety Experts Podcast, Al Brown, MEMIC's Director of Ergonomics takes a look hand injuries causes and some strategies for prevention including MEMIC's E-Ergo™️️ tool, use of gloves, and tool and workplace design.   Peter Koch: [00:00:04] Hello listeners, and welcome to the MEMIC Safety Experts podcast, I'm your host, Peter Koch. Besides our voices, our hands allow us to express creativity and emotion through gestures and complex movements. The hand and wrist, believe it or not, have more than 27 different bones and 30 muscles, in addition to tendons and ligaments that allow for a staggering number of movements in positions. We use our hands every day to point, grasp, move, support, throw, catch, you name it. Our hands are usually involved with what we're doing, even gesturing right now. As I'm talking, I'm using my hands. You can't see them, but I am using my hands. Without them or even without one of them will struggle to live up to our potential. Think about it for a minute. Consider your day. So far, whenever you're listening to this podcast, what have you done that didn't require one or both of your hands? How did you put on your glasses or put in your contacts or on your sunglasses? How did you tie your shoes or brush your teeth, drive your car, [00:01:00] grab that cup of coffee? Using our hands to do things is so commonplace that we typically take them for granted until we hurt one of them. So a story, I had to take my dad to the E.R. the other day after a fall and we were checking in. And as we were checking in, a chef who, you know, you could tell he was a chef because he had the apron and the chef's coat that had his name on it. Chef Andy, he walked in holding his left index finger covered in a bloody rag, and he was treated in the next space over from my dad and I. And once the bleeding was stopped and I was listening, he was whisked away to see the orthopedic surgeon because they couldn't treat him there. I expect he's going to have a good outcome, but I imagine, at least for the next few weeks, he'll struggle with everyday activities, not to mention his work duties. So cuts and lacerations, crushing injuries, struck by injuries are all pretty common. There's good data out there to show that PPE can help reduce the severity of the injury that was caused by the event. However, there are a raft of other injuries [00:02:00] that are even more difficult to prevent because they're not always caused by a specific event like a splinter or a laceration. Injuries caused by prolonged static or awkward postures can be just as crippling as a traumatic event, and the healing process can be way more prolonged and dependent upon the injured person's changing their behavior or the workplace changing configuration or tools. So on the podcast with me today is Al Brown PT and director of Ergonomics, for Maine Employers Mutual Insurance Company, or MEMIC. Al has been on the podcast a number of times before and always brings a great perspective as to how the body interacts with the stressors in the workplace and what to do about them. Today Al is going to help me get a better grasp. Pardon the pun, of the causes of hand and wrist injuries and how to prevent them. Al welcome back to the podcast. Al Brown: [00:02:51] Thanks, Peter. Appreciate that. I have to hand it to you. That was a great intro. Peter Koch: [00:02:55] Oh, I'd Shake your hand Al for that for being on so many times and hopefully we'll stop being [00:03:00] quite so punny as we get moving Al Brown: [00:03:03] Jazz hands. I'm so excited about this. Peter Koch: [00:03:07] So this is awesome to have you back on. And I know we've talked about this subject a lot because hand injuries, regardless of what it is, are very common and one of the more common types of workplace injuries that we're going to see. So let's talk about some of the stats that are out there like we know it's a problem, but how big a problem are hand and wrist injuries out there in the workplace? Al Brown: [00:03:28] Looking back through some of the data and when you look back through some of the Bureau of Labor reporting and OSHA, they probably account for about a third of work related injuries. And that's when you sort of include, you know, the hand, the wrist and a little bit of the, you know, the forearm. But they account for about a third and their second, probably only to back injuries when you look at that data. So significant. Significant. [00:04:00] And then, you know, there's you know, when you look at costs, for example, loss of a thumb, you were talking about the gentleman that walked into the E.R. with the bloodied finger had he chopped off his thumb and could not put it back on. That's a thirty five thousand dollar for permanent disability kind of thing. That that's a chunk of change. When you think about it, you know, when you look at tendon repairs, they can cost up to 70,000 dollars. So it because of the intricacy of the hand, the fine motor activity, the abilities, there's a lot of things that can go wrong. You know, we often think about hand injuries to in the world of manual material handling, lifting, moving, carpentry, things like that, the chef. But we do see a lot of hand injuries just in the office environment, too. As matter of fact, a good portion when we look at banking and looking at law firms and accounting for in places like that,  [00:05:00]probably the leading injury. Second, I should back up and say slip trips and fall seems to be number one, but when we look at strains, sprains and injuries along those lines, their leading body part injury is the hand. Wrist and hand or upper extremity. So it is very common that we see these across all industries. Peter Koch: [00:05:21] Yeah, and I think people tend to think about the severity of the hand or wrist injury with those traumatic type injuries. And I imagine you have stories like this, too. I have a friend way back when I was actually building houses, he was a phenomenal carpenter, an amazing guitar player, fingerpicking guitar player, could play just about any style, could hear it, and within a few minutes figure out the melody without any music in front of them. And just amazing guy. And he was ripping some plywood on a table saw without a guard, and he got a little kickback and put his hand down [00:06:00] on top of the spinning blade and pretty much cut his hand from his index finger across the meat of his thumb down to his wrist. And it took enough of the muscle out of there where it took him almost five years to get the dexterity back, to be able to finger pick again. And just, you know, you think about those severity things. People think about machinery, like you said before, with the severity of the injury. But we've also seen some pretty significant injuries that have come from those awkward postures or repetitive type injuries that might happen in an office. They just happen over a longer period of time. It's not that instantaneous. I touch something and it caught me or it crushed me and I have a permanent injury. So those same things can happen regardless. And I think it's important to know not just what can injure you in around the machinery, but what can injure you within in the other parts of the workplace. Those maybe not quite [00:07:00] so dangerous sounding jobs that are out there. Al Brown: [00:07:03] My common thread, if you ever listen to the podcast that we've talked about, I always talk about gravity. I talk about neutral. And the reason, you know, we are a structure walking around in this world of gravity. So balance is real key. Our body likes that balance the wrist and hand. There's an orchestration between brain and hand. And it's funny, we're you know, we're right. People who are either right handed or left handed. There is a core of the population that is ambidextrous. But you're either right handed or left handed, right handed people, believe it or not, your right hand is controlled by the left side of your brain and your left hand is controlled by the right side of your brain. So about 80 percent of the population is right handed. So there's about 10 to 15 percent of the population that's left handed. You talk about guitar, you're going to buy a guitar. You know, just and you said my son was left handed. He said, I went into the store, music store and I said, hey, we'd like to get a left handed guitar. They totally [00:08:00] discouraged us from doing that because they said wherever he goes, if he walks in somewhere and that happens to be a guitar laying there and someone says, hey, you play the guitar, why don't you strike a tune for us? And he picks it up and it's a right handed guitar and he's learned on a left handed guitar, he will have a very hard time playing it unless you're Jimi Hendrix. Peter Koch: [00:08:19] I was just thinking about that, too, right, Al Brown: [00:08:22] Who flipped a right handed guitar upside down and learned to play it left handed. So there's, you know, looking at fine motor again, that's that relationship between brain and hand and the fact that it's such a complex structure and much of what we do is unconscious in nature. When you start to create those muscle patterns going between hand and you look at the complexity of it and it's repeated patterns over and over and over again, they say that the hand will go through twenty five million bends and stretches over a lifetime. That's one hand. Peter Koch: [00:08:58] Wow. Al Brown: [00:08:58] So, I mean, that's [00:09:00] just incredible. And if you are someone like a guitar player or a piano player or a carpenter, that hand is just put through those repeated motions over and over again. We do a lot of unconscious repeated behavior. Peter Koch: [00:09:14] We definitely do. And there's that. We were talking about this before the podcast as well. There's that relationship between power and dexterity that the hand has. That's pretty amazing. You talk about a carpenter, right? So I need to have the dexterity in my hand to be able to pick up a nail and hold it in place. But I also have to have the power in my other hand to be able to mash that nail into whatever wood that I'm going to be driving it into. And so that's tough, too. Now, you are doing a little bit of research on some of those fun facts around, like what the hand can actually do. And I think it's pretty fascinating. So, like, if you think about power, like how strong are people's hands compared to how dexterous people's hands are because it lives in the same body, you can do the same thing. Dexterous things and pretty strong [00:10:00] things. Al Brown: [00:10:01] Yeah. I looked up some of those things, but, hey, back to that hammer thing. Yeah. And the ability to hold on to that nail and come down and strike that thing with something very hard, hoping you don't hit the wrong nail. Peter Koch: [00:10:17] Very true. Very true. Al Brown: [00:10:19]  There's a relationship there. A rookie, the new employee is going to hit more fingernails than maybe the person that is more seasoned. So, you know, there is that. But when we look at the extremes, it was a fun little search I did on the internet and I said, OK, what's one of the most powerful things the hand could do? And I said, well, grip. And I said, what's the most? So I looked up, what's the biggest deadlift of the world record for the deadlift? And I guess it was set back in May of 2020 by a person named Hawthorn Björnsson, nicknamed Thor, [00:11:00] very apropos from Iceland, and he lifted over eleven hundred pounds of force in the deadlift. So that's, you know, granted he does have an assist with the grip, with some straps. But other than that it is, you know, each hand is handling, you know, five hundred and fifty pounds of force that he has to hang on to in order to stand upright, that the large muscle body, large muscles in his body is his buttock, his back extensors, his quads have to lift, but he has to hang on to the weight with his hands. I'm going to go to the other extreme. You go to the other extreme. And I said, what's the most difficult piano piece to play? And there was a number of top choices. But the one I picked was it was Beethoven's number twenty nine B flat major Opus 106, which if you look at that online, it has got to be one of the fastest hand movements and so intricate that it's very difficult [00:12:00] to even the most seasoned piano players to play. So you look at that extreme from those fine manipulating motor activities that have to move each individual finger to lifting 1,100 pounds, you know, that that just fascinates me in the extreme abilities of the hand. Peter Koch: [00:12:20] It is amazing what the hand can do. And that's just fascinating to be able to lift 1,100 pounds with the weak link being the coupling of your hands. Right. To be able to lift that whole thing. And then I'm pretty sure Thor's not a piano player. But, you know, if he is, he's probably not playing Beethoven. But you never know Al Brown: [00:12:37] Could be could be. Peter Koch: [00:12:41] Even to be dexterous enough to take a pencil and write your name, all of the fine motions that have to happen to be able to hold the pencil at the particular angle and then produce the motions and the movement with your hand, your wrist and your fingers to make the script occur on the page is all fascinating [00:13:00] and how your hand can do that and the connection between your brain. And we've all probably maybe some of our younger listeners might not have had this as much. But I bet you remember going back to school and getting a cramp in your hand, taking notes in class at some point in time, like you're just you're furiously writing notes to keep up with the professor who's up in front of you. And, you know, you're shaking your hand out because it hurts, because you're gripping it so hard that I'm not at neutral anymore. I'm causing some discomfort and from not so much overuse, but probably not the best posture or trying to produce those different fine motor functions in a way that's not allowing me not long enough circulation to move through. So really amazing what the hand can do. And fascinating, there's lots of different parts of the body that have that like we talked about the spine before, that have that's a lot of power and in functionality and movement [00:14:00] within that as well. But the hand really lots of cool things that can happen that it can do for sure. Al Brown: [00:14:05] Well, it's been a big paradigm shift. I mean, you go back to me and you start with chalk on a chalkboard, go to a pencil, you know, and you know. So chalk is a different kind of prehensile grip to actually right on the chalk. Prehensile grips or the different things like pinch grips, like, you know, your thumb, your pulp grip. And, you know, there's three point chuck grip. The chalk was like a three point chuck grip. Then you went to a pencil, which was more like a prehensile grip or fine motor activity to now where we hover over a keyboard. So if we hearken back to the days, it's a matter of fact, the handwriting has gotten progressively worse simply because most folks are hanging out on the keyboard now, typing away. So the ability to write and take notes is really sort of it's just a different format.  Peter Koch: [00:14:51] I Finally feel normal because my handwriting has been messy all my life and now I fit in with everything else. Al Brown: [00:14:56] You fit in with the rest of the crowd. Peter Koch: [00:14:57] Lowering the bar [00:15:00] every day. Right. There we go. Just kidding. Al Brown: [00:15:03] I'm still trying to figure out the keyboard. So, you know, Peter Koch: [00:15:06] It is an interesting shift. And that shift from writing on the chalkboard to taking notes with a pen or pencil to the manual typewriter, to the automatic typewriter and now to the computer keyboard has really changed how writing or written communication affects our physical the physical demands. Right. So the written word hasn't changed. You could we could have a whole other podcast on how that is altered. But you think about written communication. I have to send something or write something that someone can read going from the student or the professor to the student, the student to the paper. And now, you know, all the way to the computer keyboard has really changed the demands of what the body needs to do in order to get the word onto whatever medium you're doing. And there's different exposures there. Right. So that exposure [00:16:00] of writing is very different than the exposure for typing, and it creates different challenges for us. Al Brown: [00:16:06] Then throw in the mouse, you know, if we go back to that office environment and then, you know, a lot of things are sort of driven by the mouse and the mouse was a later invention from the keyboard. And then we all sort of kind of placed it out to the side. So then the fine activity of the hand, there's different shape mice out there nowadays because I can't tell you how many folks I deal with that have you know, they've got tingling in this hand. They've got discomfort like on the corner right below the bottom of your little finger, like way back by your wrist. There's a bone right there. And it's called your pisiform. And a lot of people that have limited space by their keyboard will be pivoting on that. And they create what's called a contact stressor. So you'll see it'll be red and angry and they'll go, it hurts right there. And it's yeah, I don't know why. And it's, you know, just hanging out [00:17:00] on that mouse and pivoting on that part of your wrist, just moving the mouse back and forth. So it's or you take people to ask about vertical mice, mice that are vertical. Well, if it's too vertical, your fingers want to drop down to earth. Welcome back to Gravity. So even though that's a small muscle group, you tend to hang on to that vertical mouse a little bit harder than you would maybe a semi vertical or a flat mouse. So all of a sudden you're noticing discomfort in the back side of the thumb or in the forearm, the different names from De Quervain's tendonitis. And it's because you're trying to hang on to this mouse just because of its positioning. So those subtleties in life have become more frequent simply because the way we compose words nowadays are kind of hovering over these things in front of us. Peter Koch: [00:17:52] So let's just break that out a little bit, because, you know, we've talked about some of the most frequent injuries being cuts, lacerations, abrasions, and we're going [00:18:00] to touch on those and prevention of those. But let's break apart the process of typing, because most people are going to do it. You know, even if you are, you don't have an office job, you don't have a job that demands you be in front of the computer all the time, the majority of us are going to be on something, whether it's an iPad or a phone or some electronic device that's going to have some sort of static posture that's you're going to be generating words with in some form or another. So why do we see so many repetitive stress or awkward posture type injuries or claims coming from keyboard and mouse use? He talked about the pisiform bone and the pivoting on that piece and mouse. But there's other stuff that happens to, you know, people do you know, how does that happen? What happens and what do we do to prevent it? Al Brown: [00:18:49] Sure. Yeah, no, that's just one little tiny piece. But yeah, we could do a whole lot. Peter Koch: [00:18:53] Yes, we could. Al Brown: [00:18:54] Let me give you the highlights. I mean, some simple basic problems. We run into standard desks [00:19:00] that were those writing desks that we used to have in the past, that we still have are twenty nine and a half inches high and most chairs that we sit on probably go up to about 20 inches. The seat pan. There's quite a difference between twenty nine and a half and twenties, about nine and a half, almost ten inch difference between seat pan height. So if the desk, which often is the case, is too high, we have to manipulate that keyboard and put it in certain positions which as if we can't reach parallel if our forearm and wrists, are recess to be in line with our forearm and hovering over our keyboard. If we can't get to that posture on our current situation because the desk is too high, the chair's too low, we tend to either push the keyboard back or we put the keyboard might be too low or too high. We change that angle between wrist and forearm. And as that changes, the further it gets away from neutral, where the hand is parallel with the forearm, the more [00:20:00] you close down a place that delivers the nerve and blood supply to the wrist and the hands. And the more you start to fatigue the shoulders, too, and the more you start weight bearing on those and creating these awkward postures so you can get tingling in the fingers. If you're seated too low, your arm might wing out to the side and you might rested on the arm of your chair. It might be resting on the return on your desk and all of a sudden you expose and compress the little nerve that goes right around your elbow called your funny bone or your ulnar nerve. And you're noticing that your fourth and fifth finger kind of go and tingly. So again, just the height of the desk and this little discussion we're having will impact what happens to your hands if the reach to the mouse is too far. And again, remember standard keyboards, Pete, you've got the qwerty, which are the letters which are typically like a typewriter, but then, I don't know, someone mandated we got to have a number [00:21:00] pad. So they hung that out on to the right side of the keyboard. And then if you look at 80 percent of the population is right handed. Where do they all tend to put the mouse? To the right hand side of the keyboard? So now that arm has moved way out of neutral to go get it and people tend to hang on. That's when they start pivoting on the wrist or loading up the wrist in hand. And that's when we start to see the forearm elbow tendinitis, because folks are parked in a very long distance away from the body. So we're trying to bring everything back in closer. You were talking about the connection between brain and hand. One of the suggestions we often give for the keyboard with the number pad to the right, with the mouse to the right with a with a standard bilateral mouse, one that you can use in either side is what you put the mouse on the left hand side of the keyboard. What do you think the response is when we say that? Peter Koch: [00:21:52] I can't do that. Al Brown: [00:21:53] I can't do that. Peter Koch: [00:21:54] I can't do that. Al Brown: [00:21:56] And it's a simple motor pattern, just moving something around and clicking it. But it [00:22:00] brings it's a quick, easy solution to bring things more into neutral and reduce the forces on the wrist and hand and shoulder and neck. And it takes a couple, three days. It's just a motor pattern, but that's a plan. But again, that's that right left brain. This is my dominant hand. Don't try me. Tell me. And again, you go back to injury. Many folks listening to the podcast today that may have been that are right handed, that might have fallen and sprained their wrist, the right wrist or fractured it. And we're casted very quickly discover how dependent they are on that right hand, but realize after a couple of days that the left hand is a good second choice and it steps up to the steps up to the plate and does a pretty good job after a couple, three days. Peter Koch: [00:22:49] It is amazing how you can train your body to do a different act or an activity in a different way when you're forced to do it. But that's an interesting [00:23:00] part, too. And I think we'll talk about this as we go through that prevent the prevention piece. It's one of the challenging pieces of repetitive motion or awkward postures, because they're cumulative, because they take time to do that and it takes time for you to learn the other way to do it. You should be kind of doing this all along, switching from side to side so you don't have the repetition or the constant awkward posture of the constant pressure on that one side happening. But it just takes time. It's weird. I know one of my friends, they broke their right forearm and they were casted. So they really couldn't do a whole lot with that. And I remember them. The hardest thing for them to change was brushing their teeth. And they came to me one day. We got coffee together and a blistering hot cup of coffee and they took a sip of the coffee. And it burned. Right. But I took a sip of the coffee and it was hot, a little burning. But they were like incredible pain, like, [00:24:00] Dan, what's going on? It's like, well, I was brushing my teeth today with my left hand because I can't do it my right hand and I stab myself in the back of the throat with a toothbrush because they just didn't have the fine motor control of that. But, you know, a week later, they were like at no big deal. It works just fine. So it just takes a little while to figure it out, to learn it. Yeah. Yeah. That retraining of that. Al Brown: [00:24:21] Yeah. Discomfort breeds change. But I mean, that's the only thing that kind of, you know, and that's the problem is that's why people won't learn, you know, kind of flip flop back and forth unless there's some discomfort or problem or, you know, something that restricts you. You typically don't change simply because it's just more efficient to just keep moving forward and using that your right hand or your, you know, whichever handed you are. Yeah. And why change, you know, until you have to. Peter Koch: [00:24:46] Right. Right. Now, let's talk a little bit about anatomy and physiology of the hand and wrist, like we talked about that it is a really it's a very dexterous body part for us. We can do lots of things that can be powerful. It can be really it [00:25:00] can do a lot of fine motor stuff. But what allows it to do all those things? What's the anatomy that makes it all up? And then how does some of those postures affect the anatomy that cause some of those challenges in repetitive or awkward posture injuries? Al Brown: [00:25:17] Sure. Yeah. Well, you had mentioned earlier there's about and again, it varies. Some people have some extra little bones in the hand, but somewhere between 27 and 29, bones that make up the wrist and hand and it's about it, believe it or not, that's about a quarter of all the bones in the body are little spot. Yeah, right there, you know, about thirty muscles, about 129 ligaments, about 17,000 touch receptors in the palm, you know. So when you look at all those things that come together. Now, here's the thing. Most of the muscles that run the fingers, there's only tendons up in the finger, the belly of itself, the muscle itself. So if you think of a bicep, because everybody's kind of familiar with the bicep, the biceps [00:26:00] has this big meaty part in the middle of your upper arm. And then it what it does is it pars down to like a tendonous structures that connects below the elbow and then another two tendonous structures that go up into the shoulder. Very much like the hand, the meaty part of that muscle for the fingers is in the palm of your hand and it's just the long tendon structures that go up into your fingers and those things run your fingers. You can kind of wave your fingers around. You can make it sort of, you know, like bring your knuckles down and straighten your fingers out that your lumbar curls. But then the thing that moves your wrists, those muscles, the long tendons go up your forearm and those meaty part of it is your forearm itself and then attach to the elbow one of the problems we run into when you make a fist. OK, if you if you hold your hand up in front of you so that your thumb is kind of facing you and you make a fist, OK, you're going to look at the upper fingertips. They're all curling down. [00:27:00] But as they curl down, you'll notice the knuckles, you know, sort of at the base of your finger where the hand comes up and then the base of the finger. If you look at the back of that, hand back your hand, which way is the back of your hand moving? It's actually moving backwards away from that curl. Well, that's an orchestration between the flexors and the extensors of the wrist. The flexors are curling your hand down, but the extensors at the same time are pulling your wrist back because it makes it a more efficient grip. And that's why your hand tends to drop back in. Those muscles, the flexors attached to the inside of your elbow, kind of the part of your forearm that doesn't have much hair sort of that. And you get a little bump on the inside of your elbow. The extensors go up, that sort of the hairy side of your forearm and attach on the outside of your elbow called the if people have injured that before, it's called tennis elbow. And the reason for that is it tends [00:28:00] to be an injury that tennis players got. And when they would hit backhand, the ball would hit the racket and do a quick jerk and they'd get sort of a torque on that tendon. Making a fist, that balance between those muscles is so important. And, you know, we will do if you took the hand and you had someone just grip and we can do this with a grip dinamometer where you can measure the grip strength. And say you could generate 100 pounds of force with that. And you did it in neutral, which means that hand is balanced and right there in front of you. But then if we put the hand in an awkward position, kind of reach out, you might have to flex the wrist a bit. People will lose when we have them do that same amount of effort and force. They'll lose anywhere between 20 and 40 percent of their ability to generate grip strength. So think about that in the world of work in that if I have to work in an awkward position with my wrist in hand, I think of a company that I was working with that were putting trailer lights on. They [00:29:00] had to hold the light, what they were holding the light with the left hand and then there reaching up around and back to put the knot on. So that hand was on a very awkward position for an extended period of time, very inefficient, lost most of their ability to generate force. So it took more energy to do that all day long. Fatigue came quicker. What do you think the quality of the work was by the end of the day? Peter Koch: [00:29:25] Oh, I'm sure a lot more mistakes could happen there, too, right? Al Brown: [00:29:27] Oh, dropping the nut, you know, not, you know, not fully tightening the nut. Even you start to lose your ability to palpate and feel and touch and your sensory your muscle strength goes. So now here is a worker hurting themselves, the product going out of the door, out the door. You know, you're driving down the road is the consumer. But yourself a nice new trailer and you're looking at the trailer lights banging along the road because they fell off, you know, and again and you bring the trailer back and go this trailer's horrible, I'm going to give it a one star. And so, again, [00:30:00] looking at design, how are workers working? How are their hands neutral? Understand that neutral position, set that workforce up so that they're more in a balanced position, better quality work, happier worker, happier customer. Peter Koch: [00:30:13] Yeah, and you can't change you can't change anatomy. So you've got to change something else about the work. So either the tool that they're using or the ergonomics of it. We talked a little bit about how to set that, you know, an ergonomic workstation up to be more in neutral. And that's the key. You've talked about that before. You said it's been a theme throughout many of the podcasts. And it is because any time you interact with something you want to look at, if I can start the job in neutral, how far out of neutral do I go to complete the job and how often am I there and how long am I there so neutral posture is a fairly important thing to remember, regardless of what the task is, and especially for something that you're doing with your hands, arms or shoulders for sure. Al Brown: [00:30:55] Pete I mean, think of tooling, you know, we were talking about pencils and computers [00:31:00] and you threw in typewriters. I forgot about those. I sort of skipped that era. But think about the morphing or the or the number of iterations. Of the screwdriver. Peter Koch: [00:31:14] Right, right, Al Brown: [00:31:15] You know, think about what a screwdriver looks like nowadays, it's you know, it's a pistol grip, you know, if that's what we're using and it's power driven. And, you know, think about, I remember having to put together a friend of mine said, hey, I got this shed and it was one of those aluminum sheds. And they said, I got it for free. And they handed me a bag of screws. I mean, we're talking a giant bag of screws like we're talking a small kitchen trash bag full of screws and said, could you put that together? And I had, there was no such thing as a power screwdriver. And, you know, two days later, I couldn't even, like, wash my hair after it was all over. I just couldn't move my hands [00:32:00] because of the number of rotations to put that together. But had I had a power screwdriver, life would have been glorious Peter Koch: [00:32:08] Sure faster, quicker, less repetitions. But I think that that breeds even a better question because take the power screwdriver out of it. Take the screw gun out of it for a moment. You can buy a screwdriver in many different sizes and configurations, not just the, you know, a Philips versus a star versus a flat bit, but the handle can be configured very different. Some are bulbous, some are long. Some are short. Some are textured. Some are smooth. And really, if you're thinking about it, there's multiple reasons for some of the different configurations. But when we talk about ergonomics, if I can't have the power screwdriver with the pistol grip and I have to use a manual driver to do that, because sometimes you have to what's the best way? Like what's the best type of grip for that hand tool [00:33:00] that you aren't going to be able to pistol grip it with? Al Brown: [00:33:04] We were just looking at some ergo film the other day, some film a company had sent to us in what's called our E Ergo process. It's where a company can submit video footage of a job and have us analyze it. They were manufacturing small products and in that particular case, and it's on a workbench and they're sitting and if they had a pistol screw gun, the problem is they actually have to, we call it deviate the wrist, which would be instead of flexing and extending. So instead of flexing your hand forward and extending it backwards, they actually have to deviate, which would be sort of tipping your hand toward your little finger side. And there's two deviations. There's ulnar and radial deviation where you can tip your hand towards your thumb side. But in this particular case, they'd have to go towards our little finger side with a pistol grip to actually do the work. In that particular case, a shaft electric screwdriver where they could literally [00:34:00] grab and come straight down with a power grip was much better for them. And with this particular tool, some of them are air driven, even we have them on a tool balancer. So when they release this thing, instead of laying it back down on the workbench, it actually hovers back up over the workbench so they can just reach up, pull down and do the screws. So in that particular case, a pistol grip would not have been effective, would have created probably more problems in some cases when there's really fine motor like small screws, even just a standard Old-World screwdriver works a whole bunch better. So, you know, you really have to look at the specific job and the tasks to determine what's the best tool. You know, you don't go out just by a bunch of pistol grip tool, you know, screwdriver to go there all fixed. You may be creating some of the problems along the way. So, again, go back to how do I keep that person's hand in good, neutral, working posture balanced? [00:35:00] You know, I wanted balance when I see really awkward extremes of the wrist. I know there's potential problems ahead. Peter Koch: [00:35:07] Right, so that deviation on their side radial side or flexed forward or flexed backwards are things to consider with the position of the work that you're doing and then thinking about where neutral is and then determining what type of tool is going to keep you in that neutral position. Best give you the best grip. That's good advice. Peter Koch: [00:35:31] Let's take a quick break so I can tell you about our E Ergo resource that can be used to help solve ergonomic challenges at your workplace, sometimes contacting, contracting with and scheduling an ergonomist or occupational health nurse for an onsite evaluation doesn't really fit with our Just-In-Time workflow. In a competitive economy fixing the problem right now is essential. And improving worker comfort and efficiency are key components to ongoing success. So [00:36:00] free to our policyholders. MEMIC's E Ergo tool can help you overcome ergonomic challenges. With just five quick photos or a short 30 second video and a brief description of what's being shown, you can send us the critical demands and essential functions within the work tasks once received are ergonomics team can identify risks and exposures and provide reasonable suggestions for ergonomic improvement within just a few short days. Start that E Ergo process now by logging into the MEMIC safety director at www.MEMIC.com/Workplace Safety. Now let's get back to today's episode. Al Brown: [00:36:42] One thing I didn't mention is when you look at if you were looking at a tool like a hammer or very much like a tennis racket or something like that, people want to get the right size grip, too, because of the tool is too small. I see this in dental offices, too. Like if you look at the pics and the different fine motor things that they're doing on your teeth, [00:37:00] you may notice that some of your dentist, your hygienists have like fat handled tools now. Well, they discovered that those really small stainless steel, tiny tools, they were actually over gripping because it was too small. So they had to work harder. You can also go in the other direction if it's too fat over gripping. So if you're going to go out and buy a tennis racket or a racquetball racket or a nice hammer, it's always good to go down. There's like a couple of creases in your hand, but the one that kind of goes right across the middle of your hand, if you measure from that crease up to the tip of your middle finger, that's a good sort of rough way to measure what the circumference should be of that thing that you purchase. It's you know, it's a good way to kind of determine what's a good efficient grip for you. Peter Koch: [00:37:47] Would a tool that measured, similar to this, the distance between that crease in your hand or the tip of your you said middle finger, index finger, Al Brown: [00:37:57] Middle finger, middle finger Peter Koch: [00:37:58] For that. So [00:38:00] if the circumference measure is pretty close to that, well, that feel pretty comfortable in your hand, like, is it does it pass sort of the straight face test of it feels good or will it feel fairly awkward in your hand if you're not if you're not used to it? Al Brown: [00:38:14] It should for the most part, you know, call it rule of thumb. Peter Koch: [00:38:18] I applaud you Al for bringing that in. Al Brown: [00:38:22] That it will you know, and this is we're talking about a power grip, too. We're not talking about a dental tool that should be that creates. But we're talking more of a power type tool, a racket, something like that. Yes. Most likely that'll feel pretty comfortable because that's probably one of the more efficient grips that will keep the muscles that are holding it. Remember those muscles on the back side of your forearm, on the front side of the forearm, make that power grip, you know, coupled with the thumb. You know, the one thing we didn't talk about is that thumb opposes, which makes us very different from a simian hands. I mean, the hand of the ones that you see in the monkey, but the [00:39:00] human hand can oppose the thumb. There's nine muscles that run that thing. So that's what helps us determine that most efficient grip. Peter Koch: [00:39:08] Is that one of the reasons we see, like if you think about landscaping or yard work, you're seeing a trend over the last I don't know how many years now you've seen it where you've gone from a very small wooden handle on your rake and your shovel to maybe a thicker fiberglass handle or a cushion, the thicker cushioned handle on that rake or the shovel or whatever hand tool that you're going to be using to give you a larger grip. Because I do remember like doing work when I was growing up or for my parents or my grandparents where, you know, you had the really thin broom handled rake to rake the yard with. And now if you grab one of those, I can tell you my forearms, my elbows, my wrists start to fatigue a lot more quickly. And, you know, old tendinitis kind of comes back, it feels like. But some of the larger grips, they feel a little bit more comfortable. So [00:40:00] is that the reason why they're doing that for those tools as well? Al Brown: [00:40:04] Yeah, that's a perfect example, Pete. I mean, that's a that's a prime example of how there's been a transformation of tools. And part of that, too, is if you remember the old rakes and old shovels and things, a lot of them, they were wooden handles and sometimes they were then varnish. So they became very smooth. So it's even that texture to that. You now look at modern day tools. If you go down to the hardware store, there are a little bit more rubberized. There's a little bit higher friction surface maybe at the end in the middle, the rakes, because that ability to grip on you don't need as much force if there's a better texture between your hand. Same thing with gloves. You're seeing gloves. Now, remember the old leather gloves, the old sort of cowhide leather glove with the big gauntlet cuff on it. And, you know, people just hand them out and, you know, you just really couldn't grip very well with them. And in fact, ill-fitting [00:41:00] gloves can really reduce your ability to grip. You can lose 20 to 30 percent of your grip strength simply because the glove is ill-fitting. I remember working at a large industry here in Maine and all they handed out were those gloves in large. And they have hands of every size there. So the person that fit them well, you know, fit their hand well would probably do well again, fitting the work to the worker. But then you give someone that, you know, might be a small person or very large person, probably more small where the hand goes in there and he got all this extra material and then folks. Well, you can't how come you can't grip on to that? And it's not because they have any less skill or ability. It's just they're trying to overcome all this extra material. So, you know, it's amazing how tools and gloves and things like that have really changed. And it's important to look at the right tool, the right glove, the right, you know, the texture [00:42:00] when you're when you're looking at ergonomics. Peter Koch: [00:42:02] So it enhances the grip. It provides better dexterity to give you the ability to use the hand and the arm in the way it was designed in the most powerful way so that you can do the work. Otherwise it gets in the way. I know I've been I've had that same thing where the only glove I have is one that doesn't fit well and all of a sudden it's I just can't do that. So what do you do? You take your glove off and then you go do the work and it might be better for you from a dexterity standpoint. It might be better for you from an economic standpoint, but it exposes you to all the other hazards which really haven't got into yet. And I think it's a good time to jump in to that particular exposure because we you know, we started this conversation with the chef coming into the E.R. with the bloody rag and cut his finger and having to go see the orthopedic surgeon. But there's a lot more ways that you can hurt your hands and probably for lack of a better term, more popular ways to hurt your hands [00:43:00] than a repetitive motion injury. So talk a little bit about that. What are the other ways beyond a poor ergonomics or a poor workstation set up where you can find hand and finger injuries? Al Brown: [00:43:12] Sure, sure. I mean, if you look at some of the common causes, it's, you know, fatigue, distraction and attentiveness. I'm guessing the chef someone yelled to him, "hey, hey", he turned and was still chopping as he was still doing that unconscious behavior. And just that inattentiveness changed things. And, you know, there goes the finger. So he has a new restaurant called Nine Fingers. It's a great place that no. So probably serves finger sandwiches. But there you go. One of the one of the things I always try to encourage, particularly in the manufacturing or the construction industry, is very simple thing. Jewelry and one in particular rings are really they contribute big time [00:44:00] to hand injuries that simply I encourage employees or employers to just say take your ring off and just put it on a chain on your neck, if you want to make sure that it's still with you and all that kind of good thing, or they have these breakaway rings now that now exists, which I'm actually seeing more and more in the industry because a simple ring Pete, to give you an example, coming down a ladder, if you're walking, you coming down a ladder and your hand over your feet and you're in good contact if you're lowering your body in that left hand with that ring, gets hooked on the ladder rung and you lower yourself, you don't react quick enough to go back up to protect your finger. And oftentimes we've seen fingers that are literally amputated or degloved where the skin is kind of pulled up and off. So just taking that ring off, having a glove on would have probably helped a bit. But still, the other [00:45:00] exposure that has to is in the automotive industry and ring on it. And you are working with something that's electric, like the battery, and you happen to ground out with that hand. That ring will conduct the electricity and cook the base your finger pretty quickly. So again. So those are two just jewelry. You know, as I say, if you want to keep your finger, don't put a ring on it. Peter Koch: [00:45:26] Oh, Beyonce. Al Brown: [00:45:28] Oh, sorry Beyonce. But that is true, you know, so we really tried. I worked with the lumber company and really, you know, I actually put together a sort of a fact sheet on that the degloving and that kind of thing to convince workers that you really, it was funny because I had one worker got stood up there and there was his ring finger gone and he goes, oh, yeah, that happened to me. I said, so there you go. Peter Koch: [00:45:53] Don't lose that story. Right. Gosh. Al Brown: [00:45:56] So and then, you know, other things like an industry. And it's funny because I'm [00:46:00] an ergonomist. So I walk in the industry and I look at more kind of physiology things that can happen to tendinitis is the muscle strains. But in manufacturing, you know, there's a lot of I learned the term at MEMIC pinch points where there are open wheels and belts where a finger can fit in and that, you know, you can create a amputation, you can create a crush injury, you know, so guarding and things like that or something, just like your friend took the guard off the saw and decided, you know, something went. And again, it's usually a tool that sort of changes its behavior, maybe either misuse or inappropriate use of the tool or, you know, he didn't have the guard on. Quickly it occurs. You know, you're thinking that wasn't good. Peter Koch: [00:46:50] No. And it just it really just takes an instant. I was reflecting, as you were talking about the ladder in the ring. And I imagine just about anyone [00:47:00] who's climbed a ladder. Often has had that experience where they're coming down and their ring catches for just a moment and it might not be enough to injure, but it's enough to remind you that, oh, that was close. And I got away with it. But, gosh, maybe the next time I'm not going to get away with it, maybe the next time I'm going to get caught and I'm going to actually start to load my entire body weight on that. And I'm going to what's going to happen. And there's plenty of evidence in the world to show that that's not a good thing. And again, like amputations, machinery, amputations, where someone either an improperly guarded tool or the employee purposely defeats the guard or the guard is not functional. And they get their body part, their finger, typically the tip of one of their fingers is going to get too close to those rotating parts. And there it's gone. And even, you know, we don't we take for granted a lot the weight of things that we work around.  [00:48:00]Again, it's funny, there's always a story for something. But again, I worked with a guy. They were loading jersey barriers onto a back of a truck after they had finished a construction project. And as he was loading the second to last one, he was guiding it with his hand. Right. So had it on the inside of that. And it didn't touch really hard against the Jersey barrier. That was that it was sitting down against what had touched enough. So it crushed the tip of his middle finger inside his glove. But, you know, pretty much lost the tip of his finger from his nail bed up to the top because it was crushed with the weight of it. And it just took an instant. And he talked to him later on. He said, oh, I knew how heavy it was, but I only think about the quote unquote, impact of what would happen if it just tapped against another immovable object. So just we take things for granted. A lot of things for granted. Al Brown: [00:48:53] Yeah. Speaking of granite, in the world of stone masonry and building stone [00:49:00] walls and landscaping, that same incident occurs when someone is moving a large rock and placing it on another. And it's actually referred to as the granite kiss. And that's where two rocks and your finger become. And so that's something you can't take for granted when you're placing rocks. Peter Koch: [00:49:23] You sure can. And I would imagine you start to look at that type of industry and this goes to landscaping or even carpentry or any time you're going to be working with your hands in an environment where there's a lot of abrasive materials, just a glove. And again, the right fitting glove is going to go a long way to prevent many of those minor injuries. And in a minor injury like a cut or laceration, even someone's using a box knife to cut sheetrock or they're cutting up cardboard to put in the recycling piece. A fairly [00:50:00] minor injury is going to take that person out of the work for a little while to go get treated. And they might not even go to the doctor, but they got to go get a bandage and clean it out properly, because if they don't, chances are it's going to get infected and then it's going to be worse later on, where a simple 5, 10, 15 dollar pair of gloves, depending on how dexterous you really need your hands, would have fixed that or prevented the injury. The event would have still happened, like the slip with the knife or the granite kiss would have still happened. But the glove would have reduced the severity of that event. That's something we don't always think about. But it's a recommendation that happens almost all the time when we go down onto a job site where they're doing something manual with their hands and they're not using gloves, why not use gloves? Al Brown: [00:50:47] Yeah, just think like passing lumber. You know, I worked at a lumber mill or just slide boards off what they call the green chain and sliding, you know, and if barehanded, how [00:51:00] many times have you slid a board through your hands and just taken a sliver somewhere? And just that tiny piece of wood is painful and we're not even talking about something that might be, you know PT, which has got the chemicals in it, which now you would you know, you've introduced a sliver with chemicals into your hand. So just a glove allows you to let that slip through and avoid or at least mitigate that risk a lot just by having that extra protection. Peter Koch: [00:51:29] Sure. Al Brown: [00:51:30] So, you know, I never sort of do anything without my gloves on. You know, as I've gotten older and I'm less physical, my hands are less resistant. I don't have the buildup. So even more important. And that's when you look at some of the data from OSHA, NIOSH, it's a lot of times it's the new employees, the sort of the new workforce less experienced that, you know, these things occur. So even more to protect and guard them. Folks [00:52:00] in the middle tend to be a little bit more seasons have been around, they kind of get the value of that, and then the next exposed group is more the older worker, 55 and older experienced understand. But their recovery time takes a lot longer. So you really do want to make sure they're protected doing what they're doing. Peter Koch: [00:52:19] Recovery's a lot longer, and I think reaction time is a lot slower as well. So you just think about what a glove would do, even that simple passing lumber from point A to point B or even if you're a finished carpenter and you're moving sheet goods from point A to point B and it slips a little bit in your hand, your reaction time isn't good enough to keep it from moving enough to maybe drive a splinter in your finger so the glove would help. It would help prevent that potential for injury there. And there's so many different types of gloves to. Al Brown: [00:52:54] Yeah, and Pete think of this, we're talking manual material handling, you know, grip protection. [00:53:00] But think about your world of ski resorts. Sure. You know, and thermal protection, you know, and that you got to have, you know, if you're protecting the hands. Because I tried to find the naval study that I wanted to look mid-shipment. They actually looked at mid-shipment and they said they wanted to see how temperature affected the hand dexterity. So they said, I want you to tie a knot. It was very simple knot I don't know what the knot is, but they said just tie as many of these you can in a minute. And they had their hands at 70 degrees. You know, it was just room temperature, 70 degrees. And that was the ambient temperature. And they could tie I think it was 42 knots in a minute. I mean, it was a symbol, bup bup bup bup bup bup. So they could go pretty quickly. Then they lowered the ambient temperature down to like fifty degrees and just really reduced. You know their hands were cold. And you know what happens when your hands get cold. They went down to six knots a minute. They couldn't they didn't have the dexterity to [00:54:00] complete that task. So when you look at oil delivery folks, when you look at the ski industry, when you look at anybody who's out in a cold environment, that might have to do fine motor activity know that, look at power workers up in bucket trucks up trying to do nuts and bolts during this, you know, winter storm, you know, and then they've got on double gloves for insulation. You know, their ability to generate force and be dexterous drops off considerably. So you have to keep that in mind when you're looking at the worker and what it is they're doing and how is that going to impact them? Peter Koch: [00:54:40] I can tell you from personal experience, both myself having to tie knots in cold weather as a ski patroller and then as the patrol director going back in and, you know, looking at those really bone chillingly cold days where as a patroller, you're out doing something and then you're having to repair a fence or do something that requires [00:55:00] you to be dexterous with your fingers and your hands. And you look at the result and many times the knot won't be the same knot. It'll be something that's much easier to tie rather than trying to tie a more complex knot that would be the correct, not for that particular situation. Easier to untie later on when we have to, but it was the only knot that they could tie because their fingers just weren't functioning well enough. And that doesn't even need to be a hypothermic issue where you've got some brain function challenge. It's truly the dexterity of your fingers and the gelling of everything, just not making it work the way you want it to. And that goes it doesn't need to be an outside person. Many times in the wintertime, you might have a mechanic working in a shop, right. That the door's open and closed, open and close, open and close. And it might be warm in the office or the parts room, but you get out onto the floor where the guy is doing work and it's pretty chilly out there. And it might be in the, you know, low 60s, which could be comfortable for you. [00:56:00] But when you're there all day on a concrete floor, your hands could get pretty chilly and work production is going to go down and the potential for mistakes and injuries go up from there for sure. Al Brown: [00:56:10] Well, that's you know, what happens in a situation like that is core temperature drops off your body, core temperature drops off. And what it will do is it'll pull the blood in from your extremities to kind of it's a survival mode and your core will try to stay warm. So what happens is your ability to do fine motor activity drops off exponentially. So I dealt with this once in the manufacturing environment where they had a cold mist blowing on, you know, to help them with the work. I'm not sure what the reason for the cold mist, but it really impacted. And they were putting together plugs, electric plugs. They just couldn't understand. And I said, you know, with the cold mist, it's very difficult. You'll change the temperature, the core temperature of the hand and their ability to manipulate goes down tremendously. [00:57:00] And that the example there's a sort of local example of how can we improve that and then the general example of you of opening the door to the whole bay and you're chilling the person, reduces their ability to produce fine motor activity. So you've got to keep those things in mind when you're when you're thinking about was my production down? Peter Koch: [00:57:23] Yeah. There's so many different things that could go into that. That's a whole body challenge. Right. When we started thinking about core temperature drop and one of the first effects you're going to see are going to be your fingers getting chillier because blood is trying to come back into the core something. But, you know, knowing that there's different ways to prevent it, you could prevent it locally with gloves. But that's not going to change the overall core temperature of the person you might need to look at different opportunities to do it. Yeah, so lots of different ways to lots of different reasons that people might put their hands in the wrong spot. It could be because the dexterity [00:58:00] isn't there. It could be because they're moving a lot of physical things around, whether it be stone, rock or other product. And whenever you're doing it with your hands, you're putting your hands at risk. And they are. They are I mean, they are the things that really get us to interact with our world. You think about what you can't do if you don't have use of your hands like we started at the beginning of the podcast. It's phenomenal how many times you interact with the world, with your hands and even if you lose another sense. So you talk about someone who might have vision issues or hearing issues like that tactile sense that you have with your hand to be able to identify something in front of you or around you by touching it is just makes your world that much bigger. And without that, because of an injury, whether it be repetitive injury or because of a traumatic injury, you lose a whole part of your world. We talk about it like when we do when [00:59:00] I do hearing conservation training, we talk about your hearing and how it really broadens your world and that inability once you start to lose your hearing, to have great conversations with people or talk to them in a loud environment or when it gets really bad hear, the beauty of the world around you. And when you start to get hand injuries, those same things you're going to miss out on, it might not be something you hear, but to be able to shake someone's hand or to be able to pet your dog or something that you really enjoy, you're not going to be able to do that if you don't take care of your hands. And it's just a big part of it. We just take them for granted. Truly take them for granted. Al Brown: [00:59:39] You know, a thought Pete just think about us as aging to, you know, we're an aging population, so, you know, we didn't touch on the thing about arthritis and those kinds of changes that occur on the hand or comorbidities. But as we age, what do we tend to do? But, you know, what's the leading cause of injury in the work environment that's slips, trips and falls? And what's the thing that we stick out [01:00:00] to kind of, you know, cushion that fall is usually the hand. And even in the ski world, you know, you're talking about skiing before. And when you fall down, you tend to put that hand out. And what's the thing that usually takes the hit is that, you know, there was a fracture or usually it's a broken wrist. And the function, all that, that had been taken for granted before, as you just mentioned, really comes you know, you realize, oh, my goodness, I really lost the function of my hand. And as a physical therapist, it takes months of rehab to regain just the majority of that range of motion and strength. But you'll never come back 100 percent. So, you know, it's one of those things to think about again as an employer or just around your everyday life. Think about, you know, yeah, I want to get the right tool and all this, but look at slip trip and fall hazards all around. You know, that that could lead to a broken wrist. Peter Koch: [01:00:59] Sure. You [01:01:00] could do everything that you can to get, like you said, the right tool. I've set everything up ergonomically, but the box that I didn't pick up behind my workstation that I just tripped over and now I've done the same thing to my hand that I that I might have done if I didn't get the right tools. So it's a big picture of peace preventing injuries. No matter what it is. It's truly a big picture view that you've got to take, because even if you take care of one particular hazard, if you haven't identified and manage the others, you can still put yourself at significant risk there. So what else, did we miss anything about hand injuries, whether it be a traumatic injury from a hand to wrist, or an injury from awkward postures or prolonged postures? Is there something else that we want to touch on here before we kind of get towards the end of our podcast? Al Brown: [01:01:45] Right. Yeah, I guess just the final thing, because I think we've handled this really well. I think we've covered most topics and, you know, think of contact stresses in the hand. You know, we [01:02:00] never talked about, you know, there's different things. De Quervain's tenosynovitis pain on the back side of the thumb, you know, that's created by we'll see with scissors, manual scissors, where you're constantly opening the scissors back up to create the cut, that lifting the thumb is not really made well to pull open, you know, abductor's pull the thumb back to open the scissors up and they make scissors now that have a spring-loaded that will self open. So you have to do is grip and close to your power grip. So that's where your most efficient ganglion cysts, where you get some pressure on a tendon or a trigger finger. To a certain extent, you know, you have sleeves those remember those long tendons. I talked about the go to the tip of your finger. They actually pass under sleeves, so they stay. So these tendons don't bow out away from your finger. It looks like your skin's blown away. These little sheets hold the tendon close to the finger. Well, if you inflame one of those tendons and now it's bigger and it's on one side of these this little loop, [01:03:00] and then when you close your finger, you kind of force it through, it'll click and then you notice that your finger is stuck down and you have to kind of grab it and pull it back up to move that thick intended. It's a lot of times you're getting a contact stressor or one of the tools in your hand by putting a lot of pressure on that tendon, which creates the enlarged, you know, the large tendons. So now it's bulbous and can't go through that sheet. So again, you look at padding

Dr. Shannon M, Clark discusses vulvar and pelvic anatomy and obstetrical lacerations during delivery, as well as prevention and care. --- Support this podcast: https://anchor.fm/adoctordeliverspodcast/support

Welcome to the emDOCs.net podcast! Join us as we review our high-yield posts from our website emDOCs.net. Today on the emDocs cast with Brit Long, MD (@long_brit) and Manpreet Singh, MD (@MprizzleER) we cover wounds and lacerations in the ED. To continue to make this a worthwhile podcast for you to listen to, we appreciate any feedback and comments you may have for us. Please let us know!Subscribe to the podcast on one of the many platforms below:Apple iTunesSpotifyGoogle Play

In part two of my recent interview with Lee Morrison, we talk about his approach to instructor development and his new evolution "the Path to the Peaceful Warrior." *** Grab Joe's book Neon Jungle: A Bouncer's True Tales of Lessons, Laughs and Lacerations at this link: https://geni.us/neonjungle Make sure you check out this episode on our website: www.violencepod.com LISTEN ON APPLE PODCASTS: https://itunes.apple.com/us/podcast/managing-violence-podcast/id1441934641?mt=2&uo=4 LISTEN ON GOOGLE PODCASTS: https://www.google.com/podcasts?feed=aHR0cHM6Ly9hbmNob3IuZm0vcy83Y2NlMDAwL3BvZGNhc3QvcnNz Want to check out the bonus content for this episode and others? www.patreon.com/managingviolence Make sure to subscribe and leave us a review so you never miss future content.

In part two of my recent interview with Lee Morrison, we talk about his approach to instructor development and his new evolution "the Path to the Peaceful Warrior." *** Grab Joe's book Neon Jungle: A Bouncer's True Tales of Lessons, Laughs and Lacerations at this link: https://geni.us/neonjungle Make sure you check out this episode on our website: www.violencepod.com LISTEN ON APPLE PODCASTS: https://itunes.apple.com/us/podcast/managing-violence-podcast/id1441934641?mt=2&uo=4 LISTEN ON GOOGLE PODCASTS: https://www.google.com/podcasts?feed=aHR0cHM6Ly9hbmNob3IuZm0vcy83Y2NlMDAwL3BvZGNhc3QvcnNz Want to check out the bonus content for this episode and others? www.patreon.com/managingviolence Make sure to subscribe and leave us a review so you never miss future content.

Lee Morrison is the founder of Urban Combatives, a legend of the self-protection industry, and someone Geoff Thompson refers to as a "self-protection God." Lee returns to the podcast in this multi-part interview. In Part 1 we discuss Lee's Tier 1 Civilian curriculum, preparing for worst-case scenario sudden violence, and how you can be useful in times of crisis. ** Our book of the week this week is Living in the Deep Brain by Rory Miller. You can pick up your copy here: https://geni.us/iYKc2 While you're there, grab Joe's book Neon Jungle: A Bouncer's True Tales of Lessons, Laughs and Lacerations at this link: https://geni.us/neonjungle Make sure you check out this episode on our website: www.violencepod.com LISTEN ON APPLE PODCASTS: https://itunes.apple.com/us/podcast/managing-violence-podcast/id1441934641?mt=2&uo=4 LISTEN ON GOOGLE PODCASTS: https://www.google.com/podcasts?feed=aHR0cHM6Ly9hbmNob3IuZm0vcy83Y2NlMDAwL3BvZGNhc3QvcnNz Want to check out the bonus content for this episode and others? www.patreon.com/managingviolence Make sure to subscribe and leave us a review so you never miss future content.

Lee Morrison is the founder of Urban Combatives, a legend of the self-protection industry, and someone Geoff Thompson refers to as a "self-protection God." Lee returns to the podcast in this multi-part interview. In Part 1 we discuss Lee's Tier 1 Civilian curriculum, preparing for worst-case scenario sudden violence, and how you can be useful in times of crisis. ** Our book of the week this week is Living in the Deep Brain by Rory Miller. You can pick up your copy here: https://geni.us/iYKc2 While you're there, grab Joe's book Neon Jungle: A Bouncer's True Tales of Lessons, Laughs and Lacerations at this link: https://geni.us/neonjungle Make sure you check out this episode on our website: www.violencepod.com LISTEN ON APPLE PODCASTS: https://itunes.apple.com/us/podcast/managing-violence-podcast/id1441934641?mt=2&uo=4 LISTEN ON GOOGLE PODCASTS: https://www.google.com/podcasts?feed=aHR0cHM6Ly9hbmNob3IuZm0vcy83Y2NlMDAwL3BvZGNhc3QvcnNz Want to check out the bonus content for this episode and others? www.patreon.com/managingviolence Make sure to subscribe and leave us a review so you never miss future content.

GURO Billy Brown has been involved in the Martial Arts for most of his life, starting with his father at the very young age of 3. Having since trained in and researched many different styles and systems, he was teaching at the young age of 14 and was teaching professionally by age 16. In 1999 he founded Progressive Martial Arts Training Systems. He is also the founder of the world renown Counter Assault Tactics Program, which is dedicated to training Civilians, Women Only, Business Professionals and Law Enforcement officers in realistic and effective personal protection skills. ​ Spending 20 years of his life working club doors and private security, his real world experience is vast and this gives him a rare teaching element of reality that MOST martial arts instructors do not have. This has led many law enforcement and military units to his door as well as presented him the opportunity to work many Private Security details for people like Brooks and Dunn and George Jones. His Woman's Counter Assault Tactics Program is known throughout the U.S. as being the most effective, yet easy to learn course available to date. And his Stand On Violence Against Women Is Legendary. Seeing the weaknesses of the current self defense courses and schools for both civilians and tactical professionals, he sought to form another unique organization that was highly innovative and just ahead of the curve. So, in 2009, DefendUSA/ Adaptive Combatives was born!

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Dr. Kameelah Phillips on the show to discuss optimizing health during pregnancy.  Dr. Kameelah Phillips is a board certified Obstetrician and Gynecologist, wife, mother, and lifelong women’s health advocate.  Since high school, she has been involved in local, national, and international organizations aimed at advancing women’s health care issues through advocacy and direct patient care. In this episode, we discuss: -The impacts of COVID-19 on pregnancy and post-partum -Factors that impact the United States’ maternal mortality rates -Six ways to optimize your health during pregnancy -The importance of interprofessional collaboration -And so much more!   Resources: Calla Women's Health Website Dr. Kameelah Phillips Instagram Calla Women's Health Instagram   A big thank you to Net Health for sponsoring this episode!  Learn more about the Redoc Patient Portal here.     For more information on Dr. Phillips: Dr. Kameelah Phillips is a board certified Obstetrician and Gynecologist, wife, mother, and lifelong women’s health advocate.  Since high school, she has been involved in local, national, and international organizations aimed at advancing women’s health care issues through advocacy and direct patient care. Dr. Phillips graduated from Stanford University with a degree in Human Biology with an emphasis in Women’s Health and Human Sexuality. After graduation, she worked at the San Francisco Department of Public Health in the AIDS office as a Research Assistant on HIV vaccine studies.  She relocated to Los Angeles to attend the University of Southern California Keck School of Medicine. During medical school, she received numerous community service awards. She was privileged to travel to Ghana, Cuba, and Tanzania on health missions during this time. Upon completion of medical school, she attended a competitive OB/GYN residency at the New York University School of Medicine. She also served on an emergency medical mission in Port-au-Prince, Haiti to provide women’s health care during the 2010 earthquake.  Dr. Phillips is an educator, mentor, and expert in women’s health issues.   She loves to help women and girls feel comfortable with their bodies, so that they can be aware of changes or new developments.  Her interests include Minority Women's Health and health care disparities, lactation, sexual and menopause medicine.  Dr. Phillips is a member of the International Board of Lactation Consultants and speaks Spanish. She enjoys teaching residents and medical students. Her guilty pleasures include reality T.V.   As a Real World Alumnae, she has used this platform to travel nationwide to discuss domestic violence, smoking cessation, and other health-related issues.  She loves a good bargain, flowers, and deep-tissue massages. You can follow her on Instagram @drkameelahsays   Read the full transcript below: Karen Litzy (00:01): Hi, Dr. Phillips, welcome to the podcast. I'm excited to have you on. And this is the first time I'm having an OB GYN on the program. I've had lots of physical therapists who work with women's health and pelvic health. So this is really exciting to get a different point of view on women's health and on pelvic health. And now, before we get into the meat of the interview, we are still living in a pandemic, COVID-19 is still here. It has not mysteriously disappeared or vanished. And so there are a lot of women who are getting pregnant, who are living through pregnancy at this time and who might be a little nervous, a little concerned about what can happen during their pregnancy is COVID affected. So what I would love for you is any advice for those pregnant women in the time of COVID? Kameelah Phillips (00:58): Yeah, absolutely. You know, one thing I really try and impress on patients that is absolutely unique to OB GYN is despite what's going on in the world, whatever chaos is going on, women still have babies women still go into labor. Women still take healthy babies home. So for us in particular we've made some minor, not, I shouldn't say minor there there's significant, we've made some changes in how we deliver care and the hospital setting, but for us, it's really been, you know, not so huge of a change because you know, hurricane Sandy earthquakes in Haiti, I've been through both of those, we still deliver excellent care to women. So one thing I would ask them to do is just really take a deep breath and while things are going on around us remember that their primary concern is to take care of themselves so that they can take care of their baby. Kameelah Phillips (02:11): I have told patients that a little bit of their OB care is changing. So we might have fewer visits, but really the important things we will always make sure that we hit the important time points and hallmarks of a pregnancy. So you won't miss anything. I've been telling them that labor and delivery has changed a little bit. And I think this changes pretty much coming across country, but whereas it used to be a time where, you know, extended family was welcome. It's important that they recognize now that only one or maybe two people will be allowed to be present for labor and delivery. And our hospital in particular, both moms and support family are being asked to wear a mask. We do check moms for coronavirus. We use the nasal swab. The extended family is not tested, but they're expected to keep their mask on. Kameelah Phillips (03:16): And most of the time our moms are coming back negative, but if they do come back positive, you know, we have a discussion and education with them as to what it's going to be like, knowing that they're now corona virus positive and going to be taking home a newborn. So we talk about those things. But for all intents and purposes, women are coming in. They're having healthy, safe deliveries, both C-sections and vaginal deliveries. Their hospital stay we've shortened a little bit in New York, we're going back to keeping women two days or four days, but other places in the country are, are shortening. The hospital stays in an effort to get women home safely and so that they can use hospital resources for the people that need them. But we're having healthy and safe deliveries. There was a panic, I think, amongst the pregnant community at the beginning of the pandemic, and everyone wanted to have a home delivery that still continues to not be the best response to this. Kameelah Phillips (04:28): It is still safest to deliver in a hospital or birthing center, certainly not at home to have best outcomes. We still recommend that women breastfeed that's the best way to feed your baby despite Corona virus, even if you were previously infected. And when women go home, I just ask them to be considerate of the new immune system in their house, right? So limiting visitors, washing their hands. If people come over, keeping them not being afraid to say, Hey, keep your face mask on while you're with the baby or around the baby. And really using the technology that we have to their benefit. So while it's not what we're used to, the grandparents meet their babies over FaceTime or zoom now. And that's not going to be forever, but you know, if you have people who are unable to quarantine and can guarantee that they're negative, I asked them to defer visiting. Karen Litzy (05:29): Yeah. Thank you. That's all really great advice. And I should have mentioned in the beginning that we are both located in New York city. And so right now it's different.   Kameelah Phillips: Yeah. So obviously New York was the epicenter of the pandemic, certainly in the United States, if not the world at one point we have now our numbers have gone down, but the safety for the pregnant and new moms have, has not is right. Yeah. Right. So we are still on top of new infections, preventing infections in the hospital, the doctors, the nurses, the people who clean your rooms, we're all washing our hands, wearing gloves, keeping our mask on because it is our priority that you come in healthy and that you leave healthy. Karen Litzy (06:33): Yeah. Perfect. All right. Well, thank you for that. And hopefully if there's any pregnant moms or other healthcare practitioners that are working with pregnant women kind of give them a little bit more information to pass along or to kind of keep in their heads. So now let's switch gears slightly here. I'd love to talk about maternal mortality rates in the United States now in the United States. We know, unfortunately that we do have a very high maternal mortality rate amongst advanced countries, or what's the best word for that advanced countries? Is that the right developed countries, industrialized countries, like we know what you're talking about, you get it right. So the questions that I have are what populations are most effected. And then what, in your opinion, do you feel like needs to be done to improve those maternal mortality rates? Kameelah Phillips (07:32): I am firmly under the belief that we can as a nation, as a country walk and chew gum at the same time to make these rates better. So to answer your first part of your question we have plenty of data that show that black women, African American women in particular are most vulnerable during pregnancy labor and delivery. And postpartum times the rates of increased death can be anywhere from five to seven times higher than their white counterpart. And these rates are abysmal for a developed country to have such a discrepancy in healthcare is really saddening and frankly just discussing it's unacceptable. But there are other ethnic groups that are also at risk that, you know, we always talk about black and white and really this country is so diverse, but our native American population is also significantly affected by maternal mortality rates that are poor as well as Alaska. Kameelah Phillips (08:57): We always forget about Alaska. So African American women, native American women and Alaska women, and it's complicated. It is a combination of access to care. It's unfortunate that we seem like we're talking about the same things over and over, but access is a big issue. We live in the biggest city in the United States, but you know, Manhattan alone, what the Island of Manhattan has four hospitals there used to be more, there used to be more can you imagine? But some of our outlying communities that are more ethnically diverse or Latino or African American have far fewer hospitals. And certainly in those hospitals, the resources aren't comparable to anything that you would see in Manhattan. So along with, you know, access there's hospitals, there's doctors there's birthing centers, all of these are less often found in lower resource places. Kameelah Phillips (10:06): So access is a big one education both on the part of the health field and of patients themselves is a problem. I think we're starting to really get some traction on the African American population, helping them understand that this is a very critical time in their life. And so they have to be hypervigilant about blood pressure, weight gain, diabetes, all of things, all the things that can be triggers for issues in pregnancy. Those are the big things that stand out access and education.   Karen Litzy: And do you also find that, and I find this in other aspects of healthcare especially when it comes to feeling pain that oftentimes women are not believed as much as men are. And, that is in other parts of healthcare, certainly true. Do you find that women maybe during pregnancy or even post pregnancy, like maybe that the day they gave birth, if they're there trying to explain things that are going on and perhaps they're not being believed and are just yeah brushed to the side so that I think is absolutely the case for a lot of the issues that women experience around the maternal period. Kameelah Phillips (11:22): And it's not limited to women. It also crosses ethnic and socioeconomic boundaries. We have a real issue and I'm part of the establishment, right? I'm part of the medical community. So I feel free to air up our dirty laundry, that we have a real issue with bias and medicine and we talk about racial bias and how that can impact black people. But we have a bias against women. We have a bias against women and, you know, she's being hysterical, she's being dramatic or pain's really not that big women in our discomfort in our needs are routinely downplayed and even by other women, because we've sort of ingrained in our head that, you know, women tend to be more dramatic, whatever. Kameelah Phillips (12:30): We downplay the needs of poor patients who come in, Oh, you know, she's just being loud for no reason or, Oh, that's just how they're. So this isn't just an issue of women. It goes across class, it goes across ethnicities. But for us, when we're pregnant, it has to be addressed and highlighted because when a woman is saying something isn't right. Something isn't right. And that should be taken seriously because in the postpartum period we get lucky a lot of times because women are generally young and healthy, but when things go bad in obstetrics, they happen quickly and then its big. So for example, if a woman was like, my bleeding is kind of heavy and say, maybe she just delivered a baby, a woman could easily lose one to two liters of blood in like a few minutes. So we had a really bad postpartum hemorrhage the other day. And I was like, this is impressive when you see what the body can do. Especially in labor, it happens quickly. And so it's incumbent upon us as healthcare providers to take women seriously. Karen Litzy (13:27): And then I would also think there is, and again, I don't know if this is true or not, but I know kind of where I come from more looking at the pain world and from my own experiences, as I personally would downplay my own pain. So as not to bother someone. Right. And do you feel like in the world of OB GYN, if you're going for pregnancy, like, do you have to kind of really educate those patients to say, listen, if you're feeling something doesn't feel right, like you need to speak up, right. Well, like you're bothering us. Have you encountered that?   Kameelah Phillips: I have encountered that. And it's really incumbent upon all of us to relearn these narratives that we've picked up just growing up in the United States of like not being the complainer or not being the squeaky wheel, not rocking the boat. Like those all have negative connotations right. Kameelah Phillips (14:47): In the obstetric space. When you don't speak up, we can have really negative, horrible outcomes. So part of my experience with patients is to listen to what they're saying really repeat back what they're saying, like, okay, I hear you're having X, Y, and Z. Did I get that right? And if it's something that is quote unquote normal in the space of a, you know, a growing uterus or a growing body part of my job is to really provide education, to help them manage their expectations for what they should expect. Growing uterus, growing weight gain, swelling, what they should expect from their body. If it's the first time they've been pregnant or the sixth time they've been pregnant, you know, all the pregnancies are different. And if we have a clear understanding her giving me her complaint, me giving her feedback on what I think she's saying, and then giving her the anticipatory guidance, I think she needs, and we still have an issue. Then it's incumbent on me to escalate it and really make sure that there's nothing there that's going to hurt her. Karen Litzy (16:01): Yeah. Great. That's perfect. And I love the kind of handling of expectations and monitoring expectations because that goes such a long way when, especially if it's your first time or not, like you said, your first or your six times, but kind of knowing what to expect at certain times is very comforting. And so then as if you're the patient, then you can say, Oh, you know, she said, this might happen, but I'm not, you know, it's not happening or it's going above and beyond what she said. So maybe this is time that I reach out and contact my physician on this, there are times where you may need to reach out to your doctor. And so knowing when those times might be, is really helpful. Kameelah Phillips (16:53): Exactly. So when a woman leaves the office and you know, it'll be maybe a month before I see her again, I tell her, you know, this is what I think might happen. It's okay. If it doesn't happen to you, but in the next four weeks, you might expect, you know, your pants size to change general discomfort in this area. You might feel something fluttering in your belly, like giving her those points to look out for. And again, managing those expectations and I'll get a phone call, Hey, this is maybe more I'm having this. Plus this is this in the realm of normal. No, it's not come in. You know, we can really help women out by giving them education cause it's empowering. And it helps us do a better job taking care of you.   Karen Litzy: Yeah. And it also keeps people away I would think from dr. Google or far down the rabbit hole of how many doctor Googles do you get? Kameelah Phillips (18:17): You know what, I can't anymore. Just so many doctor Google's with doctor said, I can't even more. Or my Facebook friend Sally said, Stay off. And it's funny cause when their partner comes with them, the partner inevitably just looks at him and like glares at them because they know that they're on Google or they're on these, you know, small chat rooms where everyone is on the T level 10 when the patient's issue is actually maybe a one or zero. And so it freaks her out. Yeah. I encourage patients to stay off of Google. Because yes, there are some times when it might answer your question, but really we're aiming for individualized personalized care and Google doesn't offer that to you. And so I really ask my patients to stay off of it. That's what their visits are for to write down the questions as they go. And honestly, it's so funny. They'll come in with like, say there's five questions just in the scope of time, given them the anticipatory guidance. Kameelah Phillips (19:17): Like by the time they actually get to the appointment, they may only have two questions because they're like, Oh yeah, she said that was going to happen. They know exactly, exactly. It helps to stay off Google.   Karen Litzy: Yes, yes, yes, yes. And now I think we've touched a little bit, I think on this, but let's see if we can delve into this more and that are what are ways women can stay healthy throughout their pregnancy so that maybe it can contribute to a decrease in the maternal mortality rate, even if it's just chinking away at the tiny little bit, because like you said, it's a big bucket with a lot of stuff going into it. But if there are ways that women can, like you said, empower themselves to stay healthy and give themselves the best chance, what advice do you give to women to stay healthy? Kameelah Phillips (20:04): Yeah. So in thinking about this, I have six points that I usually share with patients. So I'll go over them really quickly. But my first point is to find a doctor that you trust. I'm really big on that. I'm really big on that. I tell people to find someone that they trust because inevitably, you know, most pregnancies are fine, but if we get into some mess, I need to know that you know that I am your advocate and I am on your side. And if you hesitate or you don't feel like you can trust me a hundred percent, I'm going to ask that you explore other op, find another doctor because I want you to the best experience possible. And I even say this with my GYN patients, like if I tell a patient, you know, I really think you need surgery for this. Kameelah Phillips (20:56): I don't sign them up for surgery that day. I've let them go into the world, do their due diligence, meet with three other doctors. And I promise you, I have not had a patient not come back because they trust me. So that's a big thing. Find someone you trust. I think it's really important that patients meet with their doctor frequently, meaning that you come to your visits, you got to show up, right? So we can get data from you like your blood pressure, your weight how you're feeling, checking the baby regularly, blood work, this data that we're collecting at every visit. And it might not sound like a lot 15 minutes, but it actually gives us a picture of where we're going with your health. So that's important. I asked my patients also to stay active and exercise. I am not sure why there's this misconception that you should be sedentary during pregnancy first trimester. Kameelah Phillips (21:55): I get it that progesterone knocks everyone out there on the couch. They can't, you know, they're nauseous. They don't want to, I get that. But for the most part, when you feel healthy in pregnancy, I need you take care of yourself. And that means exercise and eating healthy and patients are, Oh no, but the baby really wanted the chili cheese fries. No, no she didn't the baby requests. Yeah. Did she send you a text message to get that? So really encouraging, like if you would feed your six month old, you know, a Coke and chili cheese fries for lunch, that's a separate conversation, but you know, trying to do as best they can. In terms of staying active and eating healthy education is a big piece for me. Every time they leave, I'm like, okay, we're entering this phase. These are the major risks for this phase. Kameelah Phillips (22:53): So I need you to go home and look at this website and read two minutes about diabetes, cause you're doing your diabetic test and this is why it's important. Being flexible is huge. Patients, I think often have the misconception that physicians or that I control their pregnancy. And really, I see myself as just like a tour guide, ushering your baby safely into this world. And so it's important that they're flexible to whatever the results come back as whatever the ultrasounds tell us, however, the baby is behaving in labor, that they're flexible. In my industry, I'm not sure what the corollary will be with physical therapy, but people who come in with very strict demands as to how they expect their process to be are the main people who have complications as opposed to just letting us do our job, to get you guys to the finish line. Kameelah Phillips (24:02): So being flexible is really important. And then my last one is to not refuse life saving treatments. We were, it was in the, I told you the other day I had a postpartum hemorrhage and I might back of my head. I was like, this woman's going to bleed. So as we were pushing or when she got admitted, I was like, you know, this is the type of situation where I see XYZ happening and when XYZ happens and she lost all that blood. When I came to her about needing a blood transfusion, she was already on board to not refuse treatment that could possibly save her life. So not refusing like blood products or blood pressure management, those are increased surveillance. Those are the big things that hurt and cause women to lose their life. So really not refusing important treatment. Karen Litzy (24:58): Yeah. And I think thank you, those are great ways that women can stay healthy. And you know, as you were saying, they need to be flexible. And I always go back to movies where they show the woman going in and she's got a birth plan and it has to be this and it has to be this. And there's no flexibility around that. So I could see how that could be really dangerous if you're going in with that kind of a mindset of, you know, I have to have this baby without any drugs and have to have it vaginally. When in fact there might be some complications where that's just not possible and it's just not possible. And, or advised or safe. Kameelah Phillips (26:00): And again, we don't decide that, right. The baby's position, the mom's uterus, the pelvis, like all of these things that are outside of our control decide that we're just here to make sure you both come out on the other side. Okay. And I can't underscore that. Cannot underscore that. Like I don't have anywhere to be there's this misconception that doctors always have like tickets. So like I have to be at the opera tonight. No, we don't have anywhere to be we're here for your baby, but you know, we have to have some flexibility, like let us just do our job and we'll get you through this.   Karen Litzy: Yeah. I think that's great. And then of course, I always love the third point, which is stay active and exercise and move during your pregnancy. And I think I'll give a quick plug for physical therapists. I think this is where physical therapists and women there are a lot of physical therapists who are pelvic health specialists and who work specifically with pregnant and postpartum women. And this is where I think we can actually maybe make an impact in that maternal mortality rate as physical therapists. Kameelah Phillips (26:54): Yeah. Yeah. I spent the first part of my career in a group dynamic and it was very hard for us to think outside the box with complimentary specialties that can help make this process of pregnancy, which is physically mindblowing. Like people, if you haven't necessarily been pregnant before or been in an intimate relationship with someone who's going through pregnancy, you can not imagine how physically difficult it is to have a baby. And so when I was bringing up the options of like physical therapy, no, no, no, she's fine. The body heals itself. I'm like, but it's not like, look at her walk. You know, I'm looking at her. Diane is like, like, let's think outside the box. So in my new practice, I'm making much more of an effort and actively establishing relationships with people that, okay, you're having this issue. Kameelah Phillips (28:07): Now let's connect with the physical therapist because you know, the hips give women the most trouble, the hips, maintaining flexibility labor and delivery, the act of pushing literally separates your pelvis. You know, it's not, of course you have issues with your pelvis afterwards. Lacerations, you know, women who undergo episiotomies that pelvic floor has literally hit the wall and back. So to not expect that pregnancy is a hundred percent, the most physical activity you can do with your body just really undermines and belittles the whole process. And so part of my process now is to send women to physical therapy, postpartum, even if it's just for one visit so they can have an idea of how to improve their core, how to keep their pelvic girdle in shape and engaged because most women have more than one kid. Kameelah Phillips (29:11): So that's a lot of, you know, trauma to the body. And we can do better. We know that it works, we know that it's available, but it's up to us to provide the education and the next steps for them to heal.   Karen Litzy: Yeah. Well said, well said I love it. And now as we wind things up here what would be, what would you like the audience to take away from our discussion today? Kameelah Phillips (30:29): I think that it would be helpful to really understand that most doctors do their best to provide women with excellent obstetrical and Gynecological care. I think that a good doctor is really open to receiving information from other specialties in this case PT, physical therapy as modalities that can compliment what we offer. That's not in opposition to what we do so that if we could somehow strengthen the relationship between obstetrics and physical therapists, everyone would win. Like it's for all of us, the patient the obstetrician, the physical therapist the patient's family. It's, you know, pregnancy is the deal. It affects literally you physically, emotionally, psychologically, and sometimes the physical impact of sometimes a lot of times the physical impacts the emotional and the psychological and your sense of wellbeing and health is so impacted by like how you physically look and feel. And you guys have a direct, you know, you have the keys to helping us, you know, improve women physically. So if we could strengthen that relationship and not see it as so oppositional, I think it's a triple win for everyone.   Karen Litzy: Yeah, I agree. And the last question I have is one that I ask everyone. And given where you are now in your life and in your career, what advice would you give to your younger self? Kameelah Phillips (31:41): So I'm out of residency 10 years, and I'm just starting my first private practice venture. And looking back, I probably should have done this five years ago. And yet I had a lot of other things going on. I was like birthing my own children and that kind of thing. But at the root of it, honestly, I was scared. I was scared of failing. I was scared of the unknown. I was scared of doing things that I'd never been taught before. Like formally I didn't consider myself an entrepreneur, all these like negatives, right? Negative, negative, never didn't have it. Shouldn't wouldn't, couldn't like, and I would give my younger self, like a kick in the butt to like, just get out there and you know, unless it seems so cliche, but you don't know unless you try. And when you're young, there's nothing to lose. Kameelah Phillips (32:53): Except the fear that's like this imaginary fear that's holding you back. It's a time to be brave and courageous and adventurous. And so I would probably give my younger self like the little push off the ledge the encouragement that I needed to have started this venture and experience earlier. And I would just tell her to be fearless. What do you got to lose? You can always, you know, move back in with your parents. That's what we're doing these days. Right. So like, why be afraid to fail like that just now it's so funny. Cause I think about it cause I'm in it now, but what did I have to lose? Nothing. Nothing. Yeah. Like time, but that would have been a learning, you know, you would have learned so willing to learn. Kameelah Phillips (33:52): So yeah, I would have jumped sooner.   Karen Litzy: Excellent advice. Thank you for that. And now where can people find out about you about your new practice? Where are you on social media? Where can we find you? Kameelah Phillips (34:57): So on social media? My main page is drKameelahsays, my practice page is Callawomenshealth, like the flower. I love the like beautiful erotic nature of the calla lily. So that's my practice Calla women's health. I'm on the upper East side of Manhattan, but also available for telehealth visits, physical visits throughout coronavirus. I've been on the grind in this office. So taking new patients of course also happy to see them.   Karen Litzy: And for everyone listening, we will have all of this information, one click straight to all of the practice and the social media at the podcast.healthywealthysmart.com. Under this episode, it'll all be in the show notes. So if you didn't get it, don't worry, you can get it that way. So thank you so much for coming on. This was a great episode and I think you've given a lot of wonderful advice to healthcare providers and to women who may be pregnant or want to be pregnant or maybe has already been pregnant. There's a lot of stuff here. So thank you so much. I appreciate it. And everyone, thank you so much for listening. Have a great couple of days and stay healthy, wealthy and smart.   Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on Apple Podcasts

Cuts. Lacerations. Symptoms of a Stroke or Heart Attack. When in Doubt, Check it Out. Doctors want you to know it's safe to go to the ER. If you don't, it could be a fatal mistake. The chicks from Chick2Chick are "chirping" with a Doctor at Penn State Health about safety protocols in place in light of Covid-19 and why ignoring care for you or your family may not be the best medicine.

When describing wounds there is a tendency to describe "cuts" as "lacerations" and "lacerations" as "cuts" as if the two words mean the same thing. They do not. Learn the differences in this bonus episode. https://www.acepnow.com/article/laceration-incised-wound-know-difference/ (Laceration or Incised Wound: Know the Difference) https://www.bmj.com/rapid-response/2011/10/29/distinction-between-lacerations-and-incised-wounds (Suturing versus conservative management of lacerations of the hand: randomised controlled trial) --- Head over to https://www.itmattersbutitdoesnt.com (itmattersbutitdoesnt.com) where you can http://patreon.com/chadhall (become a patron) https://www.itmattersbutitdoesnt.com/support/ (find other ways to support the show) https://chadhall.ck.page/d2ec2d5cfc (sign up for my book recommendation newsletter) leave a voice mail by clicking the blue button https://www.itmattersbutitdoesnt.com/episodes/ (browse the full episodes archive) and more FYI I use affiliate links whenever linking to books as a way to help support the podcast. I offer both Amazon links & Bookshop.org links. Bookshop.org costs a bit more but every purchase supports local, independent bookstores. Consider using their links if you can afford to. https://bookshop.org/pages/about (learn more here.) Support this podcast

As Free Speech advocates, we support the people’s right to protest and make their opinions heard. Unfortunately, demonstrations in the U.S. these days are becoming more frequent and violent. After a short break due to the pandemic, people are again out in the streets. Some have legitimate concerns; others, however, have bad intentions. How can you stay safe if you get caught in the middle of civil unrest? Dr. Joe Alton gives his thoughts. With the violence we’ve seen in major cities, I’m sure there are quite a few people, especially law enforcement officers, that wound up getting hit by a brick or other projectile, and wound needing stitches. Lacerations of the skin can occur off the grid in survival scenarios, too, but there’s no hospital ready to close the wound. It’s up to the family medic, and that person needs to have a working knowledge of, not just how to throw a stitch, but when a wound should stay open due to risk of infection, and what type of suture materials would be best for the purpose. Some basics from the Altons. Wishing you the best of health in good times or bad, Joe and Amy Alton Hey, don't forget to check out Nurse Amy's entire line of medical kits and supplies at store.doomandbloom.net. You'll be glad you did.  

As Free Speech advocates, we support the people’s right to protest and make their opinions heard. Unfortunately, demonstrations in the U.S. these days are becoming more frequent and violent. After a short break due to the pandemic, people are again out in the streets. Some have legitimate concerns; others, however, have bad intentions. How can you stay safe if you get caught in the middle of civil unrest? Dr. Joe Alton gives his thoughts. With the violence we’ve seen in major cities, I’m sure there are quite a few people, especially law enforcement officers, that wound up getting hit by a brick or other projectile, and wound needing stitches. Lacerations of the skin can occur off the grid in survival scenarios, too, but there’s no hospital ready to close the wound. It’s up to the family medic, and that person needs to have a working knowledge of, not just how to throw a stitch, but when a wound should stay open due to risk of infection, and what type of suture materials would be best for the purpose. Some basics from the Altons. Wishing you the best of health in good times or bad, Joe and Amy Alton Hey, don't forget to check out Nurse Amy's entire line of medical kits and supplies at store.doomandbloom.net. You'll be glad you did.  

Sarah Fesnak, MD, an attending physician in the Emergency Department at Children's Hospital of Philadelphia, discusses the evaluation and management of lacerations in primary care. Appropriate referrals to the Emergency Department and the wound follow-up after repair are reviewed. Published December 2019. This podcast is for general informational and educational purposes only and is not to be considered as medical advice for any particular patient. Clinicians must rely on their own informed clinical judgment in making recommendations to their patients. ©2019 by Children's Hospital of Philadelphia, all rights reserved.

Tonight we start off talking about the Dragalia Lost Anniversary event and how it has been the time to get Five Stars with a daily free 10 Summon.  From there Bel gushes about Destiny 2 Shadowkeep and it playing towards his particular game style. He also talks about getting caught up in the race for world's first on the new raid.  From there we talk a little bit about Overwatch before diving into a discussion about Sayonara Wild Hearts. Finally some discussion about the Cities of Sigmar book and the changes to Warhammer it brings. Topics Discussed: Dragalia Lost Anniversary Event Still playing daily a year later Destiny 2 Shadowkeep Expansion Destiny version of Looking for Raid Garden of Salvation World First Race Come from behind Victory Competitive PVE Content Overwatch Discussion Sayonara Wild Hearts Loading Ready Run Rhythm Cafe Cities of Sigmar Goodbye Elves Happy Days for Dwarves

Today we welcome in Meg and Cindy of CapeIvy.com, which provides fleece poncho capes to kids and adults for extra comfort during hospital stays, to discuss some tips to help make your family's lengthy hospital stays a little more bearable. We also explore topics from the Sears' book The Portable Pediatrician: what to do about mouth lacerations/injuring from trauma, abdominal pain, and staying hydrated during vomiting episodes.

Our Story – Support Us – Annual Report – Corporate Snapshot – Research Partners – Our Supporters Health Information – Brochures – Inform – Podcast – Read – Learn Hub – Resources Funding Schemes Services – NDIS – Personal Care – Domestic Assistance – Sleepovers – Meal Preparation Assistance – Community Access Services – Complex Care Supports & Solutions – Health & Well-being Programs – Support Groups – Psychology & Counselling Shop – Shop Healthcare Products – Shop Mobility Aids Contact Us Looking After Your New Tattoo Did you know your fresh tattoo is essentially a wound? And just like any other wound, your new ink requires specific care to successfully complete the healing process and avoid infection. Our nurse has answered the top 5 questions for looking after your new ink:   1. How long does a fresh tattoo take to heal? 2 – 6 weeks is the average time. However, the exact healing time can be dependent on the size and design.   2. Is Bepanthen the best antiseptic ointment to use? Bepathen is a popular antiseptic ointment choice. However, other antiseptic ointments include Savlon and Soov. Any of the three can be used on new ink once gently cleaned with a combination of antimicrobial soap and lukewarm water.   3. How important is aftercare? Very important. The aftercare you provide  is crucial to preventing infection, removing blood residue and preserving the design you have chosen.   4.  What should I avoid during the healing process of my tattoo? Whilst fully healed tattoos are resistant to most activities, new designs should be handled with care and the following avoided until the healing process has taken place. >  Touching your tattoo with unwashed hands. This also includes letting anyone else touch it.>  Washing the area with extremely hot water or harsh cloths.> Shaving the area in which your tattoo is placed>  Wear tight-fitting or any other clothing garments which are likely to rub against your tattoo.   5. Once my tattoo has healed, is there anything I need to do? Once the healing process has taken place your design will still be very fresh and will, therefore, require protection against the sunlight. Always Cover your tattoo in a high SPF sunscreen when exposure to sunlight is likely to occur. Gentle high SPF sunscreen options include; SunSense Sensitive or SunSense Daily Face.     Looking for a step by step guide to aftercare? More Wound Care Advice From looking after a new wound to how to store wound care products, check out our wide range of health tips from leading health professionals. What is Wound Debridement? Wound care articlesWhat is Wound Debridement? Debridement is a French word that literally means “to remove constraints”.  In the case of a wound and wound debridement, constraints may be due to necrotic, or dead tissue. This type of tissue has little to no blood supply and as such,... How wellbeing affects wound care Wound care articlesSmith + Nephew are a leading portfolio medical technology company and they have some advice about wellbeing and wound care. Lacerations & Abrasions Wound care articles Lacerations & AbrasionsThe Skin The skin is the largest organ of the body, and it is the first line of defense against disease and any breach in skin integrity has the potential to develop an infection1. The skin has several important functions, it protects the...

Author: Katrina Iverson, MD Educational Pearls:  The winter holiday months present a unique picture of patient presentations to the emergency department Some of the unique presentations include: Children falling off Santa’s lap Sledding injuries Falling off ladders Lacerations, ingestion, and insertion of broken ornaments (pediatrics) Parents tend to hurt themselves on their children’s toys References: Lauche R, et al. (2018). ‘Santa baby, hurry [extra carefully] down the chimney tonight’ – Prevalence of Christmas related injuries 2007–2016 in the United States: Observational study. Advances in Integrative Medicine. https://doi.org/10.1016/j.aimed.2018.11.004 https://areyouawellbeing.texashealth.org/common-winter-injuries/ Summarized by Travis Barlock, MS4 | Edited by Erik Verzemnieks, MD  

Practice Bulletin #165 Prevention and Management of Obstetrical Lacerations at Delivery

EP 10.4 Pediatric Injuries: Lacerations by Dr. Barbara Taylor Cox

EP 26 2: Lacerations and Foreign Bodies by Dr. Barbara Taylor Cox

Lacerations are the single best opportunity to demonstrate your procedural skills during your clerkship!!! To Close or Not To Close? Closing a wound with sutures, etc = Healing by “primary intention” INCREASES risk of infection but DECREASES scar Leaving a wound open = Healing by “secondary intention” DECREASES risk of infection but INCREASES scar Step […]

Both Quesinart and yankee Candle have recalled products for cutting people. If you have the products, take them back or contact the manufacturer.

In today’s episode Dr Jones talks about the very big nutritional differences between cats and dogs, and how you need to be feeding your cat differently to prevent and treat disease. Kidney failure and pets- you should be focused on this one ingredient, and it's not protein. Ringworm- what is it and how best to naturally treat it. Holistic options for Wounds and Lacerations.

Chinese composer Bright Sheng grew up hearing traditional Chinese music but became fascinated by Western classical music. As a composer, he's forged a highly successful career blending both sound worlds into a fascinatingly distinctive sonic identity. Bright Sheng: H'un Lacerations (excerpt) New York Chamber Symphony/Gerard Schwartz Sheng: Dance Capriccio Shanghai Quartet; Peter Serkin, p. Sheng: Three Chinese Love Songs “Blue Flower” “At the Hillside Where Horses are Running” “The Stream Flows” Lisa Saffer, soprano; Paul Neubauer, viola; Bright Sheng, piano Sheng: The Blazing Mirage Hong Kong Philharmonic/Sheng; Trey Lee, cello Sheng: String Quartet No. 4, Silent Temple, III Shanghai Quartet

We cover a trick of the trade from Dr. Brian Lin, posted on the Academic Life in Emergency Medicine (ALiEM site) on hemostasis in finger tip avulsions. Dr. Lin also has his own excellent FOAM site on all things laceration - LacerationRepair.com. We also cover FOAM on dogma of wound care from Dr. Ken Milne's The Skeptic's Guide to Emergency Medicine, Episode #63   Then we cover laceration and wound care core content pearls using Rosenalli (Rosen's Emergency Medicine and Tintinalli's Emergency Medicine Review).