Looking after an injury isn’t good enough to satisfy the doctor’s inquisitive nature. There is always another question. If Eli Manning, the New York Giant’s quarterback, shows up with a forehead laceration, the worry is not necessarily how to make the scar look good, but whether the brain underneath has been damaged. Percy Harvin collapses at the Viking’s training camp complaining of a migraine and the next medical thought deals with the potential of sudden cardiac death. So it goes in medicine. Nothing is at it seems. There are dangers lurking beneath the surface and it’s the doc’s job to look for them.

Behind every injury, there is a story. An elderly patient who f breaks a hip may just have fallen, but why? Was it because they tripped on the dog or did they pass out when they fell? Are there other injuries in addition to the broken bone? And what medicines do they take that could have led to the fall? Or do they take blood thinners like Coumadin or Plavix that could lead cause future bleeding to occur? Why do they take those medications and will that underlying illness increase the risk of an anesthetic?

Specific injuries lead the doctor to look for complications and that means more questions. Bruised ribs makes warning lights go off looking for damage to underlying organs. While it makes sense to worry about the lung, the lower ribs also protect stuff in the abdomen, including the spleen that lies underneath the left diaphragm and the liver underneath the right. Trauma to the chest wall can lead to a few days of ICU observation for a fractured spleen.

An injured wrist may appear normal on X-ray but asking about pain and tenderness in the snuffbox, an area near the base of the thumb, may be the clue that the scaphoid is broken. It may take a couple weeks for the injury to show up on plain films but the treatment in a splint or cast needs to start right away.

Sewing up lacerations is fun but takes second place to making certain nothing other than the skin is cut. Hands are tough because of the tendons, nerves and arteries that run just beneath the skin. A good looking scar doesn’t help a missed nerve injury. Does the finger feel numb or tingling? Is there burning? Does it feel cold? And while the patient may say that everything is alright, the doctor needs to examine the area and be happy that the tendons are working and the nerve and blood supply are normal. Even with all that, before the skin is closed, the doc needs to look inside and find everything in working order.

It is too easy to ignore potential pitfalls. While common things are common, the basis of medical care is to look for those things that are not and questions are where the process begins. If the patient can’t answer them adequately, family and friends may be on the witness stand. A paramedic may be the person who provides the clue. The key is to ask…and ask again.

The news seems to be filled with celebrities who become overdose victims. Usually, it’s an accidental poisoning but sometimes it’s because of an intentional ingestion. While alcohol remains the most commonly misused drug and prescription pain medications like Vicodin and Oxycontin make headlines, it is the over-the-counter medications that are forgotten as perhaps most dangerous. The two that don’t get any respect are aspirin (salicylic acid) and Tylenol (acetaminophen).

Aspirin is perhaps nature’s most versatile drug. It’s a pain killer, an anti-inflammatory, controls fever and prevents blood clots. It’s available almost for free; generic aspirin sells for a penny a pill. It seems to be in every medicine cabinet and is there for the taking in an impulsive moment or when thoughts of self harm are overwhelming. Too much aspirin affects almost all the organs in the body. Commonly, it causes ringing in the ears, nausea and vomiting, changes in the acid-base balance in the body, pulmonary edema (fluid buildup in the lungs) and kidney failure. Most other organ systems in the body from the brain to the heart, liver and skin can be involved.

Making the diagnosis is easy if victims volunteer that they overdosed on the drug, otherwise it make take detective work looking at blood tests to make the diagnosis. Like most overdoses, treatment is supportive, making certain that basic body functions like breathing, heartbeat and circulation are maintained, but in significant overdoses, early dialysis may be needed to get rid of the drug from the body.

Tylenol is a nastier drug overdose. The drug is included in Many combination over the counter cold medications, as a stand-alone medication and comes in many user friendly forms (liquid, chewable, tablet, capsule, gelcap…are there more?) The bad news about Tylenol overdose is that there are no symptoms right away. Instead, the damage happens days later, causing the liver to fail. Once that happens, there are few long term treatment options other than liver transplant.

The good news is that Tylenol OD has an antidote, if given in time. Actually, it’s not an antidote in the true sense of the word. Tylenol gets metabolized by the liver into chemicals that causes liver cell death. A medication called mucomyst makes the liver deal with it and leaves the un-metabolized Tylenol hanging in the blood stream and lets the kidneys remove it from the body. The treatment needs to start immediately and can be given by mouth or intravenously.

Accidental overdoses happen and prevention is perhaps the most important treatment. Labels of over-the-counter medicines may not make exciting reading but the fine print will tell people what they might be putting in their body. Adding a cold medication to routine Tylenol and topping it off with a prescription pain killer like Vicodin or Lortab may be just too much Tylenol.

And when it comes to intentional drug overdose, medical treatment needs to happen side by side with psychiatric help and counseling. Perhaps one of the most important things we learn from celebrities is that even those who seemingly have everything do not live utopian lives and need help to cope with
the real world.