Q:
What is the difference between using staples to close a cut rather than stitches. Do they have pros and cons?
Greg T. – Atlanta GA
A:
The biggest advantage to staples is that they are very fast. Once a wound has been cleaned and anesthetized, I can staple a typical laceration closed in less than one minute. However, there are several situations where
I prefer sutures. If you have a complex, jagged laceration, sutures can help bring that wound together in a more anatomic way. Sutures tend to leave a smaller scar, with tiny little holes on the sides of a laceration, where staples leave the more typical “railroad tracks.” With sutures, you can get wound edges very close and provide an excellent result. I never use staples on the face.
Every doc I know uses staples on scalp cuts, which are very common. You can put in staples with minimal hair removal which patients appreciate. Sutures are a pain to put in without shaving the area around the cut.
Q:
Dear Your ER Doc:
I have seen you write about the dangers of carbon monoxide poisoning before. I recently read an article where victim’s were taken to a hospital that had specialized facilities for treating this condition. Can you explain what these are and if they are common at most hospitals?
A:
Carbon Monoxide poisoning is usually treated by high-flow (100%) oxygen. All hospitals have the capability for administering oxygen to patients who have been exposed to carbon monoxide. Occasionally, severe cases of carbon monoxide poisoning are treated in Hyperbaric chambers.
Patients can be placed in these chambers where they can breath oxygen that is at higher than atmospheric pressure. Most hospitals do not have hyperbaric chambers, but patients may be transferred to a hyperbaric center if necessary.
Q:
Can you tell me more about sulfite sensitivities and any symptoms which may accompany a reaction? Thanks for your insight into ER medicine. Always informational and some times quite humerous.
Shelly
West Covina , CA
A:
Great question Shelly!
In the ER we see patients with allergic reactions all the time, and a large percentage of the time, we can’t figure out what caused it. This is because there are so many different potential sources of allergy out there (food, medications,plants, animals, detergents, mold, etc.). Sulfites are yet another possible source of allergic reaction, and one that we often forget to consider.
People can develop sensitivities to sulfites at any point, and about 1 percent of the population tends to be affected. It used to be common to spray fresh produce with sulfites and this practice has now been banned. Food that contains sulfites must have it listed on the ingredient label now. Those who are sensitive might develop asthma symptoms, GI upset, rash, or even severe allergic reactions like anaphylaxis. If you suspect you may have a sensitivity to sulfites, or other allergies, I would recommend evaluation by an allergist. They can help identify what is causing your symptoms and suggest a treatment plan.
Thanks for the question!
Q:
How do you feel about the use of cough syrups?
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Mark – Portland, OR
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A:
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I’ll admit I’m not a big fan of cough suppressants. I frequently am asked for a prescription for medication to “just stop me from coughing.” But it’s important to remember that there is a reason for the cough. The body is trying to get rid of debris in the lungs, and infectious material. It isn’t necessarily a good idea to simply stop the cough from happening.
Cough suppressants like codeine act on brain to decrease the cough reflex. Better than simply stopping the brain from wanting to cough are treatments that allow the lungs to clear infection, and to heal. This includes steam therapy, expectorants to clear mucous, and staying hydrated. Cough drops can help an irritated throat feel better and decrease cough. Sleeping with the head elevated can also be useful. Some patients benefit from inhaled medications to relax the airways and allow improved airflow. Antibiotics are sometimes indicated, as well as steroids such as prednisone.
Most of the time, to determine the best solution to a cough, a visit to the doctor is needed to take a history and listen to your lungs. For patients that have a dry, hacking cough that is keeping them awake, cough suppressants may be an option, but it shouldn’t be an automatic.
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Q:
Dear ER Doc,
I have been hearing about the low carb diet lately and am thinking about trying it out. Â Is this just another fad diet or is there some science behind it? Â I need to lose about 50 pounds.
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Lisa, Fresno CA
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A:
Lisa, there certainly are a lot of fad diets out there that don’t have any scientific basis, but low carbohydrate diets are not among them. Â Recently, a study was published in the New England Journal of Medicine which compared 3 diets against each other–a traditional low fat diet, a Mediterranean diet, and a low carbohydrate diet. Â The low carbohydrate diet was based on the “Atkins diet” which has been in use for many years. Â In this study, the low carbohydrate diet compared very favorably to the other diets, both in total weight loss and improvement in cholesterol profiles, despite the fact that calories were not restricted in this group. Â There were some limitations to the study, and further research will be required (as usual), but overall, this is helpful information. Â If you are interested in pursuing this option, I urge you to speak to your physician and get more information regarding both diet, and exercise. Â I applaud your desire to make healthy changes, which include weight loss, and I’m sure it will lessen your chance of visiting me in the ER!
