you're outside you know we've got to use common sense all the time again we're going to talk about regular things that we see in the emergency room giant season a are things that my daughter has cooked up this evening we asked a very all of the most up to date technology from our radiography suite to our tracking boards and ambulance entrance but even beyond the new facility we still have a kind of pride ourselves  having great care and a threat fast throughput of patients which is how quickly you're in and out of it which all of our viewers can relate to that you don't want to spend a lot of time in emerged we saw actually we  actually saw one today that they had been in another hospital we won't mention his name but waited and waited and waited and actually sort of come to ours and they were amazed at how quickly they came in were seen and actually were admitted to the hospital we have how many rooms eighteen eighteen and they're all monitored state of the art now mom rooms in a day are right to trauma room separate ambulance entrance we actually have a god forbid we ever need it we have a separate good number of them here locally at allegheny general where i trained also i would say actually seventy five percent of my doctors are trained at allegheny perfect yep and as we now it's really one of the state of the art facility  right stuck in your ear right someone might have retrieved it's very painful inside the ear so when those wings are really fluttering and moving they're an agonizing pain so actually what we do is put either a little sailing or a little i know it's very scary but i learned something about driving and driving in school zones and driving around with pavements and i'm going to share some with the audience if unless you're you want to share this with you do or how do you know if you're driving the reason i find out why the reason you have fifteen mi sensor and if you're driving ten miles an hour you know long it takes a car to stop for world this drive would say probably twenty feet close to eight feet so ten feet  ten miles an hour stops an eight feet pretty good that's why the now if you up that to thirty miles an hour it takes on web pavement like forty five feet to stop wow some risk factors or if you've had a previous problems with your heart certainly chest pain of your reason to come to the emergency department they almost that's the separated in dig into groups of people but let's just take all comers and say that you're having chest to problems that are good so i'm going to talk about gallbladder problems so you know we if you're having chest pain you know and you don't really have good reason to be having an awful something like that then right then you would want to come in and if you're having any associated symptoms the shortness of breath on the obama thing sweating what's interesting as you well know about the female population quite often their presentations completely different they  certain period of time half are twenty men you know that we used to try to base it on that but you know it can be an engine that can just be last a couple of minutes that bickley if it's just a sharp pain for a couple of seconds probably not engineer but you know i have seen people who've had very atypical pain like that then turns out to be engine are are again related to a blocked vessel so you know again time is not necessarily certainly if it becomes a recurrence issue certainly if it is a pain that is worsen with activity and relieved with rest but there's a lot of other cause chest pain just besides your heart you know if you've been traveling had you mentioned younger people let's say you're seventeen eighteen what would be a notice this is common to cause that sudden cardiac death and kids are playing basketball sports activities excellent tonight's guest dr john landis board certified emerge from physician been to cannes bird for almost two decades now over that two decade marks and so i now john you know we're fortunately not up against the penguins tonight we probably aren't against the pirates which actually saw some interesting stuff recently i actually saw it on e s p n and they talk specifically about you know whether or not to let the kids under the age of thirteen you do but throw body checks in hockey and i saw a really interesting discussion from some former n h l players and their thoughts and i just wanted to get an idea from you tell us a little bit about concussions especially in the younger age group that you see you know when should people committed emergency room and you know what's what happens once they see that's a good question we see a lot of kids that come in with head injuries of various sorts and typically i would say a good ninety five percent of what i see are really not severe head injuries whether it's sports related or otherwise but that smaller percentage that do that years they come in and they've either had a significant sports related injury maybe a fall of bicycle skateboard whatnot and they usually come in immediately because of the loss of consciousness or if they're delayed they've continued to have nausea vomiting or vision some symptoms like that and that's really what kind of has kept sidney crosby out as he's exhibited continue cognitive tarpaper cognitive impairment in that he can't remember things and he says you know there's a formalized test that has been developed that they that they put these folks through determine whether they're still having some problems with their brain so when they came in to see me with a detailed examination and determine if a cat scan is needed to rule out any structural abnormality that might be there and if the cat scan looks ok here's what i will do after that if i've determined that they suffered a significant head injury is all referring to a neurosurgeon not because they need surgery but because that is the person that can then reassess them and guide them for continued evaluation and that continued evaluation were really tell them because they always and my dad always say when can they go back and play say after you see the neurosurgeon and they determine that so because they need to ask you those questions when when you see somebody that comes in and you know let's say they took a shot they could not in a day that frequently i assume they don't remember whether they got knocked out or not witnessed the event from somebody else for the most part right right what's the most fall off a bicycle even with the helmet on a good fall off a bicycle even with a helmet you won't maybe not crack your skull open but you're going to still have the head injury and you mentioned concussion when you do that cat sca which is that the test they do the pictures of the brain doesn't show anything or does it not show anything you're doing that just so you don't have a bleed or something like that right right well let's hope it doesn't show something it does show something you know we're looking at a pretty severe head injury a bleed of some sort but in just the concussive state without bleeding it won't show anything ok is that person typically admitted to the hospital  they are you keeping an observation emergency room for some period of time usually at the injury was significant enough and they have continued symptoms then i will send them for admission and we say we would send that person to a trauma cent tales really that stems from the fact that you know you don't want to let someone go to sleep you said head injury and then just keep sleeping and then go to wake them up twelve fourteen hours later in the wake up because it had something significant you know really in the pre cat scan days that that's how we would evaluate people i mean i haven't practiced without a cat scan of my career but precast scan days mom and dad wouldn't take patients to the yard for talking about kids they would stand keep them at home watching for a while and make sure that they didn't that they woke up and we still do that after you have had a head injury and i give you detailed instructions about your head injury and what i will do is send you home with head injury instructions that indicate on the patient up every two hours ok if i determine that it's a minor head injury and usually it's a very fine line as to what separates those but usually the patients i have that i keep waiting had parents keep waking them up for ones that have continued symptoms headache maybe a little was it maybe a little vision problems and again the nurse or jen referral and for the next twelve hours they get wake up head injury and destruction is ok again tonight's guest dr john landis we're covering some of the common things we see in the merger and plus some of the things that my ten year old daughter decided to stomp him with and we have another one from the true story of the emergency room she wants to know if you ever spray paint in the face have seen spray paint the face mention all and unintentional and so what do we do for spray paint in the face of my daughter correct again nothing to do over the weekend read a newspaper and i see that there are people that keep these exotic animals and i read about a guy that had some know crazy stuff like this sure i'm sure there are a number of local people that is have venomous snakes that they keep pets and they take them out and walk on i don't know why you know i just read this article and i believe i live in a cocoon i guess right well as another health system we have a cache of antidote ok because it is very expensive i can't give you an exact figure but a whole treatment costs hundreds of thousands of dollars so we keep the cash that if we were to have a snakebite then we would send that patient again to a trauma center and they would mr is there anything to do and you're out in the field i mean is there any way to tell  they're poisonous but not poisonous enough to know copperheads or point poison on there and a good number snakes have a little bit of poison that you know won't actually make you sick but most people who would come in with a snake bite probably are bit by a garter snake or a king snake or black snake or something that somebody is mice is harmless right and you can tell by those bites because they're there really won't be any thing but maybe a little local inflammation they won't have the immediate symptoms and yours is a puncture wounds very very shallow they don't have you know fangs that particular to things ok well you know that's what i want to ask you about that one of the more common injuries that you see in the emergency room since ok low back pain usually work related sometimes not work related as you know sometimes real sometimes not so real but in any event most of the time  and now has some low back pain the bones will look normal and it won't be a test that shows us anything however fifty five year old guy or a six year old guy that suffers the same injury it might might be worthwhile to get rays so back pain is a common injury and then lacerations of all sorts all parts of the body is there anything you can tell people to do to prevent them it's sort of been safer being well one thing that we do in our house is we keep all the knives on the side of the sink and wash them without putting them into the soapy water me to until it's time to wash it one writes it off because a lot of times people throw th you know you just have to fish it out with something beside your hand because it's probably the second most common cause of kind of dishwashing related lacerations ok and we're still doing tetanus shots these days regar touched a little bit by concussions we talked about wearing helmets thriving in a safe zone being safe being safe motorcycles murder cycles murder black murder cycle not good well i think the repeal of the helmet law was was a bad thing really bad thing you know you are taking yourself i mean you gotta wear seat belt but line and that's the safest thing you can do is wear a helmet i know it looks cool not having a helmet ponytail proppant behind it but careful not everybody has the opportunity to have a punk well right i couldn't understand how you could know you could certainly cowbell there's absolutely no question about that look be safe out there go slow in those schools it's just ridiculous there's no excuse to speed in the schools and if you need us we're there twenty four seven the emergency room seventy four seven four five three zero seven seven seven two four seven four five three zero seven seven out of town call collect we have eighteen beds ready to serve you little weight if any board certified doc