The Most Common Summer Injuries, And How To Prevent Them | Refuah

Health Tele conference awareness tips. I mentioned health expert Dr. Ariner and Mark Awesome. It's an honor to be here. Thank you so much. Um, so my name is Ari Grner. I I'm an emergency room pediatric emergency room doctor. What that means is that I'm a pediatrician. um just like the pediatrician that you take your kids to, but I went back and trained in emergency medicine and I work now in the emergency room, pediatric emergency room at Westchester Medical Center. I split my time, so I live here in Muny. I split my time between working at Rafua in the acute care, which is our urgent care. Um sometimes I work in pediatrics in Rafua, like I said, I'm a pediatrician as well, and then a couple shifts a week I'm spending time in the emergency room at Westchester, which is pretty much the closest good hospital, we'll say, um in the area. It's a very nice balance for me um because I get to see the we'll say more severe types of cases in the ER. I get to see the less severe cases here in Rafua. And it's a nice connection because very very very often I'll be working in the emergency room and then a patient comes in and the patient is being sent from Rafua. So if somebody walks into Rafu in acute care and they need higher level, they need an emergency room. My colleagues, the people here like Mark and other people that work here will send them to the ER and it's a very nice connection. and they have, you know, they have a high doctor over here and then they go over there and I'm there working in the ER and we get to have what we call like a a full followup from beginning to end. I can call call the people here, get a story what's exactly going on and then I see them in the emergency room. >> Hi, my name is Mark Schuster just like my good friend Dr. Gman over here. Um I've spent many years about 12 years working in the emergency room but I do adult emergency room does pediatric um but I worked in the emergency room for about 12 years and I've been working in the urgent care for about the same amount of time as well. What I really like about it is we see from all gamas from the small minor injuries to the broken bones to the more severe cases and unfortunately the more severe ones in the emergency room. We get to see I don't work in the emergency room locally here. I work in the city in the emergency room so I don't see their food patients there but we get to see all kinds of people all kinds of injuries all kinds of illnesses all kinds of diseases. And I think like Ahri, just the two of us seeing all the gamuts, it really exposes us to a lot of different medical conditions, different injuries, and allows us to be better providers to be able to handle whatever comes through the doors here or wherever we work. It's a good question. Um, you know, in the winter kids are in, they're in school, they're at home, it's cold outside, so things happen, but it's not even close to the degree that we see in the summer. Summer, all the kids are out and about. The weather's nice. A lot of people are going up to the mountains, and you have kids all over the place, and the injuries are to a totally totally totally different level. Um, the most common things on a daily basis now in the emergency room, every single day we're seeing kids falling, injuries, lacerations, broken bones. Kids are going swimming. There's many, many, many pool injuries. And just in general, kids are all over the place, going on trips, going here, going there. The summer, it's sun, the sun is out, it's hot. Um, dehydration, sunburns. It's like the degree of what happens in the summer is a totally totally totally different Madre, a totally different level compared to what happens in the winter. Sure. So like Dr. Goner mentioned and you mentioned the summer leads to a lot of challenges and like I always like to say an ounce of prevention and being proactive could lead to a lot of bigger problems later on um and lead to a lot less pain, a lot less infections, a lot less hospitalizations like Dr. Gmer mentioned. So, one of the hottest topics we all know about right now is obviously the topic of scooters, bikes, rollerblades. They might be oldfashioned rollerblades, right? But kids are out and about again. So, things like helmets, reflectors, and teaching your kids what to do when they do get injured, whether it's calling the right number, telling your parents right away. Um, these are things that could prevent further problems later on. Dr. Governor, what would you say one of the biggest injuries that we could prevent with reflectors and helmets and uh prevention would be? >> I mean, like you like you're mentioning going like the it's the electric scooter thing is out of control at this point. It's like it's to a degree that I don't think anyone in medicine has ever seen. You know, a bike you fall off a bike, you get a scraped knee, maybe once in a while a kid will fall into their arms and get a broken wrist or a broken forearm. With the electric scooters, every single day we're seeing kids falling off. I mean, these things are going how fast, 20, 30 miles an hour. You have little little kids riding on them. Even with helmets and with reflectors and with the protectors, it's uh it's it's like basically impossible to prevent injuries. That's that's I think the biggest thing right now going on in the medical world, specifically more so for pediatrics is Fore is the license to drive. Foreim overnion dehydrated. So made like incredible incredible human body that maintains temperature in an incredible way. You think about it sometimes. I think about it. You play outside basketball or you're running around outside for a little bit. You check your temperature before you're outside in the heat. You check your temperature after. Your body temperature stays the same. Hashem has in place systems to make sure that our temperature stays exactly where it's meant to be. Whether you're outside in the cold, outside in the heat, which is pretty incredible. But at some point, if someone's out long enough, in the heat long enough, at some point those systems are are no longer able to keep up. So, at some point, what happens is a person's body temperature will go a little bit higher. So we'll go from 98 to 99, from 99 to 100. And we're not talking about someone who's sick and they have a fever. That's a whole different story. Someone who has a fever, a kid is sick, they have a temperature of 102, 103, 104. That's not an emergency. Kid is sick, go to the doctor, you get it checked out. We're talking about when someone's out in the heat and their body temperature is no longer able to stay in the normal range and it starts going a little bit higher, a little bit higher, a little bit higher. That is a absolute emergency emergency situation. even a temperature of 103, temperature of 102, which normally wouldn't be an emergency if it was stomach fever. But if it's it's due to heat where somebody is outside too long and their body temperature is no longer able to keep up, that's an a life-threatening emergency. We see that all the time in the emergency room. People come in, we check their blood work in such situations and you see organ failure. Their kidneys are no longer functioning. The body is meant to function at a specific temperature. is yeah, it's a good question. So, a normal body temperature, we're talking in Fahrenheit. So, you know, if you take a thermometer, put it under your tongue, or you check your kid's temperature, 97, 98, 99, all of those are fine. Sometimes I get people come into the emergency room, they say, "My my kids temperature was 99.1." That's all normal. Anything basically under 100, 100.4 is considered a normal temperature. Um, but what happens in the heat is if the body gets overwhelmed with heat, it starts to get higher and higher, like I said. And even 101, 102, you're already talking about real emergency situations. What you're asking about hiking and being outside is a great point. Um, sitting outside in the heat for many, many hours, that alone is enough to raise the body temperature at some point. You know, we all know if you're outside for an hour or two, body temperature stays the normal range. Outside for six, seven, eight hours, it will start to climb. But if you're outside doing some type of exercise, what happens in the body when you're doing exercise is it creates more heat. It creates more energy and more heat. Think about when you go for a run, your body turns red and flushed and you feel a heat coming from your body. So, if someone's outside in the heat, it's 100° outside, so it's already hotter than their body temperature. Now they're running around, going on a hike, playing ball, whatever, exerting themselves in some kind of way. They're creating even more heat. That adds to the danger. Now we're talking about a real real real situation where somebody's body temperature very very quickly could raise above the normal and develop this thing called heat stroke, which is a life-threatening emergency. Wow. was mentioned temperature. That's a really good question, Penny. Infants are very complex because like you said, they can't talk. They can tell you they're not feeling well. They can tell you that they feel very One of the best things parents could do to look out for infants is see if they're having wet diapers. If they're eating normally or if they're having tears, normally when you cry, you have tears. Normally, your child has a certain amount of wet diapers a day. But if their diapers are not wet for an extended period of time, if when they cry, it's more of just like a moan and they can't make real tears, that's a sign of dehydration. As well, there's something called AMS, alter mental status. That means if your baby's usually very cranky, very active, and now he's not active anymore. If he usually wants to eat and he's not eating, you know, and many other examples, if he's altered from his you his or her usual state of sleeping, eating, playing, whatever it is, those are all warning signs. But again, it's not just infants which are difficult elderly or anybody that's sick. Also, they don't react the same way a regular teenager or a regular young adult healthy would react. So if you seen the elder person who seems to be a little sluggish, a little schlack, not talking as much, doesn't want to get out, it could be for many reasons, but if they're altered in any way, and know you don't have to go around checking your neighbors uh if they're crying or having if they're going to go to the bathroom, but if they're altered in any way, not acting themselves, not talking themselves, it's a great it's a great hint that something is very wrong. body isn't called. Sure. So again another wonderful question. Prevention is key. If you know you're going outside on a really hot day, even very big mistake, even if it's cloudy, sunscreen. People think that if it's cloudy outside, you're not going to get a sunburn, you're not going to get affected from the sun. Even if it's cloudy, the rays come through the clouds and it will make you get dehydrated or gets really sick even quicker and get sunburns. So, sunscreen is a big one. a cap, a hat, a visor, something to protect the sun from your head. And just drinking drinking a lot of water, maybe even some Gatorade, but not soda. Soda is very bad for you. It dehydrates you. Um, a lot of water, a lot of electrolytes, and constantly staying dehyd staying hydrated is going to prevent the dehydration state. And if you're not sure, drink some more. If you're still not sure, even drink some more. but on obviously staying out of the sun and staying in the shade. And um these are just a few tips to keep it from getting to the state of now we're in the emergency room, now we're at the doctor, now we're calling. Prevention is the key. By the way, is very dehydrated. >> Sure, you can get dehydrated even if it's not sunny outside. It's a matter of when your storage of of fluids and sugar and everything else in your body starts to go down, now your body is in reactive mode. So like Dr. Gner said, even if it's only 101, 102, which normally is not bad for you if your body is already, if your body's already on the dehydrated side, and at the end of the day, now your body's in fighting mode. So now you're working overtime to maintain what normally you'd be able to on a regular day even when it's not too hot. So really just listen to your body. Hashem made the body talk to you. And if you're not feeling well, you're not sure, go get checked out. There's many facilities, many doctors. Not sure, go get checked out. It's a good question. I want to just say one more thing about prevention that I think is very important. Real real real realist saving lives and um the the every year in the from community every summer we hear a story of an infant being left in a car and I'm sorry to bring it up. I know it's it's painful and it's sad but almost every single year we hear a story of some from community myy lakewood borrow park whatever it is aritus of an infant being left in a car in the United States there are about 40 car deaths a year in the entire country in from infants that are left in cars the fact that one or two of those every single year is a from person is astounding you know it's like that doesn't make any sense to me so I don't have an ita I don't have a good solution but I think it's something we have to discuss and think out. Everyone has to be aware and be extra cognizant. Come up with some ita. A lot of people will say different things. Some people will take off their shoe when they put their infant in the car and throw it into the back. It sounds silly, but you know, you're not going to leave the car without your shoe. If your phone, you never leave the car without your phone or your keys or whatever it is. It's heartbreaking. It's heartbreaking. And and it's astounding that out of the 40 kids in the entire country each year that Nebuch die from from heat, infants that are left in the back of the car that every year come out, you hear at least one or two that are from people. I'm not trying to be Mikatri on Kalistall to say that we're doing something wrong, but I think the awareness has to be there. There's got to be some awareness. The the whatever we talked about from being outside in the heat, from exercising, all that stuff. Being in a hot car is times 100. 10 minutes in a hot car, body temperature soarses. You You've gone inside a car in the summer. You get inside your car, your seats are steaming hot. Something about being in the car, it traps the heat in with the windows closed. In 10, 20 minutes could could pass away. for dehydrated. So, there's different madregas. There's different levels of dehydration when you say dehydration or really what we're talking about here a little bit more is heat stroke. You know, when when the body temperature can't keep up, there's different madregas. Everybody has been in a situation before where you're outside on a hike or running around and you get a little bit overheated. Maybe you feel a little bit. Um, you probably feel a little bit thirsty. You know, if somebody feels like that, if they want, they can check their own temperature. Everyone has a thermometer at home. If your temperature is normal, you feel a little bit, you go inside, you take a break, you drink some cold water, and you rest, that's probably a reasonable way to deal with something like that. If you're talking about a situation where the body temperature is already rising, so someone's temperature is already, we'll say, above 100, 100, 101, 102, that is a medical emergency. What you can do while you're waiting for hatsah. So the first thing you should do is call hatsah or call 911. And while you're waiting, the simplest thing, it sounds it sounds so simple, but the simplest thing you could do is put the person in a cold environment. A cold environment. That could be um bringing them in the house. That could be opening up the freezer and putting them in front of the freezer. In the hospital, what we do, and this is going to sound um you know, it's like funny like people think in the hospital everything is all complicated and we're doing all this complicated. Some of the things we do in the hospital is push it, push it, simple, simple things. If somebody comes in, I had a situation once. This was actually really interesting. It was a it was a firefighter who was on the roof of a building fighting a fire in July. So, it was like 100° outside and he was on top of the building fighting a fire of extreme extreme heat. He came in, his temperature was 104. And he was totally not with it. He was conscious. Eyes were open. He was not making any sense. Couldn't tell me his own name. Couldn't tell me where he was. Came in with a whole crew, a whole cover of firefighters. They all brought him in and um this guy was on the brink of death. I mean his his body was overheated. All of his organs were damaged. You know, we check his blood work, we see the kidneys, the liver, everything is damaged. What do we do for him? We literally put him in an ice bath. Again, it sounds like what? That's what you do in the hospital. In situations like this, the simplest, safest thing you could do to save that person's life is to put them in a cold environment. So, we put the guy in a tub. We have a tub in the hospital. We take a ton of ice and you just start taking buckets of ice and dumping it on him. And every 20 minutes, 10 minutes, we're checking his temperature and you slowly see it start coming down. Temperature comes down to 100. All of a sudden, the guy's talking again. He's making sense. Of course, he's going to stay in the hospital. We have to make sure his organs are okay. But we saved his life simply by putting him in a cold environment. So, first thing you should do if someone's at the Madrega where their body temperature is rising, where they're not making sense, they seem like they're out of it, something is seriously wrong. First thing you do is call it solo. The second thing you should do is bring them into a cold environment. So, like we've said many times, prevention is the key. So, if you know your kids are going swimming, make sure there's an adult there. Make sure that the kids follow the rules. a silly rule like no running near the pool. It sounds very silly, but that's how kids fall and slip and hit their heads and then land up at my good friend Dr. Governor's emergency room. Um, and these have lifelong effects. So, always having an adult present. Always making sure that there's a gate with a lock on it. um especially if there's little kids and be mocked if you if you can about puddle jumpers, floaties, light vests, and making sure that there is a proper first aid equipment and emergency equipment in something does happen. And most importantly, know the address where you're going swimming. If you're going to your neighbor and god forbid something happens and you got to call, you're going to say, "I'm by um Freriedman's house." What are you going to say? You got to know the address where you going to be. And even more importantly is what's Satala's number. Just a small little anecdote as a paramedic for Atala. Just a few weeks ago, I had someone around the corner for me. The call came out for a baby choking. I got there less than 30 seconds as it was around the corner from my house and Rox, the kid had just thrown up and the kid was breathing again, but you could tell that there was a real choking. The child was completely, as we call, floppy and lethargic. It was a real real choking. Now, the interesting thing about this story is that the parents were not home and the teenager was holding the baby, but the teenager because she was in charge and she had an emergency crisis in her hand, she actually forgot's number. So, the 8-year-old who learned's number in school was the one who saved the day because 8-year-old ran and called because he had remembered it. So, this works for chokings. This works for injuries and especially by the pools. Make sure everybody knows the number. Whichever area you're in, everyone knows the address you are. And if the adult is going to be in the pool as well, make sure there's a second adult because things happen to adults also, not just the children. So if the adults can go in the pool, make sure an older child, teenager, adult is there to watch even when the adult is in the pool. And another amazing thing we could do for our children is teach them, even especially our older children, lifeguarding skills, CPR. Where is the AED in case you need it? And that's all it takes. A minute, two, three, four minutes to get there. Is there an AD? And if there is, where is it? Everyone should know where it is. These are just some prevention tips and preventative measures we could take. And Mer, we should never need these things. But because we're going into the summer, we got to be prepared. >> Yeah, usually a lot of people who have pools, I don't have a pool, but a lot of people have pools, you'll see the sign up. It says this is the address. This is the local. Probably a great idea. So a lot of the common injuries are children falling, breaking bones, um cutting themselves on steps or on the cement or on the sides of the pool. Some of them need stitches. Some of them are just boooos don't need stitches. Some of them need cast. Some of them don't. But when in doubt, Rosham, there are a lot of facilities locally. Even if it's not an emergency, you need to call out or go to the emergency room. But there's a lot of facilities close by. Urgent cares, acute carees, doctor's offices, go get them checked out. Because if that cut, which you thought was nothing, turns out it needs something, now we're talking about an infected cut and an infected wound. And that's where they're going to land back in my friend Dr. Ari Gmer's emergency room and going to be a lot worse. So from a scrape to a bite to somebody eating something by the side of the pool and having allergic reactions. It's nothing to do with the water. But we're all there eating snacks next to the pool. If you're not sure, don't eat it. If you're not sure if you're allergic to it, if you know your child has allergies to different foods, double check it or inform them that before they're going to eat something. So it ranges anything from boooos to allergic reactions which are really critical in matter of seconds or minutes to broken bones and leu there are some really bad injuries diving board injuries um just jumping into pool and hitting your back or your head or anything like that. So you have some really simple injuries to really really serious injuries. mention, >> sure, the dive board emergencies and those, you know, we always focus on the big things. So, everyone knows don't jump off the diving board, don't jump into the shallow. Those are the big injuries and everyone's cognizant and aware about that. But sometimes it's the clinish ones, the small ones that we forget about and we don't focus on. So, yeah, most of the injuries that I see from the pool areas are the falls and the horsing around and then you fell backwards also on the shoulders and hit your head and now you have a cut in the back of your scalp. Sometimes it's the small injuries, the clinish ones which we seem to forget about and just focus on the bigger ticket items. So it's really important to not to lose focus and just focus on the small simple ones because everyone knows about the big ones. It's the small ones that we don't know about and sometimes those are the ones that slip under the radar. It's a good question and it's a terrifying obviously a terrifying scenario. Um the first thing which is easier said than done is to try if you're the parent there to try not to panic. To try not to panic. Easier said than done obviously, but panicking usually doesn't help anyone. So to try not to panic. The the second thing is we need to get this kid out of the pool. So that is the number one priority right now. If a kid is in the pool, especially if their head is under the water, every second that they're under the water, they're not getting oxygen. They're having more and more brain damage. So the brain doesn't get oxygen, the brain gets damaged. And they're probably also getting more water into their lungs, and the lungs are getting damaged. So you need to get the kid out of the pool. Now, here it depends. Does the parent themselves know how to swim? It's not always a given. Sometimes the person who's in charge of watching, if the kid is in the six foot deep water at the bottom of the water, is the parent going to know how to get them out? Is it a lifeguard? Somebody who knows how to swim. That's the question. You don't want to have two patients instead of one, right? You could tell me, right? Isn't that what they say in that first thing is to make sure that the that the provider is safe. You don't want to have another patient. So, um, that's that's really the question. That's why a lot of pools will have devices that even someone who's not an expert swimmer is able to rescue a child out. I don't know what you call it, but they have like a big hook. What What's it called? >> Hook. A floating tube. >> Yeah, there's floating tubes. There's big long metal hooks like six, seven feet long that you can literally scoop somebody out of the bottom of the pool. So, if someone has a pool, that's an important device to have because like I said, not always is the parent somebody who knows how to swim. If the parent feels confident, they know how to get the kid out, they should get in, get that kid out of the water. That's obviously your first first goal. Once the kid is out of the water, you want to lay them down. Their head should be, they should be lying on their back, but their head should be to the side. And the reason is because often almost always when kids drown they end up vomiting. And if the kid is not conscious, you don't want them lying back vomiting and then choking on their own vomit. So lying on their back a little bit to the side. The next thing is, and this really goes back to what Mark was saying earlier, is we should be teaching people basic CPR. And I think that's a great point. Um, does the parent know how to do CPR? The most important life-saving technique that you can do while you're waiting for to come is to start CPR. CPR. People often think it's like a very very complicated, you know, how am I going to do CPR? I'm not a medical person. But really, the key of CPR is really, really, really pushing on the chest. You should learn how to do it. You shouldn't do it if you don't know what you're doing. But the key part of CPR is if someone's heart is not beating, it's called cardiac arrest. Every second that they're in cardiac arrest is life-threatening. Um, if somebody learns basic CPR, they push on the chest, you can artificially beat the heart for the person. You're pushing on their heart, getting blood through their body, getting oxygen through their body while you're waiting for a hotel. I would say that's that's a key. So, if someone this summer is planning on being the the parent who's observing, the parent who's on guard, who's watching, even just once a week, twice a week, take a CPR course. Try your best to figure out how to do basic CPR. I would say those are the keys. Anything else you would add, Moshi? >> Yeah, like there's a famous line, being brilliant on the basics. Like Ari said, ice cubes saves a fireman's life. It's not really complicated. It's brilliant on the basics. The ice cubes know your address. Know how to do CPR. And if you're not sure, learn it. You know, ignorance is not an excuse. Take a class, take a course, but everyone should know the basics. Just the basics is going to go a long way. Full capping life. Definitely. Totally. Definitely sounds like a reasonable point and and makes a lot of sense. 100%. >> Okay. Yeah. It's villain. It's undertame. for a certain int. Takes zombies. Um, tix is a big one. Tix is a is a big big um related to Lyme disease. I would say that is probably the most common thing in terms of insects that people come in for is um concerns about ticks, removal of ticks, concerns about Lyme disease. Second after that is probably like wasps, bees, you know, like things like that that cause stings that people are concerned about. Wow, that's a loaded question. The effects of a tick. What it could lead to? That's a hard question. All right, let's start with the with this with the the basics. We don't have to get those complications. If we do our doohabas and catch them when it's early on, that means all little children who can't check themselves when the mother or father bathes them, inspect from head to toe, behind the ears, by the waist area, behind the knees. Very important. I know we talk about it all the time, but the same way we can't say wear a reflector enough and wear a helmet enough, we can't say it enough times. Check your children, your small children or even your bigger children if they can't see on their back themselves. Just check them especially if they're outdoor playing because if you catch a chick a tick on early a tick when it's only on early you either remove it yourself you can go to the local doctor urgent care emergency room they can remove it from you and you can save yourself a lot of problems now once you're not sure how long it was in for once you're getting the rashes once you're getting all the other symptoms you want to shed some light on this one what are the possible complications and how to go about it >> um yeah so the thing we're concerned out with ticks in this region, which is, you know, the the New York, New Jersey, Connecticut. The ticks here carry something called Lyme disease, which is a is a hot topic. Everybody reads about it all the time. You see it in all the magazines and everything like that. Um, but I would say if somebody finds a tick on their child, it's not an emergency. It doesn't mean they have Lyme disease. It means they have a tick on them. For the for the tick to cause Lyme disease, it has to be sitting on the skin for at least a full day, for 24 hours. So, if you know you check your children every day, I checked them last night, no ticks on their body. I checked them today, I found a tick on their body, then 100% that is not going to cause Lyme disease. What should you do? Take the tick off. Find someone else that knows how to take the tick off. And you don't have to worry at all about Lyme disease. If it's been, you know, for sure if it's been less than 24 hours. Once you're getting to a situation where you're not sure, which is probably the more common situation, you don't know how long it's been there. I haven't checked them for a few days. I found this tick. Now, we're not 100% sure. Then we do start to get worried. Could this potentially cause Lyme disease? The tick carries Lyme disease inside itself, which is sounds crazy. And if the tick is inside the skin, it can transfer Lyme disease into the human being. But again, it takes at least 24 to 36 hours. So if you're not sure how long the tick's been there, you think it might have been there for a while, then we do start to worry about Lyme disease. If that's the situation, then what we do in the ER, in acute care, in the doctor's office, is give one dose of antibiotics called doxycycline. It's one single dose. And people are always confused, one dose. post never heard of such a thing. Usually, it's 10 days, 7 days, 14 days. The the reason here is because we're giving a dose of antibiotics to prevent lime from infecting that person. So, we found a tick. We think it might have been there for at least a day, if not more. And we're worried that maybe now there is lime that is going to start infecting that person. One single dose of antibiotics could prevent that infection from taking hold. And that's all you need. A lot of people are confused about that in both directions. Some people are saying, "What? I don't want to take antibiotics. I don't believe in antibiotics. It's very important to take that one dose." And a lot of people on the other end are saying just a single dose. I want to have 14 days, 21 days. What do you mean? What if I got Lyme disease? It's that is the recommendation and that's what's been proven is if you get a single dose of doxycycline, if a if a tick has been on the person for a decent amount of time, that's all you need and you should be totally fine and good to go. I just wanted to add on that. Um, we talked about taking a tick off right away. Please, please, please, I'm begging on behalf of myself and every other provider. If you're not sure how to take a tick off or you're not sure if you know how to, don't attempt it. Because what happens is you end up pulling off a leg or half of the stomach and then you start coming into the clinic or the emergency room and now there's a half a stomach or the head inside the skin and now your child is already crying and is already sore and now we have to start doing a procedure which is not so comfortable and remove some of it, part of it, all of it. And now we're dealing with a screaming child and it's a painful procedure. Masha in if we do it properly the first time it's really not painful and it takes a matter of seconds. So if you're not sure, like I said before, there's a lot of facilities around whether you're in Muny, Brooklyn, upstate, wherever you are, find someone competent, find a doctor, doctor's office, acute care, urgent care, and do it properly the first time. It saves a lot of problems. And again, like I already said, if you're not sure, there's blood tests and different things we could do on a later date. But as always, don't panic. There are maks to treat it, to prevent it, and to deal with it. Sure. If you know you're going to be going on a hike or in wooded areas, there's different sprays like Off or bug repellent or wearing long pants. It's just some simple things you could do. Wearing long sleeves if you know you're going to be entering yourself into a a situation where you possibly might get one. A little offspray, longer clothing. Um, these are all ways to prevent it. Yeah. So there's really we we can divide the population into two categories. The people who are allergic to beast things or wasps things and the people who are not allergic. Huge huge huge huge difference there. Somebody who's not allergic. So it's unfortunate. It hurts. There's going to be redness. There's going to be swelling. Um I get people that come I you'd be surprised. People in general are surprised what people how people come into the emergency room for certain things. People come into the emergency room for a beasting, which maybe you'd be surprised about, but there's nothing to do other than I do the same thing that parents would do at home. You fill a bag of ice, I put some ice on it. Um, that's basically it. You can give some Tylenol. You can give some motin if there's a lot of pain. And you basically just watch it. It will go down. It's unfortunate, but it's not a medical emergency. We'll say like that in a regular healthy person. If someone is allergic to bee or wasps things, that's a whole different story. That is a medical emergency. And not every not everyone will know if they're allergic or not because they may have never been exposed before. They may have never had a sting before. But the signs of of a severe life-threatening allergy is if obviously if the patient or child is having trouble breathing. Um if they're having huge huge swelling, I'm talking about not just right there, but all of a sudden their entire body or their entire arm is looking red. Um if they're having vomiting, those could be signs of what we call anaphilaxis, which is a life-threatening allergic reaction. And um if someone is seeing something like that and they're concerned that it could be anaphilaxis, a life-threatening emergency, they should call my friend Moishi, call Hatsah um and Hatala will come and evaluate. But that is something much more concerning. So I would say for the most part wasp beastings not fun but not usually an emergency. Poison ivy. So another one besides for what talked about with the be bites and wasps another really big one is something called contact dermatitis which really covers a lot of things. Poison avi poison oak. A lot of these things just retouch or outside in the woods, forest, or playing outside. You kick the ball across your lawn and now you go to the bushes to get it and now you come out and you touch something. Sometimes you don't even know right away. It's only a few hours later and you realize you're scratching and your face is all blown up. It's very important when you come in from playing outside, soap and water. Sometimes simple thing like soap and water can prevent that poison, ivy, oak or whatever it is from spreading. And if you do start to get itchy after you touch something, go with the basics again. Some benadryil, ask your parents. Your parents will I'm sure know how to dose it for you. And if not, they'll phone a friend or a doctor or somebody else. But poison ivy is really, really big. And again, prevention. If you know you have poison ivy around your house and your kids are playing, they sell in every Home Depot, Lowe's, every store the poison ivy spray. Spray because I guarantee you, I've had it with my own children. We've all had it. One child with poison ivy can uh wreck havoc on your house for a week. Their face is blown up. They're scratchy, they're uncomfortable, they're in your bed all night, it's really not kishmach. So spray around your house, wash hands, soap, soap and water after you come from playing, even if you're not going to eat supper. And if you're not sure, go to one of the local clinics because if you catch up when it's small, there's steroid cream. There's different things we can give you before again, we end up visiting after the middle of the night. An accident is the severity of injuries really vary from minor fender benders to really really really bad injuries. Um hopefully this summer we will have zero of any kind of shm. Um but let's just start with the basics for for you to know. If you're in an accident and you think you're hurt, you're not sure you're hurt, you call it, you call 911. If you think you're hurt, don't get out of the car. Stay where you are. The first responders and rescuers will come help you. Um yes, you could check and make sure everybody else in your car is okay. But if you yourself think you're hurt, just stay where you are. If there's a danger, you smell smoke, fire, there's wires, things like that. That's a whole separate partial. But if you're hurt, stay where you are. People will come to rescue you. People come to help you. If you have children in your back seat, if you have children in your car, check on them, make sure they're okay. But we start with ourselves. You know, safety starts starts with you. If you run out into the, you know, unfortunately every year you get into an accident and you open your car door and on the highway and unfortunately someone clips you on the way out, just stay where you are. Obviously, make sure your car is safe if you could. You know, check with your local police department, but maybe move to the side of the road so you're not blocking traffic and making a balagan. Uh, but get to a safe area and stay where you are and let the rescuers and 911 do what we have to do. Um, but don't enter into a bigger saka by getting out of your car or there's gas, there's wires, just stay put. It sounds very basic, but we have to remember it because when we get into these situations, we panic and we can't really think. So if we think about it before end, we won't have to think about it at the time. Emergency room. Yeah, the the very severe ones. I don't even need to say. I mean, we all have heard stories of people who lost their lives. Everyone probably knows at least one family, one. So, I'm the one seeing it in the in the ER. I don't need to go into details. I think everyone understands that. Um, the types of accidents, there's a couple different things, you know, the there's the car accidents where the car itself is hit into another car, everyone is inside the car, and then what's probably even more severe, not probably, what is definitely more severe is when a child is hit by a car. So, the child is in the street and hit by a car. Those are absolute absolute worst. Um, so being inside the car, uh, you know, you don't need a doctor to tell you it's the obvious things. It's everyone should be wearing seat belts. The infants should be in car seats and the driver should not be distracted. It's so tough in this day and age. There's so many distractions. The cars themselves come with 800 different things that you can push and play and this and that and the GPS is on and the music is playing. So, I think there's like each uh, you know, everyone has their own role in the in the safety. The driver has to do their best. Lots of driving people are driving upstate every weekend. Shabas this and that driver not being distracted, the children being in the proper car seats and having their seat belts on. It's it's obvious. It's the ABCs, but that's really the the I forgot I had a story recently. I had a guy I had a guy last week, an 18-year-old guy who was driving upstate and it was 6:00 in the morning. I don't know exactly what what the story was. Maybe he was going to work. He fell asleep at the wheel on the highway. um his car veered off, flipped over and ended up in between, you know, the two sides of the highway and he walked into our emergency room talking, you know, totally totally fine. We got all the images, the X-rays, the CAT scans, blood work. He was totally fine. He left 2 three hours later. His parents couldn't believe it. Like, how how is it possible? The car was totally wrecked. He was wearing a seatelt. If he wouldn't have been wearing a seat belt, I told him this, he would have been dead. 100% would have been dead. He would have been ejected out of the car, flown out of the car, and he wouldn't be alive. So, sounds push. You don't need me to say it. Everybody knows it. I know it. You know it. We all know it. But wearing seat belts, simple ABCs, not being distracted, all that. But this the part of it of children in the street, that's a big issue. That's a big issue. And those injuries are usually a lot lot lot worse than the car accidents where one car hits another car or one car hits into something else. Same thing. I think the the prevention is is the ABCs. You know, I I work on this with my children and you probably everyone probably does the same, but teaching our kids that the street belongs to cars. Very difficult in places like Muny and in the CAT skills where there aren't really sidewalks, but it's like, you know, kids get used to just like running running across the street and they're going to see their friends and they're not necessarily checking both ways. So, simple things, teach your kids, you have to check both ways. The street belongs to cars. Um, simple simple things like that I think can go a long way. >> I just wanted to add on to what Ari was saying. You asked before the various kinds of injuries. Sometimes, like we discussed before, when you're in shock, you don't realize what's going on. Sometimes you don't realize right away how bad the injuries are. Just about 2 3 weeks ago, I responded to a call where someone was hit by a car on a bike and he was wearing a helmet, thankfully. And his head hit the windshield and he had no headache and there was a big spiderwe on the windshield. He didn't want to go to the hospital and everyone was like, "Oh, great. He's wearing a helmet to be safe." We convinced him to go to the hospital. He ended up having bleeding around his kidneys because at the time he was in shock. He didn't realize how much pain, how much injury happened to his body. And that's our job. Call, go to the urgent care, come to the emergency rooms, get checked out. If a parent is not sure, call your doctor, go get checked out. Even if the child seems okay, if there's a significant mechanism of injury, and sometimes it's just falling really hard off a bike, go get checked out because taking care of something right away leads to a lot less complications and injury later on. >> Um, I want to say one more thing about helmets. Um, helmets are important. Obviously, our kids should be wearing helmets when they're on scooters, when they're on bikes. With the new electric scooters, the helmets are not designed for kids who are going 30 mph. So, we're seeing, I'm not going to say on a daily basis, but on a weekly basis, we're seeing kids with wearing helmets. They're wearing bike helmets on electric scooters who fall off, hit their head. We just unfortunately had a actually a from kid come into Westchester for this. Um, but they're wearing helmets, they fall off, they hit their head. The helmet is not designed to protect someone who's going that kind of speed. You ever see somebody on a motorcycle, they're wearing a motorcycle helmet. This is a helmet that's like cannot bulletproof because if you're going 70 miles an hour, you don't wear a bike helmet. So, I think it's a very important point. This is the first time probably ever that we're seeing a huge amount of serious brain injuries, brain bleeds, skull fractures, things like that on kids who are wearing helmets. 5 years ago, we would have said, "You're wearing a helmet, you're fine." Kids are going speeds now much, much much faster than ever before because they're on electric bikes, electric scooters. the helmets that that you're using for your, you know, for your for your tricycle is not going to help for these types of things. >> There's a famous joke now that uh used to be we wore helmets, people wore helmets for protection. Now with the ebikes, it looks like the hum for protection in Seat belt. for the road. for the other part of the ABCs, the the obvious things that people should be thinking about driving is um and this one I I have to agree that it's a little bit of um hypocritical for me to be talking about this, but not driving when you're tired. I work overnight, so a lot of times I'm driving back in the morning, but I try I try to rest if I can. I drink a coffee, but it's important to not be over tired, especially people are going back and forth from the country early in the morning, late at night, texting and driving or being on your phone when you're driving. It it goes without saying. Uh it's sometimes you're driving and you see somebody veering back and forth, back and forth, and think in your head, this person has to be drunk or something. It's it's not possible. You pull up next to them, they're on their phone. So, we all think people think they're on their phone and they're driving. They're probably fine. They can do two things at once. We can multitask. Everyone else who's watching it knows this person is not they're not in the lane. They're like literally veering off the lane. Um, so it goes into the ABCs of like, you know, you're driving 60 mph, 70 mph. This is people's lives on the line and it's things that we deal with on a daily basis that um, unfortunately happen but also could be avoided. Fore just to sum it all up. We're all going to have an amazing summer. We're all going to go to wherever we go, whether it's the Cascals, my upstate, wherever we're going. And it's natural. We're going to ride bikes. We're going to ride ebikes. We're going to go swimming. We're going to get be bites. We're going to get tick bites. We're going to get poison ivy. And unfortunately, there will be some dehydration patients. But if we could just do our and do our responsible prevention tips, our prevention education, and do our part to keep our kids and our neighbors and everybody else safe. That would be the responsible thing. And of course, things are going to come up. If you're not sure, callah. If you're not sure, go to the local urgent care, acute care, doctor's office, and you should never land up in the hospital. But if we do these steps of prevention, being brilliant on the basics, and doing arras, hopefully I won't see you in the back of an ambulance. I won't see you in the care, and Ari won't want to see you in the emergency room, and we'll have a really enjoyable and safe summer. Yeah, summer is a time for for having fun. It's a time for being outside. The weather's nice. Hashem wants us to enjoy his world. We're not meant to, you know, the point of this is not that everyone should be inside and and terrified of what's going to happen. The point is they have fun. I have fun with my kids. We go out. We have a great time. Enjoy the summer. I'm not one of these. Uh, you know, some of my colleagues, some of the ER doctors I work with, you hear people say, "I would never uh let my kids do X, Y, and Z. I would never let them go on a trampoline. I would never let them," because we see this on a daily basis. >> Do they have kids? >> Some have kids. Um, we see this on a daily basis. And and it could get scary. But I think part of living life is that there has to be a balance. It's not the answer is not don't go swimming, don't go on a trampoline, don't do anything fun, you know, just sit inside and play chess the whole summer. Uh the point is to have a good time, but um sometimes it's literally one second, one tiny little thing that can ruin a person's life. It's like I see it in the emergency room. You see someone and it's like that one. If they would have been one foot off, they would have been one foot off the street or one foot out of the pool, like one tiny little thing, their whole life would have been different and now they're going to live with devastating, devastating, lifealtering effects for the rest of their life. It's like so I think that's the takeaway point is to to to do everything to have a good time but to to think ahead to do it in a way where you don't want to have to regret it for the for the rest of a person's life something horrible would happen. Everybody enjoy the summer have a great time and we hope to not see any any of you in the emergency room this summer. science of human lung.