Dont ride bikes in NYC and make sure you chew before you swallow- Week 6

The SICU has 13 beds. Almost always, 1-2 of those beds are occupied by bike trauma patients-bicycle bikes not motorcycle bikes. Growing up in the country, I never thought of biking as an inherently dangerous activity unless you decided you bomb down a mountainside or something like that. Not the case in NYC. It seems bikers can be doing risky things like flying down Lexington Ave during rush hour or doing presumably safe things like casually biking through Central Park, but the crowds, cars, trucks, noise, and construction permeating everything in the city will do a biker in every time. Even wearing helmets, many of the bikers experience moderate to severe head trauma and almost all of them present with some form of an intracranial bleed. Usually its a not particularly severe small subdural hematoma, but some patients present with very severe cerebral hemorrhages. Then theres the fractures, hematomas, contusions, and occasional internal organ injuries. Basically, dont ride a bicycle in NYC.

This past week an otherwise healthy young man with no trauma appeared on the unit! Well, bad for him, but interesting for the rest of us. A 20 year old male had been eating a sandwich and was so voracious he swallowed the whole toothpick and didnt even notice he did. Well, 5 days after ingesting the toothpick the patient presented to the ED with a very high white blood cell count, distension, fever,  right lower quadrant pain, and nausea. All signs pointing to a perforation which upon exploratory laparotomy, he indeed did have. He actually had some very severe obstructions and perforations and needed 10cm of ileum resected where the toothpick perforated which was surrounded by distended and congested small bowel and mursky ascites. Knowing he would need further abdominal surgeries in short succession, his abdomen was left open  and VACed close temporarily.

Speaking of VACs, they fascinate me. Several surgeons and doctors have told me that they have been the greatest contribution to medicine in the last 20 years. Not only do they close wounds in a natural manner, encouraging the tissue to close from the inside out in a zippered fashion, they keep wounds clean and dry, sealed, and they seem to actually encourage wound healing through means beyond these methods. As an undergraduate I worked on trying to tease out some of these ulterior mechanisms and determined the vibratory frequency the VAC applies to the wound bed is in such a range that it drives fibroblast migration and differentiation. Using this, my group developed a simple device that is able to apply the same vibratory frequencies a VAC does to superficial wounds which in small sample size animal trials, seemed to work pretty well. This summer Ive gotten to see tons of VACs in action. Brilliant machines.