Do you have a pulmonary embolism? I feel bad for what's going on everybody. Welcome back to the channel. Today we're going to be going over something a subscriber actually commented on my latest YouTube video and it's about a YouTube couple, Kristen and Marcus Johns. They got in a really bad biking accident and they went through their hospital course and also showed some of their radiology images or their x-rays and they wanted me to go through it and explain it in a little better detail. So that's exactly what I'm going to do today. Stay tuned. We're going to go through this whole entire hospital course of Kristen and Marcus Johns. Let's get into it. So before I start this video, I wanted to finally talk about our giveaway, our 100,000 subscriber giveaway. I mentioned it on my last video and I know we are about 30,000 subscribers too late for this, but better now than never or something like that. For starters, we're going to be giving away one free pair of big scrubs just like the ones I have on, but not necessarily this color. They're going to send it directly to you if you are the lucky winner. It doesn't matter what size you are, as long as you live in the United States of America, you could win a free pair of scrubs. But that's not it because I'm also giving away a $100 Amazon gift card to the lucky subscriber as well. Furthermore, I'm giving away some AirPods because why not? So free pair of big scrubs, $100 Amazon gift card, and also some AirPods. You'll get it straight to your door if you win this giveaway. The only thing you have to do is subscribe to my channel, follow me on Instagram, and also follow WearFigs on Instagram at WearFigs. Those are the only three requirements of this giveaway and you can win it all. All right, so let's get to this video. So Marcus and Kristen Johns are YouTubers. They're a couple. They're a pretty cool channel.  So I wanted to watch this video with you all and kind of go through it. I'll probably skip a little bit ahead because for the first half of the video, it's a long video, like 30 minutes. They just kind of talked about the accident itself, but I wanted to get into the hospital course. So let's get into it. We just thought this car was trying to kill us on purpose. We were just riding our bike and all of a sudden a car is going 80 miles an hour and then swerves at us and smashes into us. I feel like good things always happen to like super nice people. For some reason in the hospital, you always have these super nice patients and something bad like this always happens to the nice people. I don't know why. It just, it drives me crazy. The bad people like nothing ever happens to them. It's always nice people like them. I got to hospital and they told me, okay, we don't have time to put you under, but we're about to drill into your knee bone. Put four screws into your knee while you're awake to put your femur and traction, which is basically when they pull up with this machine to make the bone not like this anymore, but like this. So it's on top of each other. That's actually a pretty good description Kristen gave there. So what she's describing is when the orthopedic surgeons do the external fixation of a long bone fracture. So hers it sounded like either tibia or maybe the knee like distal femur, the lower femur, something like that. I don't really know yet because I haven't seen the images, but what they do is they drill into the bones in the leg and they slowly basically screw and unscrew and kind of spread those bones out because a lot of times when bones break, especially in the leg bones, the femur and the tibia orcigula, when they break, they tend to override a little bit on the fragments. So then as she so aptly described, they put pins in the external parts of the bones and slowly, slowly, slowly bring those bones back together until they're lined up properly. So that's what she's talking about. External fixation. They will not do that in the OR. I don't think they do have anesthetic just it may not be a surgical procedure at certain places. Some orthopedic surgeon can chime in. This is when they showed me this picture. Oh, is that my little femur? No, no, this is Kristin's. So this is exactly what I was saying. So she essentially has a comminuted fracture of the mid femur. So and she has a little butterfly fragment, which is that little piece anteriorly that's kind of off to the side. So this is a comminuted fracture, which means it's broken in more than two spots and the fragments are overriding. So they need to undo those fragments and traction them out so that they're aligned appropriately. And then what they'll probably do is put a rod within the femur to kind of help that bone heal. They'll either go from a top or below. But yeah, that's a pretty bad femur fracture. It's always good to have a nice sense of humor when you're doing through something tragic like this. I don't know. I can imagine it sucked pretty bad to have your legs broken. So Are you okay? What's happening? My left leg hurts so bad, but everything else is fine. One, two. And that's when we were able to first kind of talk to each other and then realize, oh, what happened? What was your side of the story? What do you remember? I think this is the hardest part. There's so many times, at least in my experience, if it was a serious accident enough where both of them are transported in probably different ambulances, they go to the hospital, they're in different rooms, one may be in the ICU, one may be worse off than the other. And they don't even know what happened to the other person. Oftentimes for a few days, and then they finally can rejoin and talk about it and see each other and make sure everybody's okay. But it's just unfortunate. So I'm glad they were able to see each other and at least, you know, see with their own eyes that they were both okay. As the helmet saved my life, when I flew my head smashed, but then my helmet flew off probably after the impact because I would have been bleeding and everything. But then I probably hit my head again after balancing the second time, which is what probably knocked me out. We should be dead. That's what everyone says. The fact that our spines are, we don't have internal bleeding, our veins. We don't have scars or scratches all over our face, both of our legs, all the scars down the side of our leg. That should have been everywhere. When I got admitted to the ER, they were like, okay, we need to flip you over because we need to put bandages over all your road rash all over your back. Yeah, I totally agree. A lot of these accidents like this, you can have a very bad head bleed or like epidural, subdural hematoma that can have some devastating neurologic effects, which I've seen time and time again. You can also have some internal bleeding.  And then they'll have to go to the OR and do a huge X-LAB excision and open you up to kind of stop the bleeding. So I know it sounds like I'm minimizing this, but to have just broken bones, which are terrible, especially long bone fractures, very painful, but they came out pretty good given all things considered. After our first surgeries, we're in a hospital for a total of five days and eight days. I got out three days earlier. They wouldn't release Kristin because she wasn't reaching a certain physical therapy benchmark that they wanted her to reach, which is they wanted her to stand for five minutes. So a lot of times when someone has a surgery like this or has fractures, especially other legs, you have to meet certain requirements per se from like physical therapy or occupational therapists working with you because they can't just send you home and be by yourself. If you can't participate in like normal daily routine activities, like being able to get up and go use the restroom, being able to get in and out of bed, that kind of thing, because it would be dangerous to send you home if you weren't able to do those things. So for her, she was a little delayed getting out of the hospital because they wanted to make sure that she could do these things before she left. They didn't catch that Kristin's hip was fractured. So she wasn't reaching this benchmark because she had a fractured hip. All right. So this is the post-surgery radiograph. So I know she had that femur fracture, which is they're not showing here because it's a little further down, but she also has three pins in her proximal femur now and her femoral head and femoral neck, which is I think when they repair like an intertrochanteric fracture, which can be very subtle on x-ray. And a lot of times you can't see those, which is unfortunate, but this was already after it's been repaired. This is not the pre-op. This is post-hip and also femur fracture. So she has the rod in the intramedulary rod in the femur as well as the screws that are in her femoral neck and head. They usually repair these. Like I said, this is probably an intertrochanteric fracture, which is right down between the greater and lesser trochanter here. Super, super, super hard fracture to see just on like any routine x-ray. The only way you can really see it is if it's displaced, which means it's not aligned appropriately. You can see a little offset that can still be very subtle. So another thing too is a lot of these traumatic x-rays that come in through the ER, they're not really good crisp films because a lot of times the patient is imaged either on a backboard and they can't move their leg appropriately for the perfect images. So some of them are inadequate images, which can lead to inability to essentially recognize certain fractures. And also when you have a huge femur fracture like that, it kind of as a radiologist, you have to kind of train yourself to not stop there. If there's a fracture there, there's probably a fracture somewhere else. That's kind of how I look at it. If the trauma was bad enough to fracture your bone, you have to look at the joints to see if there's a fracture as well. And again, you may not be able to see it because x-ray, post-traumatic x-ray is not the ideal source to look for an extraterritorial pantheric fracture. MRI is the gold standard for that. If she was complaining of pain still in that hip joint, I mean, you got to be thinking more towards a hip fracture or get an MRI to double check it. The thing you can do for a hip is make someone stand and put pressure on it. That just makes it worse. So she was saying, ow, my hip. Ow, my hip. I can't stand. And they told me, they told me it was phantom pain from my femur surgery. That was just, my brain was just thinking my hip was in pain. You just believed the doctor. I mean, she has a point.  You feel, they probably thought it was being referred pain to her hip from her huge fracture in her femur or her thigh. You got to listen to the patient. If they're telling you, giving you signs like this that, you know, they're in pain, it might be worth your while to double check it. We prep Kristin to come home. We have this big reunion. She comes home and it's awesome. And she's here for three days. The hospital calls and goes, Hey, we were looking at those x-rays that we took. It turns out that we think she does have a hip fracture and she might have to come in and get surgery. So that's a lot to me. Unless there were residents that were reading these x-rays overnight or something, it's weird that they would go back and look at the x-rays again because after we sign off the images, they're gone. I don't ever pull them back up and like go through them again to look at them, unless, you know, some other physician wants to go over the images with me, which may have happened. Maybe the orthopedic surgeon wanted to talk more about the images and they went over them and scrutinized them a little more and maybe saw something that could be worrisome. Maybe that happened in this case. The hip was fractured and it's called a non-displaced femoral neck fracture. Yes. A non-displaced femoral neck fracture, an intertropeaneteria fracture or it could be part of the neck that's not displaced. So she's trauma. It could have been either of those. It's hard to tell, but a non-displaced femoral neck or intertropeaneteria fracture is very, very difficult to see. Cannot stress that enough, especially in a post-traumatic film. Very difficult, very easy to miss, steers me all the time reading these films.  Yeah. So what she's describing is basically the blood supply to the femoral neck and head. It's a little worse than the femoral head, but the blood supply is through a few arteries and if they're broken or at the femoral neck is broken, you can damage the blood supply to the femoral head. And when you damage the blood supply to the femoral head, it can lead to osteonecrosis or abascular necrosis, especially when the femoral head just dies because it's not getting any blood supply. It ends up getting various sclerosis and hardened and flattens. It can be extremely painful as you can imagine. The femoral head is normal of ball and socket joint, but if this gets really flat, you're just grinding flat bone against the hip joint and it can be very painful and you have to have surgery and have your hip entirely replaced if that happens. So the goal is to go ahead, get that hip prepared so you don't have to worry about the blood supply being damaged. But I was less scared because he told me it was a way less scary surgery. I woke up out of that surgery screaming in pain. It was the worst pain since the accident that I had felt. I was like, why did he tell me this is not a painful surgery? He probably told her it wasn't a painful surgery because if you don't want to scare her.  So it could be a little painful or maybe they didn't give her the appropriate pain medications afterwards or something. I don't know.  So they have to emergency take her back in because she might have a bone marrow embolism. That's what I was concerned of.  Essentially, when the bone is broken, the fat can kind of transfer into the arteries, which are also kind of broken. They can travel up to your lungs and the fat can be lodged in the pulmonary artery in your lung and cause a pulmonary embolism. I've done a whole video about pulmonary embolisms and dbt's. So you can go check that out linked up here. So that's probably what she had or what they were concerned with because she had chest pain after a long bone fracture. So you had to go to the ER to do a worked up again.  Like it's very, very severe. So it can be very severe. Oftentimes, a lot of pulmonary embolism are small and don't really cause that much of an issue. They may have some trouble breathing or shortness of breath, chest pain like that. But the big ones, saddle pulmonary embolism is what we really care about, the central PEs, because they can kind of block the outflow from your right H and right bench crawl to your pulmonary arteries. When that happens, the blood kind of gets backed up in the heart and the heart will essentially collapse and not be able to pump and it just stops working and can kill you pretty quickly.  They run a million tests on me and they say, you don't have a pulmonary embolism. It's just a pulled muscle. You can go home and my mom are so happy. That's huge. You don't want a pulmonary embolism. You would have to be on long-term anti-covalidation. She's super young. I don't know how old she is, like 20s or so. You just don't want a young person to be on long-term anti-covalidation. It's just, there's a lot of risks involved with long-term anti-covalidation and she's better off. I'm getting in the car and they say, yeah, you need to come back in immediately because you have pulmonary embolism. She's, I feel bad for her because I don't know what's happening with the radiology department there or if like emergency medicine is pre-reading this stuff and saying they're negative and then the radiologist gets to them or whatnot. I don't know what city she's in. Yeah, I don't know why they're not telling the results immediately. I don't know why they're waiting so long. And you need to be admitted to the hospital till further notice because this is really serious. So it sounds like she has a distal pulmonary embolism or something along those lines. I wish I had the CT to confirm.  So she had to go back to the hospital now for the technically fourth time. I had to get on this blood thinner. That was the shots in my stomach that Marcus had to give me for two weeks. So she's probably talking about lovinox, which is a subcutaneous anti-covalidation or blood thinner.  I forgot, it depends on her dose, how many times a day you would do it. Kind of like giving yourself insulin, but it's a blood thinner. All right, so then they just talked about the rest of the video and they're happy that they're okay. I'm happy they're okay. And this is, you know, just a little bump in the road, which is great. It's awesome to remain positive in certain situations like this. So anyways, that concludes this video. I hope you all enjoyed it. If you like me doing more medical things and going over and explaining things in the medical detail, let me know in the comments below. If you have any questions, also leave them in the comments below. I'll try to answer them. Otherwise, I'll see you all on the next video.