After a crash, a guide for Tiny Fix

Originally written for Tiny Fix on 1/22/13

The following is based on personal and professional experience, but should not substitute for the recommendations of a medical professional who has talked to you and examined you. That said, you should always seek medical attention for symptoms after a crash.  This article provides information about the common types of injuries resulting from bicycle accidents, including several absolute indications to seek medical attention.

So you had an accident.  You fell, you crashed into someone or something, or a car hit you.  You feel shaken up, angry, upset, and probably sore, but generally all right.  You walk around a little, jump up and down a few times, and figure you’ll just go home. Your friends are telling you to go to the hospital. What do you do?

These are several absolute indications to go (or insist that your friend go) to the emergency department, or to see a doctor in clinic the same day. 

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1.  Loss of consciousness, disorientation or memory loss at the time of the accident (friends or bystanders may be required to help figure this out).

2.  Significant tenderness over any specific point on your body (as opposed to general soreness over a large area), or if you cannot bear weight or take a step.

3.  Neck pain or any weakness or numbness anywhere in your body.

4.  Unrelenting pain, anywhere.

5.  Bleeding that won’t stop, gashes that appear deep, or blood in the urine.

Importantly, victims fail to notice injuries after an accident. The adrenaline is coursing through your body, you’re in total fight-or-flight mode and you can actually fail to notice that newly acquired elbow fracture.  If bystanders are concerned about you because the accident “looked bad,” you should consider taking their word for it, particularly if the pain is not going away or getting worse.

Injuries fall into a few categories.  Some common injuries that occur as a result of bicycle accidents include concussions and head trauma, lacerations and abrasions, fractures, ligament sprains, and general muscle soreness.

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Concussions and Head Trauma

This is a tough topic, because an accident victim often cannot reliably assess their own medical condition.  Symptoms of concussion include headache, memory loss, confusion, disorientation, dizziness or fogginess, nausea, sensitivity to light and noise, and drowsiness.  Basically, if a friend or bystander tells you that you’re acting at all out of the ordinary, or they think you should go to the hospital, just go.  If you feel OK but damaged your helmet, it is a good idea to schedule a doctor’s appointment for evaluation anyway.  If left untreated, headaches, fogginess, dizziness, and cognitive impairments can persist long after the injury.  In more severe cases, trauma can cause bleeding inside the skull, which requires immediate evaluation.

 Photo credit:  Lorena Cupcake

Photo credit:  Lorena Cupcake

Lacerations and Abrasions

If you’re bleeding and it’s not stopping or appears deep (you can see fat or muscle), hold pressure over the area and get to the ER or an urgent-care clinic.  Shallow abrasions are treated by washing with soap and water to get the pieces of road out of your skin, then applying antibiotic ointment (bacitracin or neosporin) and covering with a band-aid or some gauze and tape.  Keep an eye on any healing skin wounds over the next several days; if redness, increased swelling, warmth, oozing, or increasing pain develops, seek medical attention as these are signs of infection.  When in doubt, particularly for lacerations on the face or hands, seek medical attention.

Fractures

Fractures are common, treatable, but have many degrees of severity.  All likely fractures need to be evaluated, and the sooner the better. Toe or finger fractures are obviously less severe than arm, leg, or facial fractures, but should nonetheless be evaluated.  Bone starts to heal within days so it’s imperative that fractures are properly positioned; once the bone begins to heal, if it’s improperly aligned, it will be ultimately harder to treat.  It can be impossible to tell the difference between a bad sprain or contusion and a fracture without an X-ray (and sometimes more advanced imaging), so bad pain in one particular location (“point tenderness”), inability to move a joint through its normal range of motion, or inability to bear weight should buy you a trip to the doctor for evaluation.

Sprains

Ankle, wrist, shoulder, elbow, and knee sprains are also common following bicycle crashes.  The typical treatment for sprains is rest, ice, compression of the joint with an ACE wrap, and elevation.  Over the counter medications such as Tylenol or Advil can help with pain.  Avoid aggravating movements and weightbearing if painful, but moving the joint is a good idea to prevent stiffness.  If the pain and swelling do not improve over the next few days, see a doctor.  You may have a more severe sprain, ligament tear, or small avulsion fracture.  Many types of doctors are equipped to treat these types of injuries, such as primary care physicians (internists), orthopaedic surgeons, rehabilitation medicine physicians (physiatrists) and sports medicine physicians.  It’s important to recognize, treat and rehabilitate sprains, as neglecting to properly rehab the sprain puts you at risk of recurrent sprains in the future.

Spinal Cord Injury

This is somewhat less common following bicycle accidents, but can definitely happen as a result of forces to the head and neck, for example, being thrown over the handlebars.  If the victim is unable to move or feel a part of their body, or if they are complaining of severe neck or back pain, do not let them get up or move in any significant way.  They need to be boarded and collared by EMS and taken to the ER.  If symptoms are not immediately apparent, but new weakness, numbness (particularly in the groin or perineal area), bowel or bladder problems (inability to urinate or have a bowel movement) develop over the subsequent days, it is important to seek medical attention.

Muscle Soreness

Most likely, you will be sore following an accident.  The trauma to muscles and tissues from the landing, as well as the forceful contractions of muscles around the moment of impact can cause some mild muscle breakdown.  This is usually not a big deal; stay hydrated, rest for a couple of days, and refrain from aggravating activities.  Once the generalized soreness resolves, you’re more likely to notice areas that are still tender, and again, if pain and swelling are getting worse rather than better, seek medical attention.

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Some things to do if you witness an accident:

Go to the victim and talk to them.  If the injuries appear serious or if if the person is not responding to you, call 911 immediately and check for pulse and breathing. If someone is certified in basic life support (CPR), enlist their help.  If you’re having a hard time feeling a pulse, and you are outside a store, restaurant, or any place of business, send someone in to ask for an AED, which is a portable defibrillator.  Open it and follow the directions.

Ask the victim orientation questions: What’s your name? Where are you right now? What’s today’s date? What just happened?  This will give you an idea of their mental status and ability to make informed decisions.  Survey the victim for signs of trauma (bleeding, bruising, deformities of bones or joints).  Hold a clean paper towel or gauze with pressure over any areas of bleeding.  Stay with them until paramedics arrive.

 KC in in the ED.  Photo credit:  Lorena Cupcake

KC in in the ED.  Photo credit:  Lorena Cupcake

A word on insurance and financial issues

Hospital visits are expensive.  If you need to go to the ER, taking a cab or getting a ride will save you some money.  If you feel OK and are able to walk off the scene, calling your primary care doctor for an appointment the same day is a good idea.  If you tell the scheduler, receptionist, or nurse that you were in an accident, they will usually find someone to see you, even if your primary doctor is completely booked.  There are also several free, cheap, or sliding scale clinics around the city, and if you are uninsured, you should start researching these in advance.  If your injuries are more serious, you’ll probably need to go to the hospital anyway (and lucky you, you now you have a pre-existing condition–this is why the Affordable Care Act is a good thing).  But you’re not screwed.  There are options and resources, and hospitals employ social workers to help you figure this out.  The social worker can work out things like payment plans, free medications, and help you find a provider for follow-up who is free.  These resources are probably going to become even more common, given the state of health care and the high cost of hospitalization.  Most hospitals also have charity care programs, if you are absolutely unable to pay.

To conclude, the benefits of treating even a minor injury far outweigh the risks of leaving it untreated.  Common sense is not always so common.  And please wear a helmet.

Dana Kotler, M.D