@FacundoXXII.

Is it even healthy to consume charcoal?

No, it is not healthy to consume charcoal.

I know that there's all kinds

of fad cleanses and this and that.

I would not recommend any of them.

You don't need that toothpaste, trust me.

I am Annie Onishi and I'm a trauma surgeon,

and this is Surgery Support.

[rhythmic music]

Our first Tweet comes from Wes Molebash.

Wes asks,

I'm a novice camper

and I'm putting together my first aid kit.

What do I need for a makeshift tourniquet?

Well Wes,

why get a makeshift one when you can have a real one?

This is a combat application tourniquet.

It is readily available on the internet.

It runs about 30 bucks and it is much better

than anything you could fashion from a rope,

or a belt, or a shirt.

So basically what you would do is say you had a wound here

on the arm that was bleeding uncontrollably

and you couldn't control that bleeding by simple pressure.

You would pull out your trusty tourniquet,

slide it on above the arm,

tighten it just above where the injury is,

tighten the belt and Velcro it just in place like so.

Next you're going to turn this windless.

This really hurts in real life so I'm not going to do it.

But this windless basically tightens this tourniquet

to a pressure that is above arterial pressure.

Once you tighten it,

it locks into place underneath this little clip.

You have this Velcro strap to keep your windless in place

and you would leave that on

until you could seek definitive care.

Why use a fake one when you can use the real thing.

@LizGillies writes, Wow.

How long does it take to feel normal slash not like a corpse

after an appendectomy?

I'm really over it, really over it.

Well Liz, in cases like this,

what I usually recommend is a little can of suck it up.

Appendectomy is really a minor operation.

You should really be feeling pretty much good

as new within 24, 48 hours.

Take some Tylenol and call me in the morning.

Here's a question from Redd FaFilth.

@CreepsCreations asks,

How come at the ER they cut off your clothes instead

of just taking them off?

Like, what is that?

That was my favorite shirt.

First of all,

you're welcome for saving your life.

Second of all,

we use these little kiddie safety scissors.

These are called trauma shears.

They have a nice flat little lip here so we won't cut ya.

In general if somebody is not super sick

or dying right away,

we try to make an effort to not cut stuff like jeans,

nice pants, belts, but T-shirts are fair game.

Underpants are fair game,

especially if they look old and dirty.

Sometimes we just have to get your clothes off

in a great big hurry so we can see what's hurt

and get you fixed.

Next question comes from @pbyrne.

Don't eat or drink before eight hours before surgery.

Oh, and also take these four pills

an hour before you get here.

How?

All right Patrick,

just chill out.

We just don't want you to have a big cheeseburger on board

when you're going to sleep

and getting that breathing tube put in.

If you barf that cheeseburger up

while we're putting the breathing tube in

and you get cheeseburger in your lungs,

you're in for a long stay in the ICU

with an aspiration pneumonia.

That's why you can't eat.

A couple of sips of water with your pills,

not a big deal.

Next question comes from @sexwarlocks.

Any doctors on here that know why my piss stink like beef?

No, no.

There are no doctors on here who know

why your stink like beef.

Why are you smelling your piss?

Next question is from @HarrisTwist.

Okay, but in Grey's Anatomy,

why do all the surgeons in the hospital go

and wait outside when an ambulance is coming?

Like does the hospital only hire eight surgeons

and they do everything?

There's a lot more than eight surgeons

at any given hospital.

For trauma and emergencies,

there's usually only one on-call.

No, we do not go outside and wait for the ambulance.

We got better stuff to be doing than that.

But every now and then if the choppers come in,

I love watching that thing land.

We get patients via chopper with some degree of frequency.

Probably once a day.

So I'll run out and see that once in a blue.

Next question comes from @gemmygems22.

Ouch, ouch.

Just cut my finger.

How do I know if I need a stitch or not?

Sounds like if you're Tweeting,

you're probably fine.

Or maybe the cut's just not on your thumbs.

My friends from all walks of life call me all the time

with all sorts of horrific photos

of injuries on themselves, their pets, their kids.

Essentially, you need a stitch

if you can see subcutaneous fat.

So if you can see little globules of yellow things,

that's fat.

That probably could use a stitch or two.

If you're in the neighborhood,

come knock on my door.

I got all the stuff.

Come on by.

We'll get you fixed up.

Here's a question from Brian.

@ba_27 asks,

Can someone educate me on why is it

that when I get a little cut on my finger,

I bleed like crazy but when doctors do surgery,

it seems like people don't bleed as much?

Well Brian, I'm a professional.

I know where your arteries and veins live.

Therefore I avoid them when I cut.

You don't.

Next up from @Heath_McGregor,

Can an electric eel shock a person's heart back

into rhythm like a defibrillator?

A defibrillator is a machine that delivers a targeted,

measured amount of electricity to a heart

that is either in something called ventricular fibrillation

or ventricular tachycardia.

This is a heart rhythm where the heart is just shaking

and not pumping blood.

The shock is meant to surprise the heart cells back

into a normal pumping rhythm.

An electric eel would not be able

to cardiovert a patient back into a normal rhythm

because it's not timed along

with the patient's own heart rhythm.

Next up is a question from @NapsandNugs.

Sometimes I think about the fact

that I had a surgery a while ago

and they took a whole ass organ out of me.

Like how do you sew that shit back?

Where is my gallbladder?

I have so many questions.

Well, the gallbladder is a tiny little bag

that lives underneath the right lobe of the liver.

As you can see here,

it's attached via the cystic duct to the common bile duct.

That is sort of the plumbing of your liver.

That's how the bile gets out of your liver

and into your intestines.

Once it's out,

it goes into a little jar about that big.

Sometimes it goes into a big bucket

if it's a big gallbladder.

We send it off to the pathology lab.

They look at it under the microscope

and then they discard it.

I think it actually gets incinerated.

So your gallbladder has probably been long incinerated

and is just a memory at this point.

Our next question comes from @DontMessWithPAPI.

When given anesthesia before surgery,

why does the doctor have their patient count backwards

from 10 rather than just counting one, two, three?

Hate to break it to you Papi,

but we don't actually do that.

There's no counting involved.

You just kind of drift off to sleep.

I usually try to make a little small talk

as the patient's going off to sleep.

Little kids, I try to tell them

to have a nice dream and have a good rest,

and everything's going to be fine.

Adults I like to say,

well, what are you going to eat after surgery?

'Cause that's usually what most people are focused on.

Next.

@bonsaisoi.

Do surgeons really wear diapers through long surgeries?

No.

Our next question is from @dwimidhaM.

Doctor, this has been cited as a major difference.

Which is pneumonia and which is a COVID x-ray?

This is a really tricky question.

Briefly just looking at these two x-rays,

if I had to guess,

I think I would guess the x-ray on the right.

The one on the left looks more like

a consolidated bacterial pneumonia to me.

On the left again,

all the inflammation is located to what I know

to be the locations of the right upper lobe.

COVID is not ever localized to just one lobe.

It's more diffuse,

meaning throughout all the lobes of both lungs.

Our next question comes from @Kara_Marie1220.

So if you have one of the dissolvable sutures

from a surgery you had three weeks ago,

it doesn't dissolve.

What the hell do you do?

Asking for myself because I have both ends

of a suture sticking out of my abdomen.

Upside down smiley face.

Dissolvable sutures,

they are supposed to, supposed to take about seven

to 10 days to dissolve,

depending on the suture material.

Here's an example of an absorbable suture.

This is called PDS.

This is a monofilament type suture,

meaning it's one long filament.

Something like a fishing line is also a monofilament.

This is a type of suture

that I personally have a strong preference

for when I sew on bowel.

So this is absorbable in about a week's time.

If you have some sticking out of your skin,

it's not that big of a deal.

I would just take a pair of tweezers,

yank it and cut it right at the skin

to just to remove those annoying little loose ends.

And then the knot beneath is probably already dissolved.

Or just leave it alone.

It will eventually deal with itself.

Here's a question from @meganmcginn.

How the hell does a surgeon leave

an instrument inside their patient?

Unfortunately this is something that has happened before.

You would be very surprised how big

and deep an abdominal or a chest cavity is.

I mean, in a tall guy,

I can get my whole arm inside somebody's belly.

So yes, there is room for instruments.

Here's a question from @BeesleyKari.

Why did I schedule surgery when I can't drink alcohol

for 24 hours afterwards on National Beer Day?

What the heck is wrong with me?

#NationalbeerDay.

Can't is a strong word.

Sort of depends what operation you had,

whether you're taking heavy duty pain medication.

I don't see why one little beer is going to hurt anything.

Just don't tell your doctor I said that.

Next, @bradyteufel08.

Is over applying peroxide to a cut bad?

I don't think you can over apply peroxide.

The bottle is only that big.

It's just, it's dissolving into water and air,

so I really, I wouldn't worry about it too much.

If you have a big open surface like road rash,

peroxide can be good 'cause the bubbles can sort

of rinse the little dust bits away.

But over a cut,

I don't think it's really that helpful.

Just running it under some water in the sink

with some soap is usually enough to keep it clean.

I don't really use peroxide that much,

except in that case like I mentioned of road rash.

Here's one from @SJones565.

How long does it take a wound dehiscence to close?

Asking for a friend.

A wound dehiscence,

for those of you who may not be familiar,

is when a surgical wound falls apart,

usually from an underlying infection.

The dehiscence will then after the infection

has been adequately treated and dealt with,

the wound will then sort of close

by what we call secondary intention.

So it will basically fill in from the bottom up.

The length of time that takes

will depend on a number of factors.

Number one is the infection underneath the dehiscence

adequately treated and controlled.

Number two, how big is the wound?

Number three, what is your nutrition like?

So nutrition is probably the most important predictor

of wound healing.

I think under the best circumstances in my experience

with patients with big open surgical wounds,

once the infection is controlled

and once the nutrition is optimized,

a big dehiscence takes about four to six weeks to close up.

Next from @APfenniger.

When the scrub machine gives you scrubs with holes,

you would A,

exchange them for better scrubs,

or B, suture them with O-Ticron?

#EPfellowship #lifeskills.

I mean, I use suture at home to fix stuff,

little tears in T-shirts and things

that I'm not ready to throw out.

My dog's toys will sometimes get some surgery

to get them to last a little bit longer.

But scrubs, I mean, come on.

Those are essentially disposable.

Next, @FacundoXXII.

Is it even healthy to consume charcoal?

No, it is not healthy to consume charcoal.

I know that there's all kinds

of fad cleanses and this and that.

I would not recommend any of them.

We will occasionally, occasionally,

occasionally use activated charcoal down a tube

into a patient's stomach if we know

that they have ingested certain medications,

but this doesn't work for all poisons.

Activated charcoal as a health trend is one

of the stupidest things I've ever heard.

Activated charcoal is used

for medical poisoning emergencies only.

You don't need that toothpaste, trust me.

Thank you for your questions.

This has been Surgery Support.

I gotta say,

I'm kind of worried about some of you out there.