Halloween horror in the ED—Scary happenings during residency

Halloween is a frightening, yet fun, time, filled with candy and costumes. For physicians working in the emergency department (ED), it may seem as though they only see tricks and mishaps, and not as many treats. Seeing patients dressed in their costumes reminds us that it’s a special day—I recall coming across an older gentleman dressed as a creature in the hallway and another patient in a room painted as a goblin.

Despite my limited experience in residency, I have already encountered some scary stories to share along with reviews of treatment options and some warnings we can all heed. The following tales are true cases I have seen or heard about from my colleagues—can you guess how the injuries were sustained?

Male loses three fingers two weeks before his wedding

This patient was using a table saw when he accidentally cut off three fingers from his non-dominant hand. Although this patient was not necessarily partaking in holiday festivities, with the popularity of pumpkin-carving, as Halloween approaches it is a good idea to remind ourselves and others to be careful with knives and sharp objects if partaking in this holiday activity.

In case you need a refresher on first aid for knife injuries and accidental amputations: For those unfortunate victims who end up accidentally slicing a portion of their finger or amputating an appendage, patients should keep their digits wrapped in saline-soaked gauze and then in a plastic bag and ice.

At home, if you do not have saline, you can wrap the appendage in a tap water-soaked paper towel then place in a plastic bag and ice. It is important not to place the amputated portion directly on the ice. For those who have minor lacerations, is important to first apply firm pressure to prevent bleeding and still seek medical attention for tetanus prophylaxis if using a tool such as a knife.

Teenager suffers cardiac arrest while in his zombie costume

This patient presented to the ED after undergoing a round of CPR after he collapsed while working a shift at a haunted house. Fortunately, this patient survived. Though the exact mechanism of this patient’s cardiac arrest is still unknown, there was a report that he may have been hit in the chest by a guest in the haunted house. A direct blow to the chest can result in commotio cordis, or sudden cardiac arrest that usually results from blunt cardiac trauma. This can result in myocardial contusion or “stunning” of the heart muscle, which can lead to severe dysrhythmias, such as ventricular fibrillation. Treatment is prompt defibrillation.

This is a reminder for all attending haunted houses—please listen to the instructions and do not hit the workers if you get scared!

Allergic patient experiences tongue swelling and hives

This patient happened to be eating an apple cider donut at a pumpkin patch when a bee flew into his mouth. For patients with allergies and/or intolerances, or a history of anaphylaxis, it is important to keep an Epi-pen at hand, which is what this patient did. Fortunately, he was also only 10 minutes away from the hospital and presented to us as a precautionary measure.

As a reminder, anaphylaxis is diagnosed when usually more than one body system is affected (such as gastrointestinal, respiratory or dermatologic), and treatment includes epinephrine and an H-1 antihistamine such as Benadryl.

Other secondary treatment options include H-2 antihistamines, bronchodilators and corticosteroids. These patients typically are observed in the ED for a few hours until they are asymptomatic and do not have any recurrence of symptoms.

Patients with a history of allergies or anaphylaxis should always carry an Epi-pen with them. It’s also a good idea to remind your patients who are allergic to peanuts, soy or other candy ingredients to pay attention to the Halloween candy they consume.

Intoxication incident leads to head laceration

This patient was at a Halloween party at a bar when he was severely intoxicated and fell down the stairs. Fortunately, he did not sustain any other injuries other than a laceration to the back of his head that was stapled. His injury can be attributed to alcohol intoxication. 

For those drinking on Halloween and partaking in festivities, it is okay to imbibe and let loose, but try to moderate your alcohol consumption so as not to increase your risk for falls or any other injuries. Also, be wary of any other “surprise-laced” treats such as brownies. And this goes without saying, do not drink and drive.

4-year-old arrives with purulent discharge from nose

This child had gotten her hands (or nose) into some Halloween candy a little early and stuck a jawbreaker up her nostril. Although I did not personally see this patient in the ED, I do commonly see children stick small objects into their orifices such as their nostrils and ears, with Nerds candy being a popular item. In this particular case, treatment may require forceps, small hooks or suction removal of the object visualized on anterior rhinoscopy.

For parents who witness their child stick a foreign object into an orifice, it may be worth attempting a maneuver called the “Mother’s kiss,” where a parent places their mouth on the child’s open mouth, forming a tight seal while occluding the unaffected nostril with a finger. They then blow a puff of air into the child’s mouth, which can cause the foreign body to pass through the nasopharynx and out through the unobstructed nostril. 

It’s also important to note that children aren’t the only ones who get foreign bodies caught in their orifices. Overall, Halloween is a wonderful holiday (and one of my favorites) that brings the community together and allows people to get creative and be someone else for the day. Just remember to enjoy the night responsibly and stay aware of your surroundings. 

Disclaimer: This content is for informational purposes only and should not be taken as medical advice or construed as the basis of a patient-physician relationship. Always seek the advice of a physician or other qualified clinician with any questions you have regarding a medical condition or treatment plan.

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