(applause)
We've shown you some jaw-dropping photos
of medical conditions over the season,
it's time for, what is this? Drew? What happened?
And, oh my gosh,
could it happen to me?
Where are we?
So, let's start with this picture.
Oh.
What is this? Anyone?
Anyone?
Anyone, anyone? Bueller?
(laughter)
This is a condition called Tungiasis.
This is the feet of a 10-year-old girl in Brazil,
who went and played in a pig sty, in bare feet,
and these are sand fleas.
So they're found in sand, they're found in soil,
and what they do is they burrow into your skin,
just like they would burrow through sand,
and those black things in the mounds
are the actual sand fleas.
Once they burrow in, they can grow
to 2,000 times their original size.
And the way these are treated is you have to go in
and take them out, one by one,
then you take care of the wound.
And this little girl is fine, she's completely cleared.
But this image is so striking,
from the New England Journal of Medicine.
Have you removed live fleas from under the skin?
To be fair, I've only done it once.
I've done myiasis,
Well, you've done it.
Which is bot flies, these are sand fleas,
which are even a little bit more specialized.
Very common in tropical areas, like Brazil.
Where people don't wear shoes.
Not super common, here in Los Angeles.
You know, interestingly, not super common,
but the WHO, the World Health Organization,
estimates that about 20 million people are at risk
for these conditions.
Wow.
Just be mindful, don't go play in pig styes barefoot.
Or sandy environments in tropical areas.
He's checking.
Are you just checking?
He's checking for fleas.
We're looking, I want to make sure.
All right, so let's move on to our next photo.
Any idea what happened here?
Oh.
Frostbite.
Yep, and you're not far off.
That's a really, really good guess.
This man, he actually had his fingers turn
black and blue like this, he also developed a fever,
had pain, and do you know what this was due to?
Something known as Polyarteritis Nodosa.
And this is essentially a vasculitis,
which means he had severe inflammation of
his medium-sized vessels, obstructing blood flow.
And he had to go on, basically, anti-inflammatory
treatments to improve the vasculitis.
Did recover, but he did have to have
those fingers amputated.
Oh.
So what happens is, when you have the inflammation
of these medium-sized arteries,
that can cause enough inflammation,
that your blood can't get through those vessels.
So the black you're seeing is like someone pointed out,
frostbite, it's the necrosis, it's the death of the tissue,
It's dead tissue.
Because it's not
getting the blood.
That's gone too far,
that's why they had to end up amputating.
It's also why everyone watching.
Those fingers.
If you, so one of the things I see
in the Emergency Department a lot are
the symptoms and signs from poor blood flow.
And when you first walk in, you're not sure why
someone has fingers or toes that are starting to turn blue.
But what we almost always know is that it's most likely
due to poor blood flow.
And so we have to figure out,
well is that due to long-term smoking, is this due to an
inflammatory condition, an autoimmune disease.
Cold.
The sooner you can, and most of these are treatable,
so if he had gone in sooner,
he probably could have saved those fingers,
but clearly just let it progress and progress,
to the point where the tissue itself died.
So that's why whenever you.
See an appendage turn color, you don't wait.
Yeah.
Even the slightest bit of a hue of blue,
go get it checked out.
