Trauma Surgeon Breaks Down Every Home Alone Injury

Hi, I'm Annie Onishi and I'm a trauma surgeon.

And this is each and every injury in Home Alone.

[pensive music]

We're gonna be talking about all of the injuries

from Home Alone, parts one and two.

Three and four, we don't have time for that.

[gun cocks]

This is it. Don't get scared now.

[bell dings]

[Harry screams]

That first fall looks like the most severe in this series.

He's up a couple of steps, he gets full air,

and then he lands flat on his back.

That's gonna be a lot of force

right on that landing surface.

So Harry's second fall doesn't look as severe

or dramatic as his first, but it is in the context

of having already had a great big fall

and a great big impact,

so if his ribs weren't broken before,

I bet you they're broken now.

When our ribs break, the little edges can sort of dislodge

and damage internal organs.

So from the back, they can ding a kidney,

they can ding a liver, they can ding a spleen.

So my guess is a bunch of broken ribs,

plus or minus hemopneumothorax, plus or minus splenic lac.

Marv falls down a bunch of stairs,

but he sort of is at a ground level when he does it

and sort of seems like a little bit less velocity and force.

So I do think Marv is a little younger,

which may explain why he's able to bounce back

from this injury a little faster.

[bell dings]

[iron clatters]

[Marv grunts]

So looking straight up and having the iron land on his face,

what that's gonna do is what's called

an axial loading injury.

So there's a bunch of load compressing the spine

from top to bottom.

This is most commonly seen in the context of a young,

usually intoxicated person jumping off of a bridge

or the edge of a pool into a shallow pool of water

and their head strikes the bottom of either the lake

or the pond or the pool.

We have a ground level fall with a head strike on the back.

What we worry about from these ground level falls

is something called a coup, contrecoup injury.

So we strike the back of our head, yeah,

our brain gets rocked from there,

but then as the brain settles down,

'cause it sits in a cavity of fluid,

it hits the front of the skull as well.

So you may expect to see some bleeding

in the back of the brain accompanied by some bleeding

in the front of the brain as the brain sort of rocks

about the skull cavity itself.

Hello. [bell dings]

[Marv yells]

We know that Harry and Marv are in for a whole world

of suffering tonight.

You can see how sensitive they seem

to be to what is probably more [Harry screams]

of a sensation of sort

of like a bee sting. [Marv yells]

It could cause some damage if it hit you right

in the eyeball, if it was really close range like that.

But, in general, every pellet injury I've ever seen

has just been in the fat.

[skin sizzles]

[Harry yells]

[Harry blows]

If I had to guess what type of burn this is gonna be,

my guess is gonna be a second degree,

which is a partial thickness burn.

So it burns off the epidermis part of the dermis,

which is the deeper layer of skin.

The important difference between second degree burns

and third degree burns is that,

with the second degree burns,

you don't lose the little stem cells that live

in those layers of skin, so it will heal without a scar.

So while he's branded with the McCallister M now,

that's not gonna be permanent.

I would consider a burn what's called a distracting injury.

So because the burn hurts so bad and is so dramatic

and the patient is so worried about it

'cause they may not have noticed

that they fell down a few stairs.

[bell dings]

[screams]

So Marv has lost his socks, lost his shoes,

he is stepping on this nail here.

It looks like it goes in about an inch or two.

Puncture injuries are notoriously high risk for infections.

It's this tiny little deep hole that is dark and warm

and full of blood and is a great place for bacteria to grow.

[bell dings]

[screams]

You can tell he's gotten good first aid training

'cause when he dunks his head in the snow,

it's probably mostly steam coming off from his head.

You can see that he's lost a bunch of his hair

and that the skin doesn't have that pink appearance

that his hand had, so probably not as deep of a burn,

but still definitely very painful.

You know, I think at this point,

Harry and Marv really should be suspicious

that they are invading the house of some sort of psychopath.

[playful music]

With some very sadistic tendencies

and I would have turned away at this point already.

[bell dings]

[Harry] Now you're dead!

My concern is that with glue on this fresh burn

on his head and then feathers on the burn,

I think that's gonna make wound care really difficult.

So some poor burn nurse is gonna have to go through

and pick out every last little bit of feather

from that burn and then that surface area of that burn

is way too big to numb up well,

so he would just have to sort of sit there

as they picked out little bits of feather

from his burned skin.

I think that's really gonna hurt.

[bell dings]

[screams]

Having abandoned entering the house

through any particular door

because of all the booby traps,

here we have Marv sneaking through a window

and encountering a bunch of Christmas ornaments.

That very fine glass that you see that the ornaments

are made of, when that shatters, it splinters.

And those little fine bits of glass

are impossible to get out.

It leads to a lot of pain, a lot of torture,

for both the patient and whoever's trying

to pick out all that glass.

I'm gonna kill that kid!

Well, the patient's gonna go home

with the sensation of glass in his feet

and he's just gonna have to continue

to keep his feet soaked and this stuff

will work its way out eventually.

[both yelp]

Maybe these guys should get their eyes checked

because the ground in front of you

should always be within your field of view.

So for them to not have seen those cars

makes me a little concerned that,

maybe from all these head injuries,

they may have some sort of visual defect.

No way to really know without further testing,

but definitely makes me a little suspicious.

[bell dings]

Heads up! Huh?

[Marv grunts]

When the neck hyperextends like that at a fast rate

with a lot of acceleration and deceleration,

you can get something called a Hangman's Fracture,

which is when the second cervical vertebrae

breaks in a couple of places.

It's a really unstable fracture.

It can be a very high risk for a devastating cord injury

at that level.

The lay term for these hyperextension-type injuries

is whiplash.

Whiplash really refers to all the muscular stiffness you get

after a big hyperextension injury like that.

So now we have a couple of other injuries

in rapid sequence, so not only do we have

this hyperextension injury of the neck,

then we have a heavy object in the form

of Harry landing on Marv.

So if Marv's ribs weren't broken before,

my bet is they're gonna be broken now.

This little sequence, at a very minimum,

we have at least soft tissue damage from a whiplash injury.

At the worst, we have something like a Hangman's Fracture,

a hyperextension injury of the neck.

We have, then, a fall from height,

we have a head strike, and then we have crushed

by a heavy falling object.

[intense music]

[Harry] There he is!

[bell dings] No!

That wire is very thick and very obvious,

so they couldn't see it.

Again, I'm really worried about their visual fields.

There just looks like they're not able to see anything

below about nose level.

It's very concerning.

No. Hold still.

[bell dings]

Marv.

A crowbar is gonna cause a lot of damage

'cause that's just a heavy metal object

with a lot of directed force at one particular location.

It's kinda hard to see exactly where this blow lands,

but it looks sort of epigastrium,

which is the sort of upper part of the central abdomen

to maybe some ribs or sternal area.

This assault with the crowbar, right in this area,

to me is very reminiscent of something

we call a handlebar injuries.

So when somebody is riding their bike and they crash

and their handlebars jam into their epigastric area

and squishes all the organs

and bruises them, lacerates them,

so that can really cause a lot of damage.

[both scream]

[bell dings]

Whenever our bodies decelerate in such a fashion,

be it in a car, on a bicycle, motorcycle,

or swinging from a rope directly into a brick wall,

all of our organs continue moving

until they hit the brick wall, then they stop.

That's called a deceleration injury.

A lot of our organs, including our heart, our aorta,

our small intestine, our colon,

they're tethered to the body wall in certain locations.

So when we decelerate, things tear about that tether.

These deceleration injuries can be really subtle.

You can't necessarily see them on a CAT scan

unless you order a special type of CAT scan

or unless you have a very high suspicion for such a thing.

[Marv laughs]

[grunts]

[bell dings]

[shovel rings]

As bleeding in the skull accumulates and pushes on the brain

and the brain swells, there's nowhere for the brain to go

because the skull is a fixed compact cavity.

So when the brain continues to swell,

the only place for it to go is down and out,

which is called a herniation.

So after this assault with the shovel,

we see both guys completely passed out,

total loss of consciousness,

but then a couple minutes later,

these guys are back up, walking and talking.

This makes me really concerned

for something called an epidural hematoma.

What that means is that there's blood accumulating

in the epidural space, which is underneath the skull,

but outside the brain and expanding slowly.

Classically, these people have a big head bonk,

maybe from a shovel, they come to,

and then they have what's called a lucid interval,

but slowly but surely, as that blood expands

within the epidural space, they then start

to lose consciousness again and can even go on

to herniate and die pretty quickly.

So this is actually a story we get all the time,

especially from the ski hill or after a bar fight.

And everybody's like, Okay, he's okay,

he's gonna walk it off.

And then five, 10 minutes later,

they've lost consciousness again.

[film rewinds]

So we just saw each and every injury in Home Alone 1.

Either these guys are really tough

or they've got a great trauma doctor,

'cause they're gonna be back for Home Alone 2.

[playful music]

Well hello.

[bell dings]

[Marv grunts]

He did it.

Did what? Oh!

Lesson number one is don't mess with New Yorkers

'cause that's what's gonna happen to you,

but with a good, solid right hook like that,

typically the point of impact is the cheekbone here.

This is something called the zygomatic arch.

This is a relatively fragile bone,

as far as facial structures go.

This is often the first thing to break

when somebody gets hit,

especially when their face is turning.

That looks like a pretty solid punch,

but, I think, knowing these guys, I think they'll recover.

[Harry yells]

[bell dings]

[glass shatters]

Well, it looks like Harry suffers a pretty decent fall

from height and absolutely crushes this car.

Harry is rendered speechless by this fall,

so that's either just the wind getting knocked out

of him, is sort of the lay term.

He may have broken a couple of ribs

and maybe gotten what's called a pneumothorax,

which is when the lungs collapse and air

is building up inside the thoracic cavity,

but outside the lungs.

That could make it pretty difficult to speak

or to get words out.

[brick thuds]

[bell dings]

I think out of all the injuries that we will review today,

this series of injuries is probably one

of the more severe ones.

It's probably a tie between four bricks to the head

from a high height versus the shovel

to the head by the neighbor.

So his inability to speak could be the sign

of a pretty severe brain bleed inside,

especially over the area that controls our speech,

which is usually the left side of our brain.

Sorta depends on the patient.

[Marv grunts]

Harry!

Definitely at this point, Marv would need

to be rushed over to the hospital to get checked out

for his head trauma.

[bell dings]

[nail gun fires]

Well, a nail gun to the buttock or the face,

the ER doc could just pull that out

and there's nothing majorly critical in those areas.

The nail straight to the groin,

the thing I'd be concerned about

is an underlying vascular injury,

such as to the femoral vein or the femoral artery.

If there was an expanding hematoma,

which means blood pooling up underneath the nail,

that would be a reason to go to the operating room,

to do a nice cut down, get all the vasculature exposed,

and remove that nail under really controlled circumstances.

[grunts]

[bell dings]

Every fall from height is a little bit different.

The injury pattern is pretty recognizable,

so depending on whether your ribs are broken,

whether your back is broken, whether you have

any other orthopedic injuries to either your pelvis,

your extremities, solid organ injuries

like lacerating your spleen or your liver from your fall,

that's gonna determine what needs to be done for you

in the hospital and what long-term consequences

you could expect.

With rib fractures, those people are

in a pretty real amount of pain for four

to six to eight weeks,

but certainly a bad accident or a bad fall

from height can lead to lots of problems

with chronic pain in the future.

I've reached the top!

[bell dings]

[yells]

Here, Marv is falling straight from the first floor.

That's a pretty decent height and he falls flat

on his front and his face.

That is a pretty bad way to land.

All of our bony structures at that moment of impact

are gonna compress and thereby squish all

of our organs inside.

So in addition to breaking stuff,

like his sternum, [bell dings]

the fronts of his ribs, [bell dings]

potentially his arms. [bell dings]

Any fall from height, no matter how you land,

you're probably gonna mess some stuff up.

[bell dings]

[wrenches clatter]

We suffer brain injuries more when the brain is rocked

within the fixed cavity of the skull

than really from just direct blows.

This pile of tools landing on him,

where things are just falling from the top down

and just compressing the skull on top

of the neck and the spine.

Definitely would expect some brain trauma with this,

potentially some neck trauma.

It looks like they also hit sort of the shoulder

and the arms and some other things,

so we would really have to check this guy carefully

for other orthopedic injuries.

[grunts]

[bell dings]

[yells]

Uh-oh!

[shelf crashes]

This is really reminding me of a phenomenon

that we have here in central Oregon called black ice.

That happens overnight when just the water vapor

from the air just freezes right on the cement

and makes this tiny, imperceptible layer of ice.

So, from the months of about October to January,

we get tons and tons of patients just like Marv,

who are slipping and sliding on the way out

to the car, trying to catch their balance, and off they go.

Super common to see broken arms, broken wrists,

broken ribs from just a big fall on some cement.

Another injury that we see here,

which is a really feared injury,

is something called a straddle injury.

So as Marv is sliding towards this bookshelf,

we can see him run into this post between his legs

at a decent amount of velocity.

Be it a motorcycle, a bicycle, commonly a fence post

as someone is hopping a fence

gets jammed up between the legs

and it's obviously a very unpleasant series of injuries.

That can lead

to urogenital trauma [bell dings]

that can lead to rectal trauma,

[bell dings] it can lead

to hematomas in places

where you really don't [bell dings]

want hematomas and they can be really hard to deal with

and very difficult to control.

[bell dings]

[electricity buzzes]

I know I keep saying this,

but actually I think this is the most lethal mechanism

we have seen yet to date.

This is a high voltage electrical injuries.

As the current travels through the body,

the body tissues act as a resistor,

which produces heat as electricity travels through.

So pretty much anything in the line of fire

from that source to where the patient's grounded

is just gonna get fried.

The most dangerous things that can happen

are cardiac arrhythmias.

The heart is an electrified organ,

so a big dose of electricity is gonna send the heart

into all kinds of crazy rhythms.

It can cause kidney failure,

it can cause the muscle tissue anywhere

in the body basically just to melt and liquefy,

which leads to something called rhabdomyolysis,

and it can lead to something called compartment syndrome.

So as all the tissues in the body are damaged

and they start leaking water, they swell.

I think Kevin McCallister needs some help.

[hyperventilates]

[bell dings]

[house explodes]

This is an explosion and a fire within a closed space

of a toilet and a small bathroom.

Inhalational injury is what happens when a patient

suffers a burn in a closed space,

so most commonly within a car fire.

The airway is subject to superheated air

and other chemicals that are burning.

What that leads to is severe swelling of the airway

to the point that the airway can actually swell shut.

That's gonna be a giant heat sink

with a lot of mechanical force from the explosion directly

to the face and airways.

I probably think that this is gonna

be a non-survivable injury, but maybe I'll be proven wrong.

[Marv] Oh. [grunts]

My main piece of advice to these guys would be

to stop pulling on strings and ropes in this house

'cause only bad things happen when they do that.

[intense music]

[bell dings]

[yells]

This is one construction accident I've seen many times.

My number one recommendation is you should always

have a buddy when you're using a ladder,

even if you think it's simple, even if you think it's safe,

just have somebody down at the bottom stabilizing things.

I mean, Harry has Marv, Marv has Harry.

That's the beauty of their relationship.

He looks to be about five,

six feet off the ground and it hits.

His head's definitely gonna rock with that impact,

definitely a high risk for concussion here.

[Marv] Oops.

[bell dings]

[both yell]

I'm really, really shocked and amazed by Marv and Harry.

Home Alone Part 2, this house of horrors,

is way more dangerous than the house back in Chicago.

I think these injuries look a lot more serious.

But despite all that, they've just really

done a great job of getting themselves up,

dusting themselves off and continuing on.

[Marv and Harry yell]

[bell dings]

[chest rumbles]

So quick little anatomy lesson about the nose.

So most of the nose that you can feel

is actually made of soft, squishy cartilage,

so it's not likely to break or deform in any way.

So typically if patients have broken a nose,

it doesn't look squished in the front

like what these two guys have.

What it looks like is either flattened to one side,

or if it's been broken in this way, it looks flattened,

but only really between the eyes

and then really, really swollen,

accompanied by a couple of black eyes, too.

[both yell]

[bell dings]

[wood crashes]

[Marv yells]

In medicine and in surgery,

we talk about something called the LD50,

which means the lethal dose of something

at which 50% of people, when exposed, will die.

The LD50 for a fall from height

is largely, largely accepted as four stories.

So anybody who falls four stories or more

has more than 50% chance of death.

I think this particular incident is especially dangerous

for Harry, who falls from what I would consider

a lethal height, then his friend lands on top of him,

then a bunch of paint cans fall from even higher

and land on top of him too.

So those are three pretty dangerous mechanisms all at once.

[magical music]

[wings flap]

[bell dings]

[both yell]

I think the actual pecking itself is not likely

to be that dangerous.

However, if you spend a large amount of time

in very close proximity to pigeons,

they carry a number of zoonotic diseases.

Zoonotic means a disease that you can catch

from an animal that can be pretty dangerous to humans.

There's a couple of different types of pneumonia

you can pick up from a pigeon,

namely something called histoplasmosis.

Well, all my friends living in New York,

if you see a pigeon nesting on your window sill,

you should try to get rid of them

because they have these little mites

and they can apparently crawl through your window

and infest your bed and then infest you.

[playful music]

There you have it.

That was each and every injury in Home Alone.