By: Domenic Coletta, MD
When a boxer is referred to the ER after a bout by the ringside physician, it is usually for a good reason. Certainly that individual - NOT HIS OR HER MANAGER - has the right to refuse treatment, but there are several reasons why this might not be a good idea. First, we, as physicians, are trained to recognize injuries that might require immediate attention from those that can take a wait and see approach. Granted, not all hand injuries, for example, need to be x-rayed and treated right away. However, the sooner a fracture or sprain is diagnosed and casted or splinted, the quicker it will heal.
Another argument for going to the ER, if necessary, right after a bout does not have to do with the boxer’s medical condition so much as the reality of our health care system. If you arrive in an Emergency Room Department immediately following a traumatic event, and you are blood-stained and bruised, you most likely will be made a priority over the folks in the waiting room with minor ailments. If you instead show up three days later with your headache or sore hand, chances are you will be one of the "folks in the waiting room" yourself. Along this same line of thought, unless you have excellent health insurance plan, it may be in your best interest to have your boxing-related problem covered by the insurance provided by the promoter. This may not be possible if you wait too long for the medical evaluation.
The most important reason to not delay a medical exam for certain injuries, most notably head trauma, and deep lacerations, is for the long-term health and overall safety of the boxer. The following is a list of conditions that may require an ER visit:
HEAD TRAUMA – Any significant loss of consciousness or altered mental status after a fight needs immediate medical attention with CT or MRI as an aid to diagnosis. Likewise, persistent headache, vomiting or visual problems can be signs of a severe concussion or, as in most boxing fatalities, a subdural hematoma (collection of blood in the brain) which can sometimes be treated if found early enough.
LACERATIONS – as a rule of thumb, any cut that won’t stop bleeding easily, is in a vulnerable area for future fights (eyelid for example), has wound edges brought together with a bandage or may be contaminated (sweat, glove debris, Vasoline, etc.) should be cleansed and sutured by a physician. Whereas, for the most part, facial lacerations don’t typically get infected and most boxers are not overly concerned about cosmetic results (although some want to be certain they keep their "Hollywood" looks), the sooner a wound is repaired properly the better the results.
SHORTNESS OF BREATH -- Although I have not seen this in 15 years of doing ringside medicine, the potential for a pneumothorax (ruptured lung) from a broken rib after a severe body shot, is a real possibility. This symptom should never be taken lightly even if it turns out to be nothing more than hyperventilating from the anxiety of an upsetting loss.
ABDOMINAL PAIN -- A boxer experiencing pain in the upper left portion of his/her abdomen after repeated body blows to that area may need urgent evaluation to rule out an injury to the spleen, the abdominal organ most vulnerable to blunt trauma. Delayed splenic rupture/torn spleen (sometimes weeks later) can also occur and is usually accompanied by dizzy spells from loss of blood. Any persistent abdominal pain after a fight should be evaluated by a physician. This should preferably be in an ER where lab tests and r-rays are easily obtainable.
BLOODY URINE -- It’s not unusual for a fighter to have blood in his/her urine right after a bout due to breakdown of muscle tissue and minor trauma to the kidneys. This is usually microscopic and should clear with time and fluid replacement. If bleeding with urination persists, a boxer should seek out a family physician, a urologist (specialist in urination) or the nearest ER.
BONE AND JOINT PAIN – If a ringside physician is skilled in reducing (putting back in place) a dislocated joint –usually a shoulder or elbow – and there is no apparent nerve or blood vessel involvement, that boxer can be sent to an orthopedic specialist the next day. The same holds true for a presumed ligament tear to the ankle or knee. However, any extremity injury that has that has a significant deformity or may involve the nerves (numbness or tingling) or the arteries (cold, pale skin with no pulse) needs to be assessed IMMEDIATELY in the closest ER.
DEPRESSION/MOOD SWINGS –This may come as a shock to some, but, in my opinion, not al boxers are mentally stable (of course, neither are all physicians). If you recognize any signs in yourself or A FELLOW FIGHTER of major mood swings or depression (loss of appetite, increase use of alcohol/drugs, crying, etc.) do not hesitate to reach out for help. If there’s any risk of suicidal behavior, that individual needs to be transported to the nearest ER Department. Otherwise, outpatient mental health counseling or drug/alcohol rehab may be necessary.
Fortunately, most boxers will not require the services of an ER physician. But being too stubborn or foolish about going to the hospital when necessary can have serious consequences.
Dr. Domenic F. Coletta practices in Atlantic City, New Jersey where he has been a licensed ringside physician since 1988. His medical specialty is in the field of emergency medicine and he is on the medical executive board of the American Association of Professional Ringside Physicians (AAPRP). All of the views, opinions, and/or recommendations contained herein are solely his own and do not necessarily reflect those of the New Jersey State Athletic Control Board or the AAPRP.