I’m working Christmas Day this year and I probably won’t see any of these injuries – but you never know, the Emergency Department can be an unpredictable place. Let’s take a look at some of the calamities that befell the outmatched wet bandits from the holiday classic from John Hughes. All gifs are from Home Alone, and Fandango Movie Clips.
Paint can to the face, initial encounter
A full paint can weighs about 10 pounds. Given that it built momentum swinging from the second floor I’d expect a tremendous amount of facial trauma. Injuries could include severe facial fractures and multiple dental injuries. A CT scan of the face will definitely be warranted.
Facial injuries caused by falling iron, initial encounter
If the paint can wasn’t bad enough a 3 to 4 pound falling iron striking the forehead risks causing orbital fractures and or significant intracranial injuries. This is a “severe mechanism” per the PECARN clinically important traumatic brain injury guideline and would warrant CT of the head, and face.
Thermal burns to the scalp caused by blow torch, initial encounter
The severity of thermal burns is proportional to time and temperature. Inexplicably the wet bandit remained under the flame for several seconds. This would lead to a full thickness burn that will require advanced burn care ideally at a regional burn center.
Foreign body in foot due to broken glass from Christmas ornaments, bilateral feet, initial encounter
This is why I don’t like glass ornaments on my Christmas Tree. The numerous wounds should be cleaned and irrigated thoroughly. Tetanus should be updated if >5 years since the last shot. X-rays and Ultrasound can demonstrate deeper foreign bodies. And this will be very painful – so consider both topical LET as well as regional anesthesia – perhaps via a posterior tibial nerve block.
Thermal burns to right hand due to burning hot doorknob, initial encounter
This is an injury with a high potential for significant morbidity. Though not circumferential, these burns cross joint lines, and given the contact time will likely be at least deep partial thickness (but probably much, much worse) with a glowing hot doorknob exceeding several hundred degrees Fahrenheit. The major concern long term will be flexion contractures. Referral to a burn specialist is warranted.
Gun shot wound to the forehead due to BB gun, initial encounter
And last but not least we have a BB gun shot wound to the forehead. Hopefully the wound will be superficial and require an update to tetanus status and local wound care. If aimed at the yeehaw the BB could actually penetrate the cranial vault and severely injure the eye and brain. Safety first!
Bonus fun fact, subsequent encounter
Warner Brothers was initially set to finance and distribute Home Alone at a cost of $10 million dollars. When the budget ballooned north of $15 million they backed out much to the chagrin of 20th Century Fox Executives who scooped up the film. It eventually made $477.1 million dollars at the US box office.
