Raleigh, N.C. — Patients have been showing up in area hospital emergency rooms since Saturday with sledding-related injuries, physicians said Monday.

The injuries go beyond bumps and bruises to include blunt trauma injuries, some of which are life-threatening, they said.

"(We've seen) very severe brain injury, and then we've had internal injuries, including splenic – or spleen – injuries as well as kidney injuries," said Dr. Osi Udekwu, WakeMed's medical director of trauma and general surgery.

Rex Hospital reported 29 sledding-related injuries from early Saturday through Monday evening. None of the patients, who ranged in age from 4 to 68, was admitted, a spokeswoman said.

Matthew Becker, 14, ended up in WakeMed with a compound fracture above his ankle because he was sledding Sunday while standing on a boogie board instead of sitting down. He said his trouble started when he lost his balance and tried to avoid falling on his head.

"I tried to catch myself with my foot, and it went back and hit the back of my leg," said Becker, who has several screws in his ankle and a cast on his entire right leg.

Udekwu said the patients he's seen over the weekend helped him build a list for sledding safety.

"Towing by motorized device is always inappropriate," he said.

Several WRAL.com visitors sent in photos and videos of themselves or their neighbors using pickup trucks or all-terrain vehicles to tow people on sleds, in flat-bottom boats or on boogie boards.

Udekwu also advised sledders to avoid slopes where there are physical obstructions, such as fire hydrants, parked cars and posts. One Johnston County woman was airlifted to WakeMed on Saturday when her sled slammed into a pole.

Sledders also should use only approved devices for the activity – not boogie boards – and people should be able to steer the sleds, he said.

"You should never sled with your head as the leading device, no matter what you're on," he said.

Udekwu said people should wear helmets while sledding, just as they would on a bike, roller skates or skis.

Adults should always supervise children who are sledding, he said.

"There should be both an adult at the top and bottom of the slope," he said, adding that adults need to block access to traffic if children are sledding down neighborhood streets.

Becker added one more rule for fun in the snow: "Listen to your parents."