tag:blogger.com,1999:blog-82559358952729621292024-03-05T01:18:05.149-08:00medical scene writerA blog for those who want to write realistic medical scenes and need advice.Unknownnoreply@blogger.comBlogger55125tag:blogger.com,1999:blog-8255935895272962129.post-17084320117695881712014-09-12T01:00:00.000-07:002014-09-12T01:00:06.553-07:00Writing a Character with a Kidney Stone
<span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Arial, Helvetica, sans-serif;">I have a
character with severe abdominal pain and nausea. She is taken to the hospital
by ambulance. She has kidney stones.<br />
My questions are:<br />
</span></span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgPH4y2rR7DLXqkQxdGFS3uX3okfCLA885D1PIS9xGvMae7mmLKdrViv2vDgMhlK07_RCls4hflik4PPEmxPMqEDY-Uk9XTU1bC_RhC5LiVpZRE2bYHN2yQ2_nbbPUPSHxRwh8X68Lbo2g/s1600/kidney_stone.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgPH4y2rR7DLXqkQxdGFS3uX3okfCLA885D1PIS9xGvMae7mmLKdrViv2vDgMhlK07_RCls4hflik4PPEmxPMqEDY-Uk9XTU1bC_RhC5LiVpZRE2bYHN2yQ2_nbbPUPSHxRwh8X68Lbo2g/s1600/kidney_stone.jpg" height="258" width="320" /></a></div>
<span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Arial, Helvetica, sans-serif;">Would the medic and ER physician suspect kidney stones based on her symptoms?
<o:p></o:p></span></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><br />
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<span style="color: #3333ff; font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Arial, Helvetica, sans-serif;">Yes.
Severe flank pain that radiates to the groin; sometimes passing blood in the
urine; sometimes passing “Gravel” or “Sand” in the urine. A history of kidney
stones also would point the way.<o:p></o:p></span></span></div>
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><br />
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<span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Arial, Helvetica, sans-serif;">What tests
would be administered in the ER to determine the problem?<o:p></o:p></span></span></div>
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><br />
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: 0in;">
<span style="color: #3333ff; font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Arial, Helvetica, sans-serif;">Urine
clean catch with microscopic exam—this will show traces of blood, even if not
visible to the naked eye. A CBC (Complete blood count) to look for infection.
Kidney stones can contribute to urinary tract infection. A kidney infection
(called pyelonephritis) will cause a fever and sometimes cloudy urine, in
addition to all the above. These patients need to be admitted for IV
antibiotics.<o:p></o:p></span></span></div>
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><br />
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<span style="color: #3333ff; font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Arial, Helvetica, sans-serif;">If
a fever is present, cultures will be taken from urine and blood.<o:p></o:p></span></span></div>
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><br />
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: 0in;">
<span style="color: #3333ff; font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Arial, Helvetica, sans-serif;">An
X-ray—KUB (Kidneys, ureters, bladder) to look for stones. Some kinds show up on
X-ray.<o:p></o:p></span></span></div>
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><br />
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<span style="color: #3333ff; font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Arial, Helvetica, sans-serif;">It’s
possible an IVP (Intravenous pyelogram) might be ordered. Dye is given through
an IV line, and X-ray pictures are taken as the dye is excreted by the kidneys.
Stones can appear as negative defects—no dye in those areas. As the dye travels
from the kidney to the bladder via the ureter, a stone blocking the ureter will
show up as a cut-off—the dye doesn’t get past.<o:p></o:p></span></span></div>
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><br />
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: 0in;">
<span style="color: #3333ff; font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Arial, Helvetica, sans-serif;">Sometimes
an IVP will help pass a stone, but it’s never ordered for that purpose.<o:p></o:p></span></span></div>
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><br />
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: 0in;">
<span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Arial, Helvetica, sans-serif;">I know
people with kidney stones are discharged to go home and pass the stone. <span style="color: #3333ff;">Not always. A lot of times we’d give them IV fluid to
help wash the stone down to the bladder. <o:p></o:p></span></span></span></div>
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><br />
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<span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Arial, Helvetica, sans-serif;">Is there
ever a time they would be admitted and if so, why? <span style="color: #3333ff;">Intractable
nausea and vomiting, dehydration, high fever (101 or above), too-low blood
pressure would all lead to admission. Kidney infection would lead to admission
(see above) because of the need for IV antibiotics.<o:p></o:p></span></span></span></div>
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><br />
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: 0in;">
<span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Arial, Helvetica, sans-serif;">I want my
character to spend the night at the hospital if realistically possible.<br />
Would she be given pain medication to ease the pain? <span style="color: #3333ff;">Yes.<o:p></o:p></span></span></span></div>
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><br />
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: 0in;">
<span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Arial, Helvetica, sans-serif;">If so when
would that happen? <span style="color: #3333ff;">As soon as they determine there’s
no intra-abdominal disaster, like a ruptured appendix or something of that
nature. The pain med would likely be morphine or Demerol, and would be given
IV.<o:p></o:p></span></span></span></div>
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><br />
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: 0in;">
<span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Arial, Helvetica, sans-serif;">Would they
need to do diagnostic tests first to determine the problem? <span style="color: #3333ff;">Yep—see above.</span></span></span></div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: 0in;">
<span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman";"><span style="color: #3333ff;"><span style="font-family: Arial, Helvetica, sans-serif;"></span></span></span> </div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: 0in;">
<span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman";"><span style="color: #3333ff;"><span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-family: Calibri;"><i><span lang="EN" style="color: black; line-height: 150%; mso-ansi-language: EN; mso-ascii-font-family: Calibri; mso-bidi-font-family: Arial; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: Calibri;">Questions? Comments?</span></i></span><br /><span style="font-family: Calibri;"><i><span lang="EN" style="color: black; line-height: 150%; mso-ansi-language: EN; mso-ascii-font-family: Calibri; mso-bidi-font-family: Arial; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: Calibri;"></span></i></span><span style="font-family: Calibri;"><span lang="EN" style="color: black; line-height: 115%; mso-ansi-language: EN; mso-ascii-font-family: Calibri; mso-bidi-font-family: Arial; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: Calibri;">~*~</span></span><br /><span style="font-family: Calibri;"><span lang="EN" style="color: black; line-height: 115%; mso-ansi-language: EN; mso-ascii-font-family: Calibri; mso-bidi-font-family: Arial; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: Calibri;"></span></span></span><span style="font-family: Calibri;"><span style="color: black; line-height: 150%; mso-ascii-font-family: Calibri; mso-bidi-font-family: Arial; mso-hansi-font-family: Calibri;"><span style="font-family: Arial, Helvetica, sans-serif;">Kelly has worked in the medical field for over twenty years, mainly at large medical centers. With experience in a variety of settings, chances are Kelly may have seen it. <br /> Sometimes truth seems stranger than fiction in medicine, but accurate medicine in fiction is fabulous.<br style="mso-special-character: line-break;" /><!--[if !supportLineBreakNewLine]--></span></span></span></span></span></div>
<span style="font-family: Arial, Helvetica, sans-serif;">
**Thanks to MedicineNet.com for the diagram</span><br />
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<span style="color: #3333ff; font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman";"><o:p><span style="font-family: Arial, Helvetica, sans-serif;"> </span></o:p></span></div>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8255935895272962129.post-20688466642549184362014-08-29T16:03:00.002-07:002014-08-29T16:03:44.017-07:00Poisoning by Caterpillar
<span style="font-family: Calibri;"><span style="font-size: 14pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: Calibri;">As summer
draws to a close, I got this question from a reader in Texas:</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></span><br />
<span style="font-size: 14pt; line-height: 150%; mso-ascii-font-family: Calibri; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: Calibri;"><span style="font-family: Calibri;">Is it
possible to get sick from a caterpillar sting?<o:p></o:p></span></span><br />
<span style="font-size: 14pt; line-height: 150%; mso-ascii-font-family: Calibri; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: Calibri;"><span style="font-family: Calibri;"></span></span><br />
<span style="font-size: 14pt; line-height: 150%; mso-ascii-font-family: Calibri; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: Calibri;"><span style="font-family: Calibri;">Hmm...caterpillars
don't sting, not like wasps and bees or even ants. They transfer venom
passively when the predator--or human--comes into contact with it. </span></span><br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhVQY9SDiLPYka27alHL9Qkx6DvChOsMLTxrKHMmphJPNM-HW6C4zywX7ULJxpQFBRbk9ewrau3glsUk1kSzwpuQ7IxvWAuHooeMKtpSo9WSoLjF25dUx9ahXsKhp2Okp4GVxm_p9M0ZJo/s1600/Puss+cater-Auburn-1.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhVQY9SDiLPYka27alHL9Qkx6DvChOsMLTxrKHMmphJPNM-HW6C4zywX7ULJxpQFBRbk9ewrau3glsUk1kSzwpuQ7IxvWAuHooeMKtpSo9WSoLjF25dUx9ahXsKhp2Okp4GVxm_p9M0ZJo/s1600/Puss+cater-Auburn-1.jpg" height="320" width="317" /></a></div>
<span style="font-family: Calibri;"><b><span style="font-size: 14pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: Calibri;">The puss
caterpillar</span></b><span style="font-size: 14pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: Calibri;"> is the most poisonous caterpillar in
the USA. It has dense “fur,” composed of hairs; hidden among these are
hair-like hollow spines that deliver poison produced by glands.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></span><br />
<span style="font-family: Calibri;"><span style="font-size: 14pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: Calibri;"></span></span><br />
<span style="font-family: Calibri;"><span style="font-size: 14pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: Calibri;">Despite
the appearance in the photos, it is only 1.3-1.5 inches long.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></span><br />
<span style="font-family: Calibri;"><span style="font-size: 14pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: Calibri;"></span></span><br />
<span style="font-family: Calibri;"><span style="font-size: 14pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: Calibri;">The
caterpillars live primarily in the southern states, especially Texas. They
appear twice a year, once in the late spring/early summer and again in late
summer/early fall. Favored foods include broadleaf trees and shrubs.</span></span><br />
<span style="font-family: Calibri;"><span style="font-size: 14pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: Calibri;">Humans
typically come in contact with the caterpillar by accident.</span></span><div class="separator" style="clear: both; text-align: center;">
<span style="font-family: Calibri;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhNs9a0Wk7V55kv883lEn7Hp_XyQkBba1hvLIyP48hzO6K44P6NsSOjxVjmik6CXTMa9uxwA-sXziITB-yl5kILQ4EvBdSK5lJdJtTUaZWcl0csbohSn58BVjFFkZ_BK84RewMYL5Rfksk/s1600/puss+cater-Auburn-2.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhNs9a0Wk7V55kv883lEn7Hp_XyQkBba1hvLIyP48hzO6K44P6NsSOjxVjmik6CXTMa9uxwA-sXziITB-yl5kILQ4EvBdSK5lJdJtTUaZWcl0csbohSn58BVjFFkZ_BK84RewMYL5Rfksk/s1600/puss+cater-Auburn-2.jpg" height="268" width="320" /></a></span></div>
<span style="font-family: Calibri;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></span><br />
<span style="font-family: Calibri;"><span style="font-size: 14pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: Calibri;"></span></span><br />
<span style="font-family: Calibri;"><span style="font-size: 14pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: Calibri;">Symptoms
of contact include intense pain, swelling, itching, and red blotches.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></span><br />
<span style="font-family: Calibri;"><span style="font-size: 14pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: Calibri;">It’s
not uncommon for the caterpillar to have multiple contact points, leading to
several affected areas. More serious reactions include nausea, vomiting,
cramps, and incapacitation. Death is unusual, but can happen with higher venom
loads.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></span><br />
<span style="font-family: Calibri;"><span style="font-size: 14pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: Calibri;"></span></span><br />
<span style="font-family: Calibri;"><span style="font-size: 14pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: Calibri;">The
best way to remove the spines from the skin is with cellophane/clear tape.
Because of the risk of a serious reaction it’s a good idea to seek medical
attention.</span></span><br />
<span style="font-family: Calibri;"><span style="font-size: 14pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: Calibri;"></span></span><span style="font-family: Calibri;"><span style="font-size: 14pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: Calibri;"></span></span><br />
<span style="font-family: Calibri;"><span style="font-size: 14pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: Calibri;">Thought
for small children: Don't touch!</span></span><br />
<span style="font-family: Calibri;"><span style="font-size: 14pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: Calibri;"></span></span><span style="font-family: Calibri;"><i><span lang="EN" style="color: black; font-size: 14pt; line-height: 150%; mso-ansi-language: EN; mso-ascii-font-family: Calibri; mso-bidi-font-family: Arial; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: Calibri;"></span></i></span><br />
<span style="font-family: Calibri;"><i><span lang="EN" style="color: black; font-size: 14pt; line-height: 150%; mso-ansi-language: EN; mso-ascii-font-family: Calibri; mso-bidi-font-family: Arial; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: Calibri;">Questions?
Comments?</span></i></span><br />
<span style="font-family: Calibri;"><i><span lang="EN" style="color: black; font-size: 14pt; line-height: 150%; mso-ansi-language: EN; mso-ascii-font-family: Calibri; mso-bidi-font-family: Arial; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: Calibri;"></span></i></span><span style="font-family: Calibri;"><span lang="EN" style="color: black; font-size: 14pt; line-height: 115%; mso-ansi-language: EN; mso-ascii-font-family: Calibri; mso-bidi-font-family: Arial; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: Calibri;">~*~</span></span><br />
<span style="font-family: Calibri;"><span lang="EN" style="color: black; font-size: 14pt; line-height: 115%; mso-ansi-language: EN; mso-ascii-font-family: Calibri; mso-bidi-font-family: Arial; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: Calibri;"></span></span><span style="font-family: Calibri;"><span style="color: black; font-size: 14pt; line-height: 150%; mso-ascii-font-family: Calibri; mso-bidi-font-family: Arial; mso-hansi-font-family: Calibri;">Kelly has worked in the medical field
for over twenty years, mainly at large medical centers. With experience in a
variety of settings, chances are Kelly may have seen it. <br />
Sometimes truth seems stranger than fiction in medicine, but accurate medicine
in fiction is fabulous.<br style="mso-special-character: line-break;" />
<!--[if !supportLineBreakNewLine]--></span></span><br />
<span style="font-family: Calibri;"><span style="color: black; font-size: 14pt; line-height: 150%; mso-ascii-font-family: Calibri; mso-bidi-font-family: Arial; mso-hansi-font-family: Calibri;">**Thanks to Auburn University for the photos.</span></span>Unknownnoreply@blogger.com2tag:blogger.com,1999:blog-8255935895272962129.post-43395000686300359812014-07-04T18:49:00.000-07:002014-07-04T18:49:14.150-07:00More About Snakes:Can Venom Clot Blood?A reader forwarded this video, with the question, "Can this really happen?"<br />
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<span style="color: black; font-size: 12pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Calibri;"></span></span> </div>
<div class="separator" style="clear: both; text-align: center;">
<iframe allowfullscreen='allowfullscreen' webkitallowfullscreen='webkitallowfullscreen' mozallowfullscreen='mozallowfullscreen' width='320' height='266' src='https://www.youtube.com/embed/CRrgs3NI2lI?feature=player_embedded' frameborder='0'></iframe></div>
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<span style="color: black; font-size: 12pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Calibri;"></span></span> </div>
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<span style="color: black; font-size: 12pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Calibri;">It's possible.<o:p></o:p></span></span></div>
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<span style="color: black; font-size: 12pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Calibri;">Snake venoms are complex and usually contain
multiple toxins. The main categories are neurotoxins--which affect the nervous
system--and hemotoxins, which affect the blood (and often soft tissues like
skin and muscle).<o:p></o:p></span></span></div>
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<span style="color: black; font-size: 12pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><o:p><span style="font-family: Calibri;"> </span></o:p></span></div>
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<span style="color: black; font-size: 12pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Calibri;">Some venoms contain hemotoxins. A few types of
hemotoxins:<o:p></o:p></span></span></div>
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<span style="color: black; font-size: 12pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Calibri;">--Some hemotoxins thin the blood--they
anticoagulate. <o:p></o:p></span></span></div>
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<span style="color: black; font-size: 12pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Calibri;">--Hemolysins are a type of hemotoxin
that can rupture (lyse) red blood cells. </span></span></div>
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<span style="color: black; font-size: 12pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Calibri;">--Agglutinins promote coagulation of
blood--what you see in the video is a large soft clot.<o:p></o:p></span></span></div>
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<span style="color: black; font-size: 12pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><o:p><span style="font-family: Calibri;"> </span></o:p></span></div>
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<span style="color: black; font-size: 12pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Calibri;">The video looks like a cobra--? Cobras usually
have primarily neurotoxic venom. It affects the ability of nerves to transmit
impulses and leads to weakness and death. Suffocation from not being able to
breathe is part of this. <o:p></o:p></span></span></div>
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<span style="color: black; font-size: 12pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><o:p><span style="font-family: Calibri;"> </span></o:p></span></div>
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<span style="color: black; font-size: 12pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Calibri;">Rattlesnakes produce a mostly a hemotoxic
venom.<o:p></o:p></span></span></div>
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<span style="color: black; font-size: 12pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><o:p><span style="font-family: Calibri;"> </span></o:p></span></div>
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<span style="color: black; font-size: 12pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Calibri;">Hope this helps!<o:p></o:p></span></span></div>
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<span style="color: black; font-size: 12pt; mso-bidi-font-family: "Courier New"; mso-fareast-font-family: "Times New Roman";"><br /><span style="font-family: Calibri;">
</span></span><span style="font-family: Calibri;"><i><span lang="EN" style="color: black; font-size: 12pt; mso-ansi-language: EN; mso-bidi-font-family: Arial; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">Questions? Comments?</span></i><span style="color: black; font-size: 12pt; mso-bidi-font-family: "Courier New"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 115%; margin: 0in 0in 0pt; mso-outline-level: 2; text-indent: 0in;">
<span style="font-family: Calibri;"><span lang="EN" style="color: black; font-size: 12pt; line-height: 115%; mso-ansi-language: EN; mso-bidi-font-family: Arial; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">~*~</span><span style="color: black; font-size: 12pt; line-height: 115%; mso-bidi-font-family: "Courier New"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></span></div>
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<span style="font-family: Calibri;"><span style="color: black; font-size: 12pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";">Kelly has worked in the medical field for over twenty years,
mainly at large medical centers. With experience in a variety of settings,
chances are Kelly may have seen it. <br />
Sometimes truth seems stranger than fiction in medicine, but accurate medicine
in fiction is fabulous.<br />
Find Kelly’s fiction at </span><span style="color: blue; font-size: 12pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";"><a href="http://www.kellywhitley.com/"><span style="color: #0068c6; text-decoration: none; text-underline: none;">www.kellywhitley.com</span></a></span><span style="color: black; font-size: 12pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 150%;"><o:p><span style="font-family: Calibri;"> </span></o:p></span></div>
Unknownnoreply@blogger.com5tag:blogger.com,1999:blog-8255935895272962129.post-20711978271456155392014-05-05T16:14:00.000-07:002014-05-05T16:14:12.347-07:00Writing a Case of Snake Bite in the Wilderness--A Discussion<span lang="EN" style="font-size: 12pt; line-height: 115%; mso-ansi-language: EN; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Calibri;"><span style="color: black; font-size: 14pt; line-height: 150%; mso-bidi-font-family: "Courier New";"><em>I'm writing a
scene set in a pre-industrial society. Herbal medicines, folk treatments, etc.<br />
One of my characters is bitten by a venomous snake - I haven't really specified
what kind. Can you think of ANY treatment for snake bite in this situation that
would actually be effective? Right now I have them just sort of treating the
symptoms - keeping the wound clean, applying snow when it starts to swell, etc.
<br />
Are there any more effective things they could be doing, in the absence of
antivenin?</em></span><span style="font-size: 14pt; line-height: 150%;"><o:p></o:p></span><span style="font-family: Times New Roman;">
</span><br />
</span></span><div class="MsoNormal" style="margin: 0in 0in 0pt; text-indent: 0in;">
<span lang="EN" style="font-size: 12pt; line-height: 115%; mso-ansi-language: EN; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Calibri;"><span style="line-height: 150%;"><span style="font-family: Arial, Helvetica, sans-serif;">Hello.<o:p></o:p></span></span></span></span></div>
<span lang="EN" style="font-size: 12pt; line-height: 115%; mso-ansi-language: EN; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Calibri;">
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><br />
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<span style="line-height: 150%;"><span style="font-family: Arial, Helvetica, sans-serif;">Sure. There are a few measures that you can use, depending on
how savvy the caregivers are. Right away, first aid measures should be taken as
follows:<o:p></o:p></span></span></div>
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><br />
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<span style="line-height: 150%;"><span style="font-family: Arial, Helvetica, sans-serif;">--Avoid panic—keep heart rate down, keep victim quiet. Most
bites are not fatal. In the USA, less than one percent of bites are fatal.<o:p></o:p></span></span></div>
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><br />
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<span style="line-height: 150%;"><span style="font-family: Arial, Helvetica, sans-serif;">--No ice/snow application. May cause tissue damage.<o:p></o:p></span></span></div>
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><br />
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<span style="line-height: 150%;"><span style="font-family: Arial, Helvetica, sans-serif;">--No tourniquet.<o:p></o:p></span></span></div>
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><br />
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<span style="line-height: 150%;"><span style="font-family: Arial, Helvetica, sans-serif;">--No sucking out the venom—this includes older snake bite
kits.<o:p></o:p></span></span></div>
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><br />
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<span style="line-height: 150%;"><span style="font-family: Arial, Helvetica, sans-serif;">--Wash the wound—helps remove any residual venom on the skin,
and helps cut down on bacteria. DO NOT use alcohol—this damages the raw tissue
in the wound.<o:p></o:p></span></span></div>
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><br />
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<span style="line-height: 150%;"><span style="font-family: Arial, Helvetica, sans-serif;">--Keep the heart <u>above </u>the wound. Immobilize the
extremity (if bitten on extremity)<o:p></o:p></span></span></div>
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><br />
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<span style="line-height: 150%;"><span style="font-family: Arial, Helvetica, sans-serif;">--Consider carrying the victim. Walking is exercise and will
increase heart rate.<o:p></o:p></span></span></div>
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><br />
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<span style="line-height: 150%;"><span style="font-family: Arial, Helvetica, sans-serif;">--If possible, try to ID the snake. Don’t let the snake get
in another bite by trying to catch or kill it.<o:p></o:p></span></span></div>
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><br />
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<span style="line-height: 150%;"><span style="font-family: Arial, Helvetica, sans-serif;">If you do kill it and transport it, keep in mind the dead
snake can still bite for a couple of hours.<o:p></o:p></span></span></div>
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><br />
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<span style="line-height: 150%;"><span style="font-family: Arial, Helvetica, sans-serif;">It is possible to use a homeopathic remedy if medical help is
unavailable or delayed. This isn’t a definitive treatment, but may help.<o:p></o:p></span></span></div>
<span style="font-family: Arial, Helvetica, sans-serif;">
<b style="mso-bidi-font-weight: normal;"><u><span style="line-height: 150%;"></span></u></b></span><br />
<b style="mso-bidi-font-weight: normal;"><u><span style="line-height: 150%;"><span style="font-family: Arial, Helvetica, sans-serif;">Plants to treat snake bite: <o:p></o:p></span></span></u></b><br />
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><br />
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<span style="line-height: 150%;"><span style="font-family: Arial, Helvetica, sans-serif;">--Rattlesnake master (false aloe)—clean off roots; scrape
well. Cut up and crush root </span></span><br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjsOn1e8d6nb8Vnnoe2A3wuBflGEEi4oxtNeQ6UkHao_m8OzOgclVh-AzMo6bCmS8XDL4UOnq-xM4RadPA7qDDQc5y9UxCPnVVE4c7qD5OWA1oComd7jNdX8bT97Muc9oteZL6_yfVHwys/s1600/smithsonian-garden9712.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><span style="font-family: Arial, Helvetica, sans-serif;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjsOn1e8d6nb8Vnnoe2A3wuBflGEEi4oxtNeQ6UkHao_m8OzOgclVh-AzMo6bCmS8XDL4UOnq-xM4RadPA7qDDQc5y9UxCPnVVE4c7qD5OWA1oComd7jNdX8bT97Muc9oteZL6_yfVHwys/s1600/smithsonian-garden9712.JPG" height="200" width="145" /></span></a></div>
<span style="font-family: Arial, Helvetica, sans-serif;">pieces between pieces of wood. (see photo left)</span></div>
</span><span style="font-family: Arial, Helvetica, sans-serif;"></span><br />
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<span style="line-height: 150%;"><span style="font-family: Arial, Helvetica, sans-serif;">--Yarrow root—process as above for false aloe.<o:p></o:p></span></span></div>
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><br />
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<span style="line-height: 150%;"><span style="font-family: Arial, Helvetica, sans-serif;">--Willow bark (from which comes acetyl salicylic acid, also
known as aspirin.) Cut into small pieces.<o:p></o:p></span></span></div>
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgjjCJNghtxJyf0-jj2RPEU7X1PTUVbs0FBdMke9-HEvUpD-4ZRpWMOHincmp90IICXGh3clMu0dgBFWR0gxfoqa5naa4GAx3RcpBirlgOy0W4-cbd7W6mkbib0jTnVLyzLIwibQ8j-68M/s1600/yarrow.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><span style="font-family: Arial, Helvetica, sans-serif;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgjjCJNghtxJyf0-jj2RPEU7X1PTUVbs0FBdMke9-HEvUpD-4ZRpWMOHincmp90IICXGh3clMu0dgBFWR0gxfoqa5naa4GAx3RcpBirlgOy0W4-cbd7W6mkbib0jTnVLyzLIwibQ8j-68M/s1600/yarrow.jpg" height="200" width="182" /></span></a></div>
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<span style="line-height: 150%;"><span style="font-family: Arial, Helvetica, sans-serif;">Combine the above and apply directly to the wound as a
poultice. Wrap with cloth (strips of clothing, for example).<o:p></o:p></span></span></div>
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><br />
<div class="MsoNormal" style="margin: 0in 0in 0pt; text-indent: 0in;">
<span style="line-height: 150%;"><span style="font-family: Arial, Helvetica, sans-serif;">Over the next few hours there will be a lot of swelling,
bruising, and pain associated with the bite. Chewing willow bark may help
decrease pain, as can birch bark. Yarrow may numb the wound.<o:p></o:p></span></span></div>
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><br />
<div class="MsoNormal" style="margin: 0in 0in 0pt; text-indent: 0in;">
<span style="line-height: 150%;"><span style="font-family: Arial, Helvetica, sans-serif;">Ultimately, evacuation to a hospital and treatment with
antivenin is ideal. Even if it’s a couple of days away, always travel toward
the nearest help.<o:p></o:p></span></span></div>
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><br />
<div class="MsoNormal" style="margin: 0in 0in 0pt; text-indent: 0in;">
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="line-height: 150%;"><o:p> </o:p></span><span style="line-height: 150%;">Hope this helps!</span></span></div>
</span><span style="font-family: Arial, Helvetica, sans-serif;"> </span><br />
<span lang="EN" style="line-height: 115%; mso-ansi-language: EN; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Calibri;"><em><span style="font-family: Arial, Helvetica, sans-serif;">Questions? Comments?</span></em></span></span><br />
<div class="MsoNormal" style="line-height: 115%; margin: 0in 0in 0pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; mso-outline-level: 2;">
<span lang="EN" style="line-height: 115%; mso-ansi-language: EN; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Calibri;"><span style="font-family: Arial, Helvetica, sans-serif;">~*~<o:p></o:p></span></span></span></div>
<span style="color: black; line-height: 115%; mso-bidi-font-family: "Courier New";"><span style="font-family: Calibri;"><span style="font-family: Arial, Helvetica, sans-serif;">K</span></span></span><span style="color: black; line-height: 115%; mso-bidi-font-family: Arial;"><span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-family: Calibri;">elly has worked in the medical field for over twenty years, mainly at large medical centers. With experience in a variety of settings, chances are Kelly may have seen it. <br />Sometimes truth seems stranger than fiction in medicine, but accurate medicine in fiction is fabulous.<br />Find Kelly’s fiction at </span><span style="color: blue; font-family: Calibri;"><a href="http://www.kellywhitley.com/"><span style="color: #0068c6;">www.kellywhitley.com</span></a></span></span></span> Unknownnoreply@blogger.com3tag:blogger.com,1999:blog-8255935895272962129.post-53159158521247790562014-05-02T17:17:00.001-07:002014-05-02T17:17:09.574-07:00"Roofied"--How to Write It: A Discussion
<br />
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; text-indent: 0in; vertical-align: top;">
<span style="color: #3333ff; font-family: "Helvetica","sans-serif"; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Arial, Helvetica, sans-serif;">If somebody was
roofied, passed out and transported to a hospital, what would be the course of
treatment. Let’s say, he’s not in a serious condition, but is out like a light
for a few hours. Would he be given fluids?<span style="mso-spacerun: yes;">
</span>Would he have that thingamajig<span style="mso-spacerun: yes;"> </span>on
his finger? Anything else?<o:p></o:p></span></span></div>
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><br />
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; text-indent: 0in; vertical-align: top;">
<span style="font-family: "Helvetica","sans-serif"; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Arial, Helvetica, sans-serif;">Hello.<o:p></o:p></span></span></div>
<span style="font-family: Arial, Helvetica, sans-serif;">
<span style="font-family: "Helvetica","sans-serif"; mso-fareast-font-family: "Times New Roman";">I’m assuming here you want Rohypnol
to be the “roofie.”<o:p></o:p></span></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><br />
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; text-indent: 0in; vertical-align: top;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh2tkfsJm62zcu9klNEvQol31hn4pcGAZGo_vBDCHRo_INfnKPZshTHA2HN2So-FJQX_sgLMSLWKy_8YrZGmvzlRreSh0V6Y3h_OwNIICVYo7kB13XBU3I5NO13Wh4QJioy7gzxircZTZU/s1600/soda-in-glass.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh2tkfsJm62zcu9klNEvQol31hn4pcGAZGo_vBDCHRo_INfnKPZshTHA2HN2So-FJQX_sgLMSLWKy_8YrZGmvzlRreSh0V6Y3h_OwNIICVYo7kB13XBU3I5NO13Wh4QJioy7gzxircZTZU/s1600/soda-in-glass.jpg" height="320" width="290" /></a><span style="font-family: "Helvetica","sans-serif"; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Arial, Helvetica, sans-serif;">There are multiple drugs that can be
used to a similar effect, including Ketamine (Special K), GHB, and MDMA
(Ecstasy, “E”). It’s also not unusual for a multi-drug ingestion to take place,
and to have alcohol involved, depending on the setting in which your character
is drugged—like a club, bar, or party.<o:p></o:p></span></span></div>
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><br />
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; text-indent: 0in; vertical-align: top;">
<span style="font-family: "Helvetica","sans-serif"; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Arial, Helvetica, sans-serif;">Fifteen or twenty minutes after
ingesting the drug, sedation, confusion, slurred speech, and muscle weakness
begin. Nausea and headache are sometimes present. A higher dose will lead to
loss of consciousness and depression of breathing. Coma can result.<o:p></o:p></span></span></div>
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><br />
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; text-indent: 0in; vertical-align: top;">
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-family: "Helvetica","sans-serif"; mso-fareast-font-family: "Times New Roman";"><o:p> </o:p></span><span style="font-family: "Helvetica","sans-serif"; mso-fareast-font-family: "Times New Roman";">The paramedics will first do the
ABCs: Airway--make sure there is nothing blocking the windpipe) Breathing--make
sure breathing is okay and start oxygen) Circulation--A heart monitor will be
placed to watch for rhythm disturbances. They’ll check blood sugar. An IV line
will be started along with fluids. This is mostly to have IV access for
whatever needs to be given. The fluid will contain dextrose (sugar) and saline
(salt). The paramedics will gather any obvious drugs, ask bystanders for
history—what happened. With illicit drugs, most of the time witnesses don’t
offer much.<o:p></o:p></span></span></div>
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><br />
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; text-indent: 0in; vertical-align: top;">
<span style="font-family: "Helvetica","sans-serif"; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Arial, Helvetica, sans-serif;">In the ER, your guy will be hooked
up to a heart monitor and a finger pulse oximeter (the finger thingamajig) that
measures the oxygen saturation of the blood. Likely oxygen via a tube under the
nose (cannula) will be continued. <o:p></o:p></span></span></div>
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><br />
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; text-indent: 0in; vertical-align: top;">
<span style="font-family: "Helvetica","sans-serif"; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Arial, Helvetica, sans-serif;">An EKG (heart rhythm tracing) will
be done, and lab work. Usually this will include a standard drug screen for
drugs of abuse—THC (marijuana), benzodiazepines (Valium, Rohypnol), opiates. Rarely
does the patient arrive in time to catch a trace of Rohypnol. It’s very common
to have a multi-drug intoxication.<o:p></o:p></span></span></div>
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><br />
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; text-indent: 0in; vertical-align: top;">
<span style="font-family: "Helvetica","sans-serif"; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Arial, Helvetica, sans-serif;">Blood alcohol level will be
measured—regardless of whether the guy had something to drink, it’ll be
checked.<o:p></o:p></span></span></div>
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><br />
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; text-indent: 0in; vertical-align: top;">
<span style="font-family: "Helvetica","sans-serif"; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Arial, Helvetica, sans-serif;">Romazicon is a reversal agent for
benzodiazepines, and might be tried. This can be hazardous if the patient takes
a benzo for a medical condition. Seizures can be precipitated. Most docs won’t
chance it.<o:p></o:p></span></span></div>
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><br />
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; text-indent: 0in; vertical-align: top;">
<span style="font-family: "Helvetica","sans-serif"; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Arial, Helvetica, sans-serif;">Naloxone (Narcan) is an opioid
reversal agent, and might be tried if there is concern about opiates
contributing to his decreased level of consciousness.<o:p></o:p></span></span></div>
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><br />
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; text-indent: 0in; vertical-align: top;">
<span style="font-family: "Helvetica","sans-serif"; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Arial, Helvetica, sans-serif;">Mostly it’s a matter of supportive
care. Keep the vital signs stable—temperature, pulse, respirations, blood
pressure. Fluids. Observation.<o:p></o:p></span></span></div>
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><br />
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; text-indent: 0in; vertical-align: top;">
<span style="font-family: "Helvetica","sans-serif"; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Arial, Helvetica, sans-serif;">Rohypnol generally sticks around for
four to six hours with some effects persisting up to twelve hours. If he’s
passed out, he’s going to be admitted. He might be in for three to five days,
depending on how he does. He’ll also have some degree of amnesia for the period
of intoxication.<o:p></o:p></span></span></div>
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><br />
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; text-indent: 0in; vertical-align: top;">
<span style="font-family: "Helvetica","sans-serif"; font-size: 10pt; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: small;">Hope this helps!<o:p></o:p></span></span></span></div>
<br />
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; text-indent: 0in; vertical-align: top;">
<span style="font-family: "Helvetica","sans-serif"; font-size: 10pt; mso-fareast-font-family: "Times New Roman";"><span style="font-size: small;"><span style="font-family: Arial, Helvetica, sans-serif;">Questions? Comments?</span></span><span style="font-size: small;"><span style="font-family: Arial, Helvetica, sans-serif;">~*~</span></span><span style="font-size: small;"><span style="font-family: Arial, Helvetica, sans-serif;"> Kelly has worked in the medical field for over twenty years, mainly at large medical centers. With experience in a variety of settings, chances are Kelly may have seen it. </span></span><span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: small;"> Sometimes truth seems stranger than fiction in medicine, but accurate medicine in fiction is fabulous. Find Kelly’s fiction at </span></span><a href="http://www.kellywhitley.com/"><span style="font-family: Arial, Helvetica, sans-serif;"><span style="color: #0068c6; font-size: small;">www.kellywhitley.com</span></span></a></span></div>
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<span style="font-family: "Helvetica","sans-serif"; font-size: 10pt; mso-fareast-font-family: "Times New Roman";"><o:p> </o:p></span></div>
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<b><span style="display: none; font-family: "Helvetica","sans-serif"; font-size: 10pt; mso-fareast-font-family: "Times New Roman"; mso-hide: all;">View Source</span></b><span style="display: none; font-family: "Helvetica","sans-serif"; font-size: 10pt; mso-fareast-font-family: "Times New Roman"; mso-hide: all;"><o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="display: none; font-family: "Courier New"; font-size: 10pt; mso-fareast-font-family: "Courier New"; mso-hide: all;"><span style="mso-list: Ignore;">o</span></span><!--[endif]--><span style="display: none; font-family: "Helvetica","sans-serif"; font-size: 10pt; mso-fareast-font-family: "Times New Roman"; mso-hide: all;">0 Attachment<o:p></o:p></span></div>
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<span style="display: none; font-family: "Helvetica","sans-serif"; font-size: 10pt; mso-fareast-font-family: "Times New Roman"; mso-hide: all;">If somebody was roofied, passed
out and transported to a hospital, what would be the course of treatment. Let's
say, he's not in a serious condition, but is out like a light for a few hours.
Would he be given fluids? Would he have that thingamajig on his finger?
Anything else?<o:p></o:p></span></div>
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<span style="display: none; font-family: "Helvetica","sans-serif"; font-size: 10pt; mso-fareast-font-family: "Times New Roman"; mso-hide: all;"><o:p> </o:p></span></div>
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<span style="display: none; font-family: "Helvetica","sans-serif"; font-size: 10pt; mso-fareast-font-family: "Times New Roman"; mso-hide: all;">Thanks!!!<o:p></o:p></span></div>
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<span style="display: none; font-family: "Helvetica","sans-serif"; font-size: 10pt; mso-fareast-font-family: "Times New Roman"; mso-hide: all;"><a href="javascript:;"><span style="color: windowtext; text-decoration: none; text-underline: none;">Reply</span></a> <o:p></o:p></span></div>
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<o:p><span style="font-family: Calibri;"> </span></o:p></div>
Unknownnoreply@blogger.com4tag:blogger.com,1999:blog-8255935895272962129.post-4216393576328936172014-04-28T01:00:00.000-07:002014-04-28T01:00:00.747-07:00Consequences of Choking--How to Write it<o:p><em><span style="font-family: Arial, Helvetica, sans-serif;">I've put down "The choking damaged his vocal chords" in a scene. Can that actually happen?<br /> If so, could it lead to never regaining speech? If not... how can I make it happen?</span></em></o:p><br />
<o:p><span style="font-family: Arial, Helvetica, sans-serif;"></span></o:p><br />
<o:p><span style="font-family: Arial, Helvetica, sans-serif;">I wasn’t sure what kind of choking you planned to use, so here are both:</span></o:p><br />
<o:p><span style="font-family: Arial, Helvetica, sans-serif;"></span></o:p><br />
<o:p><span style="font-family: Arial, Helvetica, sans-serif;">External choking (strangulation, homicidal or otherwise) can cause damage to the nerves that supply the vocal cords. It can also cause fracture of the cartilage that surrounds/protects the vocal cords or separation/tearing of these cartilages.</span></o:p><br />
<o:p><span style="font-family: Arial, Helvetica, sans-serif;"></span></o:p><br />
<o:p><span style="font-family: Arial, Helvetica, sans-serif;"> Two possible consequences of this type of choking:</span></o:p><br />
<o:p><span style="font-family: Arial, Helvetica, sans-serif;"></span></o:p><br />
<o:p><span style="font-family: Arial, Helvetica, sans-serif;">1) Vocal cord weakness—this results in hoarseness and early “voice fatigue” when speaking. </span></o:p><br />
<o:p><span style="font-family: Arial, Helvetica, sans-serif;"></span></o:p><br />
<o:p><span style="font-family: Arial, Helvetica, sans-serif;">2) Vocal cord paralysis—victim can’t speak, and has trouble protecting airway from secretions like saliva and postnasal drainage.</span></o:p><br />
<o:p><span style="font-family: Arial, Helvetica, sans-serif;"></span></o:p><br />
<o:p><span style="font-family: Arial, Helvetica, sans-serif;">I’ve included a color drawing to help you visualize the anatomy.</span></o:p><br />
<o:p><span style="font-family: Calibri;"></span></o:p><br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhv42eHFZH6o8aC_TPy8bESSjSZXD26tH0e259mYeczAHHY5Sj_t0p6oOQZMNLNz7C2_x516xGYQxIU9_OJi4TEbYVVsY2Imf1gWObDSAeSYjEltrJRos_bvGo-oqeHYxpJ8Sp4DGxu_SA/s1600/Laryngeal+nerve+damage.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhv42eHFZH6o8aC_TPy8bESSjSZXD26tH0e259mYeczAHHY5Sj_t0p6oOQZMNLNz7C2_x516xGYQxIU9_OJi4TEbYVVsY2Imf1gWObDSAeSYjEltrJRos_bvGo-oqeHYxpJ8Sp4DGxu_SA/s1600/Laryngeal+nerve+damage.jpg" height="256" width="320" /></a></div>
<span style="font-family: Arial, Helvetica, sans-serif;">Internal choking (like on food or a foreign body) can cause direct trauma to the vocal cords. Hoarseness and voice fatigue can ensue. Permanent paralysis of the vocal cords is less likely with this kind of injury; therefore not being able to talk at all would be less likely. It could happen, though. (See b/w drawing below)</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">In the black and white drawing, the vocal cords are the long thin structures adjacent to black oval in the middle.</span><div class="separator" style="clear: both; text-align: center;">
<span style="font-family: Arial, Helvetica, sans-serif;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhPehtafZGVaWpKW017LcbQ4dkfnfqEALbp1nGDS4v_HmOh9txPasE3WVXRQ3AWsPkMR9bHVeE1JNyFhn_IsL6QLtwSdMqKkix75nKTmQcPzPKnuklJguffI_zkAqOr6fem324-DKZ71kE/s1600/Larynx+%25232.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhPehtafZGVaWpKW017LcbQ4dkfnfqEALbp1nGDS4v_HmOh9txPasE3WVXRQ3AWsPkMR9bHVeE1JNyFhn_IsL6QLtwSdMqKkix75nKTmQcPzPKnuklJguffI_zkAqOr6fem324-DKZ71kE/s1600/Larynx+%25232.jpg" height="220" width="320" /></a></span></div>
<br />
<span style="font-family: Arial, Helvetica, sans-serif;"></span><br />
<strong><span style="font-family: Arial, Helvetica, sans-serif;">ANOTHER QUESTION:</span></strong><br />
<span style="font-family: Arial, Helvetica, sans-serif;"></span><br />
<em><span style="font-family: Arial, Helvetica, sans-serif;">If I go with vocal cord weakness... would it be logical for the victim to be unable to talk during his recuperation period? I need him unable to talk for at least a while (even when he finally regains consciousness).</span></em><br />
<em><span style="font-family: Arial, Helvetica, sans-serif;"> Regarding vocal cord paralysis…what are the consequences of being unable to protect the airway from secretions? </span></em><br />
<span style="font-family: Arial, Helvetica, sans-serif;"></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Certainly would be okay for the victim not to be able to talk during initial recovery. The nice thing about a nerve injury is you can control the extent. With external choking, there's bound to be some swelling which will push on the nerves to the vocal cords, in turn leading to weak or no movement of the vocal cords and little or no speech.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> The biggest thing about not being able to protect the airway is saliva, food, drink, etc may end up in the lungs. The recurrent laryngeal nerve supplies sensation to this area, and if no "invaders" are sensed, they can travel downward. The other issue is effective cough. Receptors in the airways send information to the brain, and the brain tells the vocal cords to close, the glottis (path to the stomach) to close, and then generates cough via rapid contraction of the stomach (abdominal) muscles. The air passes between the cords.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Without this sequence working, it's easier for stuff to go down the "wrong pipe," ie, the trachea instead of the esophagus (swallowing tube.)</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">You may consider also that your victim may need a temporary airway called a tracheostomy when initially injured. This is a hole in the trachea, below the damaged area, that allows free air movement into the lungs. This hole can be closed as the victim recovers.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">I hope this helps; if you can give me more details about your scenario, I can offer more specific suggestions.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Good Luck!</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Questions? Comments?</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">~*~</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> Kelly has worked in the medical field for over twenty years, mainly at large medical centers. With experience in a variety of settings, chances are Kelly may have seen it. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> Sometimes truth seems stranger than fiction in medicine, but accurate medicine in fiction is fabulous. Find Kelly’s fiction at </span><a href="http://www.kellywhitley.com/"><span style="font-family: Arial, Helvetica, sans-serif;">www.kellywhitley.com</span></a><br />
<span style="font-family: Arial, Helvetica, sans-serif;"></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Pictures courtesy of ADAM and MACC, respectively.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"></span><br />
<br />Unknownnoreply@blogger.com3tag:blogger.com,1999:blog-8255935895272962129.post-61873090144886491382014-04-14T11:50:00.001-07:002014-04-14T11:50:33.648-07:00A Near-Death Experience--How to Write One
<span style="color: black; font-size: 14pt; line-height: 150%; mso-bidi-font-family: Helvetica; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Calibri;"><em>I have a character that needs to have some sort of
medical emergency that would bring on a near-death experience. A trip to the
hospital, but not staying longer than a day. What will work for this?<o:p></o:p></em></span></span><br />
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt; text-indent: 0in;">
<span style="color: black; font-size: 14pt; line-height: 150%; mso-bidi-font-family: Helvetica; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Calibri;">By a near-death experience, I'm assuming you want the victim
to be unconscious and require some sort of resuscitation--yes?<o:p></o:p></span></span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiTnQVSD5xPZbHv6ePkQ11jXWb6s6CpfmXk-93xhJWVKsu5l3IIax5EJQg9uYSPt9SFL0e-vbmXRtYE7GnnhHjmQJCapH7VwN9TLztBW41h_6o_2ZT7GVe4JEYuk2nn50PCqa9q6X_7yOU/s1600/ekg.gif" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiTnQVSD5xPZbHv6ePkQ11jXWb6s6CpfmXk-93xhJWVKsu5l3IIax5EJQg9uYSPt9SFL0e-vbmXRtYE7GnnhHjmQJCapH7VwN9TLztBW41h_6o_2ZT7GVe4JEYuk2nn50PCqa9q6X_7yOU/s1600/ekg.gif" height="262" width="320" /></a></div>
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<span style="color: black; font-size: 14pt; line-height: 150%; mso-bidi-font-family: Helvetica; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Calibri;">A respiratory arrest from any cause would work. Choking
on a chunk of steak, for example. It would close off the airway. As the blood
oxygen level drops, the victim would pass out. You can do a Heimlich on an
unconscious person. The Heimlich depends on forcing air out of the victim's
lungs and dislodging the obstruction.<o:p></o:p></span></span></div>
<br />
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<span style="color: black; font-size: 14pt; line-height: 150%; mso-bidi-font-family: Helvetica; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Calibri;">Other respiratory arrests would be chemically mediated
(drugs, legal or otherwise), smoke inhalation (fire victims), and respiratory
arrest associated with cardiac arrest. If you have a cardio-respiratory arrest,
it'd be a handful for a layman to manage alone.<o:p></o:p></span></span></div>
<br />
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<span style="color: black; font-size: 14pt; line-height: 150%; mso-bidi-font-family: Helvetica; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Calibri;">A cardiac arrest (or an ineffective heart rhythm) can
cause the person to quit breathing--low blood flow to the brain. The most
common cause of cardiac arrest is coronary artery disease--blocked arteries to
the heart. An acute blockage--what most laymen refer to as "a heart
attack" blocks blood flow to the heart muscle, resulting in irritability
if the heart's electrical system; this can degenerate into deadly
rhythms--ventricular tachycardia (V-tach) or ventricular fibrillation (V-fib).
CPR might work. If your rescuer has quick access to an AED (automatic external
defibrillator) that would be better.</span></span><span style="color: black; font-size: 14pt; line-height: 150%; mso-bidi-font-family: Helvetica; mso-fareast-font-family: "Times New Roman";"><o:p><span style="font-family: Calibri;"> </span></o:p></span></div>
<br />
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<span style="color: black; font-size: 14pt; line-height: 150%; mso-bidi-font-family: Helvetica; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Calibri;">The other thing with cardiac arrest--patients with a
history of bad heart pump function (from any cause) are prone to rhythm
disturbances out of the blue. This can include young people all the way up to
the elderly.<o:p></o:p></span></span></div>
<br />
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<span style="color: black; font-size: 14pt; line-height: 150%; mso-bidi-font-family: Helvetica; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Calibri;">I hope this helps; if you can give me more details about
your scenario, I can offer more specific suggestions.<o:p></o:p></span></span></div>
<br />
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<span style="color: black; font-size: 14pt; line-height: 150%; mso-bidi-font-family: Helvetica; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Calibri;">Good Luck!</span></span></div>
<br />
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<i><span lang="EN" style="color: black; font-size: 14pt; line-height: 150%; mso-ansi-language: EN; mso-bidi-font-family: "Courier New"; mso-bidi-font-weight: bold;"><span style="font-family: Calibri;">Questions? Comments?</span></span></i><span style="color: black; font-size: 14pt; line-height: 150%; mso-bidi-font-family: "Courier New";"><br /><span style="font-family: Calibri;">
</span></span><span lang="EN" style="color: black; font-size: 14pt; line-height: 150%; mso-ansi-language: EN; mso-bidi-font-family: "Courier New"; mso-bidi-font-weight: bold;"><span style="font-family: Calibri;">~*~</span></span><span style="color: black; font-size: 14pt; line-height: 150%; mso-bidi-font-family: "Courier New";"><br /><span style="font-family: Calibri;">
K</span></span><span style="color: black; font-size: 14pt; line-height: 150%; mso-bidi-font-family: Arial;"><span style="font-family: Calibri;">elly has worked in the medical field for over twenty years,
mainly at large medical centers. With experience in a variety of settings,
chances are Kelly may have seen it. <br />
Sometimes truth seems stranger than fiction in medicine, but accurate medicine
in fiction is fabulous. Find Kelly’s fiction at </span></span><a href="http://www.kellywhitley.com/"><span style="font-size: 14pt; line-height: 150%; mso-bidi-font-family: Arial;"><span style="color: blue; font-family: Calibri;">www.kellywhitley.com</span></span></a><span style="color: black; font-size: 14pt; line-height: 150%; mso-bidi-font-family: "Courier New";"><o:p></o:p></span></div>
<br />
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<span style="font-size: 14pt; line-height: 150%;"><o:p><span style="font-family: Calibri;"> *Diagram courtesy of <a href="http://www.dmacc.edu/">www.dmacc.edu</a></span></o:p></span></div>
Unknownnoreply@blogger.com1tag:blogger.com,1999:blog-8255935895272962129.post-5242116168807666422014-03-17T12:41:00.000-07:002014-03-17T12:41:02.437-07:00A Less Common Heart Condition that Causes Disability
<span lang="EN" style="color: #333333; mso-ansi-language: EN;"><span style="font-family: Calibri;">I need a medical problem for an older man.
Serious enough that it might be life-threatening if he doesn't take
time off work and look after himself, but not immediately fatal. I
want it to start with an attack of some type, followed by a week in the
hospital and several months of decreased activity. A cardiac issue seems logical, but is there anything less commonly encountered? </span></span><br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span lang="EN" style="color: #333333; mso-ansi-language: EN;"><span style="font-family: Calibri;">Any ideas?</span></span><o:p></o:p></div>
<br />
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<o:p><span style="font-family: Calibri;"> </span></o:p></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjNghN-kSJ4Otq8cr2dr7JgvWpW-_RYJUC7AjAb9ee1GsBkEQaQhIqW3jVFGzW4SSrUFYHa2CatrNvaH6h0VPkB8dDrqh0qfrbF8SWkjJUnRtnP8yx-93Z29mDNQPSqrn2VEjjaFcI9_YU/s1600/Bacterial-Endocarditis-and-How-It-Can-Be-Prevented.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjNghN-kSJ4Otq8cr2dr7JgvWpW-_RYJUC7AjAb9ee1GsBkEQaQhIqW3jVFGzW4SSrUFYHa2CatrNvaH6h0VPkB8dDrqh0qfrbF8SWkjJUnRtnP8yx-93Z29mDNQPSqrn2VEjjaFcI9_YU/s1600/Bacterial-Endocarditis-and-How-It-Can-Be-Prevented.jpg" height="240" width="320" /></a><span style="font-family: Calibri;">One possibility is an infected heart valve, called
endocarditis. The infection can cause a valve to begin leaking, causing an
"attack." Sweating, weight loss, hemorrhages under the nails,
palpitations (heart skipping beats) can be additional symptoms. Patients may
present in sudden onset heart failure (short of breath, swollen legs, can't
breathe when lying down).<span style="mso-spacerun: yes;"> </span>Older patients
may have valvular heart disease on the basis of degeneration (wear and tear).
Old unaddressed/unrecognized rheumatic disease (from rheumatic fever) is a
possibility as well. </span></div>
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-family: Calibri;">Once the infection was recognized, your patient would need several weeks of
outpatient IV antibiotics, and consideration of a heart valve replacement. The
infection alone will be cause for seriously decreased activity. If you
transition into a valve replacement surgery after the antibiotics, he's looking
at several more months of decreased activity.<o:p></o:p></span></div>
<br />
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<span style="font-family: Calibri;">Myocardial infarction (heart attack with damage to the heart
muscle) often presents with a sudden attack of chest pain. In the USA, a
blocked artery may be treated with clot buster drugs (like streptokinase) or by
opening the artery in the cardiac cath lab (special X-ray suite) by using a
wire and a balloon. Other standard treatment includes aspirin (or other
platelet inhibitor drug), beta blocker drug (Example: metoprolol), treatment of
high cholesterol (ideally with a statin), smoking cessation, weight control,
and (if present) diabetes management. The patient would be off work for six
weeks, and need a treadmill test to determine residual cardiac disease before
clearing to return to work. Outpatient cardiac rehab three days a week for six
months is recommended. If the guy had a physical job, he might have to cut back
at work to a more sedentary position.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-family: Calibri;">If the heart attack did enough damage to seriously affect
the pump function of his heart, he could end up with congestive heart failure.
That could also be grounds for decreased activity on a more long term basis.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-family: Calibri;">Hope this helps!<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt; text-indent: 0in;">
<span lang="EN" style="color: black; mso-ansi-language: EN; mso-ascii-font-family: Calibri; mso-bidi-font-family: "Courier New"; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: Calibri;"><span style="font-family: Calibri;">~*~</span></span><span style="color: black; font-family: "Courier New"; mso-fareast-font-family: "Times New Roman";"><br />
</span><span style="color: black; mso-ascii-font-family: Calibri; mso-bidi-font-family: "Courier New"; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: Calibri;"><span style="font-family: Calibri;">K</span></span><span style="font-family: Calibri;"><span style="color: black; mso-ascii-font-family: Calibri; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: Calibri;">elly has
worked in the medical field for over twenty years, mainly at large medical
centers. With experience in a variety of settings, chances are Kelly may have
seen it. <br />
Sometimes truth seems stranger than fiction in medicine, but accurate medicine in
fiction is fabulous. Find Kelly’s fiction at </span><span style="color: blue; mso-ascii-font-family: Calibri; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: Calibri;"><a href="http://www.kellywhitley.com/"><span style="color: #0068c6; text-decoration: none; text-underline: none;">www.kellywhitley.com</span></a></span><span style="color: black; font-family: "Courier New"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></span></div>
<br />
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<o:p><span style="font-family: Calibri;"> </span></o:p></div>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8255935895272962129.post-48737293930553312642014-02-12T12:14:00.000-08:002014-02-12T12:14:59.433-08:00Choking on Valentine's Chocolates--How to Write It
<br />
<div style="line-height: 150%;">
<i style="mso-bidi-font-style: normal;"><span lang="EN" style="font-family: "Calibri","sans-serif"; font-size: 14pt; line-height: 150%; mso-ansi-language: EN; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">My character receives a box of chocolates for Valentine’s Day. When he eats
the first one, he chokes. His roommate thinks the chocolates are poisoned, but
the guy is only choking. How can I write the choking?<o:p></o:p></span></i></div>
<br />
<div style="line-height: 150%;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN" style="font-family: "Calibri","sans-serif"; font-size: 14pt; line-height: 150%; mso-ansi-language: EN; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Choking</span></b><span lang="EN" style="font-family: "Calibri","sans-serif"; font-size: 14pt; line-height: 150%; mso-ansi-language: EN; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"> happens when something blocks the airway—the
trachea. Food and air share the same route until dividing into the esophagus
(passage to the stomach) and </span><div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjliQXByskr4vJOrUorHILwuRYy-8GbnmseNFarp1YpLAUJkwOau0HpbTzZ212LCCe25xxVL_9aO6e5ntdaQzSPMcKvEaPSH_1PNA8p-OpIpm1KqvPUIiijTZi7JhYLwtDTdQsAvX_oCxA/s1600/111.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjliQXByskr4vJOrUorHILwuRYy-8GbnmseNFarp1YpLAUJkwOau0HpbTzZ212LCCe25xxVL_9aO6e5ntdaQzSPMcKvEaPSH_1PNA8p-OpIpm1KqvPUIiijTZi7JhYLwtDTdQsAvX_oCxA/s1600/111.jpg" height="268" width="320" /></a></div>
trachea (airway). A specialized flap called the
epiglottis covers and protects the airway during swallowing. Anything that
makes it past the epiglottis—food or object—can get stuck and cut off the air
supply. Drugs, alcohol, and some medical conditions increase the risk of
choking.<o:p></o:p><br />
<br />
<div style="line-height: 150%;">
<span lang="EN" style="font-family: "Calibri","sans-serif"; font-size: 14pt; line-height: 150%; mso-ansi-language: EN; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">The victim usually grabs
their throat—universal choking sign—and becomes agitated.<o:p></o:p></span></div>
<br />
<div style="line-height: 150%;">
<span lang="EN" style="font-family: "Calibri","sans-serif"; font-size: 14pt; line-height: 150%; mso-ansi-language: EN; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">The blockage can be partial
or complete.<o:p></o:p></span></div>
<br />
<div style="line-height: 150%;">
<span lang="EN" style="font-family: "Calibri","sans-serif"; font-size: 14pt; line-height: 150%; mso-ansi-language: EN; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">With partial
obstruction, there may be gagging, wheezing, coughing, or other sounds. It
requires air movement to make sound.<o:p></o:p></span></div>
<br />
<div style="line-height: 150%;">
<span lang="EN" style="font-family: "Calibri","sans-serif"; font-size: 14pt; line-height: 150%; mso-ansi-language: EN; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">With complete
obstruction, the victim can’t talk or make noise. Because of lack of oxygen, he
may begin to turn blue (cyanosis) from low blood oxygen.<o:p></o:p></span></div>
<br />
<div style="line-height: 150%;">
<b style="mso-bidi-font-weight: normal;"><u><span lang="EN" style="font-family: "Calibri","sans-serif"; font-size: 14pt; line-height: 150%; mso-ansi-language: EN; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Treatment on the Scene<o:p></o:p></span></u></b></div>
<br />
<div style="line-height: 150%;">
<span lang="EN" style="font-family: "Calibri","sans-serif"; font-size: 14pt; line-height: 150%; mso-ansi-language: EN; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Airway obstruction is a
medical emergency. Have a bystander call 911. Even if the victim is fine by the
time the paramedics get there, it’s vital to call immediately. If there is no
one else around, do the following <b style="mso-bidi-font-weight: normal;">before</b>
calling 911.<o:p></o:p></span></div>
<br />
<div style="line-height: 150%;">
<b style="mso-bidi-font-weight: normal;"><u><span lang="EN" style="font-family: "Calibri","sans-serif"; font-size: 14pt; line-height: 150%; mso-ansi-language: EN; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">The Five and Five method:<o:p></o:p></span></u></b></div>
<br />
<div style="line-height: 150%;">
<span lang="EN" style="font-family: "Calibri","sans-serif"; font-size: 14pt; line-height: 150%; mso-ansi-language: EN; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">--Five back blows: using
the heel of your hand, strike the victim between the shoulder blades five
times. This may dislodge the obstructing object.<o:p></o:p></span></div>
<br />
<div style="line-height: 150%;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgtQNwnnHXpGR8CC5Nwm7vmRjKHSFofYDRTbDhmmSzs5R7Kj0Z889s5_bzQ9GgeLUBOeXbuAQIF0j-8FK4LVFWe2DE_uXThyphenhyphenw5aICdrFVWBMYgt_W5hk-7qidcT8747T3HbDsw_5C9_6uU/s1600/chokingadult.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgtQNwnnHXpGR8CC5Nwm7vmRjKHSFofYDRTbDhmmSzs5R7Kj0Z889s5_bzQ9GgeLUBOeXbuAQIF0j-8FK4LVFWe2DE_uXThyphenhyphenw5aICdrFVWBMYgt_W5hk-7qidcT8747T3HbDsw_5C9_6uU/s1600/chokingadult.jpg" /></a><span lang="EN" style="font-family: "Calibri","sans-serif"; font-size: 14pt; line-height: 150%; mso-ansi-language: EN; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">--Five abdominal thrusts
(Heimlich maneuver): Stand behind victim; wrap your arms around their waist and
tip them forward a bit. With one hand, make a fist and place it just above the
belly button. Grip the fist with your other hand. Press hard with a quick
upward motion—a thrust—the way you’d try to pick someone up. This generates an
artificial “cough,” or rush of air from the lungs to “blow loose” the blockage.<o:p></o:p></span></div>
<br />
<div style="line-height: 150%;">
<span lang="EN" style="font-family: "Calibri","sans-serif"; font-size: 14pt; line-height: 150%; mso-ansi-language: EN; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">If the victim is obese
or pregnant, place the fist in the middle of the chest.<o:p></o:p></span></div>
<br />
<div style="line-height: 150%;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN" style="font-family: "Calibri","sans-serif"; font-size: 14pt; line-height: 150%; mso-ansi-language: EN; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">NOTE:</span></b><span lang="EN" style="font-family: "Calibri","sans-serif"; font-size: 14pt; line-height: 150%; mso-ansi-language: EN; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"> If YOU are the victim, make the fist and
position the same way, and lean on a hard surface. Forcibly push your fist
in/up.<o:p></o:p></span></div>
<br />
<div style="line-height: 150%;">
<span lang="EN" style="font-family: "Calibri","sans-serif"; font-size: 14pt; line-height: 150%; mso-ansi-language: EN; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Repeat the five and five
until effective or help arrives.<o:p></o:p></span></div>
<br />
<div style="line-height: 150%;">
<span lang="EN" style="font-family: "Calibri","sans-serif"; font-size: 14pt; line-height: 150%; mso-ansi-language: EN; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">If the victim loses
consciousness (passes out) position them on their back. Position hands just
beneath the ribcage and gently thrust upward.<o:p></o:p></span></div>
<br />
<div style="line-height: 150%;">
<span lang="EN" style="font-family: "Calibri","sans-serif"; font-size: 14pt; line-height: 150%; mso-ansi-language: EN; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">If there is no response
and the victim has no pulse, Begin CPR until help arrives. Do NOT try to drive
the victim to the ED yourself.<o:p></o:p></span></div>
<br />
<div style="line-height: 150%;">
<b style="mso-bidi-font-weight: normal;"><u><span lang="EN" style="font-family: "Calibri","sans-serif"; font-size: 14pt; line-height: 150%; mso-ansi-language: EN; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Treatment in the ED<o:p></o:p></span></u></b></div>
<br />
<div style="line-height: 150%;">
<span lang="EN" style="font-family: "Calibri","sans-serif"; font-size: 14pt; line-height: 150%; mso-ansi-language: EN; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">In the Emergency Department,
a needle in the trachea can be used to restore air flow until the obstruction
is relieved and/ or a larger more permanent airway can be placed in the
trachea. A small cut is made in the skin slightly below the Adam’s apple, and a
needle is inserted to make a temporary detour for air.<o:p></o:p></span></div>
<br />
<div style="line-height: 150%;">
<span lang="EN" style="font-family: "Calibri","sans-serif"; font-size: 14pt; line-height: 150%; mso-ansi-language: EN; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">I don’t recommend a
layman try this needle maneuver in real life, but in fiction it’s potentially
useable.<o:p></o:p></span></div>
<br />
<div style="line-height: 150%;">
<span lang="EN" style="font-family: "Calibri","sans-serif"; font-size: 14pt; line-height: 150%; mso-ansi-language: EN; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">In the field, this might
be done without the cut. There are blood vessels in this area, so I don’t
recommend using a hunting knife to make a big hole—no matter what you’ve seen
in the movies. A small pocket knife would be believable.<o:p></o:p></span></div>
<br />
<div style="line-height: 150%;">
<span lang="EN" style="font-family: "Calibri","sans-serif"; font-size: 14pt; line-height: 150%; mso-ansi-language: EN; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Yes, you could use any
hollow object instead of a needle. A heavy duty drinking straw, a pen casing, etc.
would work. Just be sure it doesn’t disappear down the hole and make things <i style="mso-bidi-font-style: normal;">worse</i>.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt; text-indent: 0in;">
<span style="font-size: 14pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";"><span style="font-family: Calibri;">No matter what, call
911 beforehand.<o:p></o:p></span></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt; text-indent: 0in;">
<span style="font-size: 14pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";"><span style="font-family: Calibri;">Hope this helps!<o:p></o:p></span></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt; text-indent: 0in;">
<i><span lang="EN" style="font-size: 14pt; line-height: 150%; mso-ansi-language: EN; mso-bidi-font-family: "Courier New"; mso-bidi-font-weight: bold;"><span style="font-family: Calibri;">Comments? Questions?</span></span></i><span style="font-size: 14pt; line-height: 150%; mso-bidi-font-family: "Courier New";"><br /><span style="font-family: Calibri;">
</span></span><span lang="EN" style="font-size: 14pt; line-height: 150%; mso-ansi-language: EN; mso-bidi-font-family: "Courier New"; mso-bidi-font-weight: bold;"><span style="font-family: Calibri;">~*~</span></span><span style="font-size: 14pt; line-height: 150%; mso-bidi-font-family: "Courier New";"><br /><span style="font-family: Calibri;">
K</span></span><span style="font-size: 14pt; line-height: 150%; mso-bidi-font-family: Arial;"><span style="font-family: Calibri;">elly has worked in the medical field for over twenty years, mainly at
large medical centers. With experience in a variety of settings, chances are
Kelly may have seen it. <br />
Sometimes truth seems stranger than fiction in medicine, but accurate medicine
in fiction is fabulous. Find Kelly’s fiction at </span><a href="http://www.kellywhitley.com/"><span style="color: windowtext;"><span style="font-family: Calibri;">www.kellywhitley.com</span></span></a></span><span style="font-size: 14pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";"><u1:p></u1:p><o:p></o:p></span></div>
Epiglottis pic: nicernet.org; Abdominal thrust pic: ADAM (Mayo Clinic)</div>
Unknownnoreply@blogger.com2tag:blogger.com,1999:blog-8255935895272962129.post-55313807919693880332013-12-12T14:29:00.001-08:002013-12-12T14:29:45.847-08:00Trapped by a Snow Blower--Injuries and Setting the Scene<br />
<span style="font-family: Arial, Helvetica, sans-serif;"><em>I have a character who is using his snow blower on a slope, and it tips over on him and traps his arm in the blades. He needs to be stuck for at least a couple of hours in the ice and snow. Will this work?</em> </span><br />
<span style="font-family: Arial;"></span><br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgOYcsi3duvVRlnLIiG8XL5ujxXg5cv6VxVN18uG5kcDh6K4swIlxf-c8k-EZn_kEgJ7hzwFb3t-T-NxlYMr2gFVpqTr2ig9ayS0bOjOEM3EKGBo05v6KVkEFej06WONPEG6n3W7Hmq07o/s1600/hand_snow_blower_1286_1.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgOYcsi3duvVRlnLIiG8XL5ujxXg5cv6VxVN18uG5kcDh6K4swIlxf-c8k-EZn_kEgJ7hzwFb3t-T-NxlYMr2gFVpqTr2ig9ayS0bOjOEM3EKGBo05v6KVkEFej06WONPEG6n3W7Hmq07o/s200/hand_snow_blower_1286_1.jpg" width="141" /></a><span style="font-size: 14pt;"><span style="font-family: Calibri;">About 6000 people are injured
annually (in the USA) by snow blowers. These machines can “clog” with wet snow,
and there is the temptation to clear the blockage manually. (NEVER do this.
Always use the tool that comes with the snow blower). The most common injuries
are to fingers. Because of multiple sharp motor-driven blades, these machines
are capable of cutting skin, muscle, tendon, and bone. Amputation of the
affected digits is often necessary.</span></span><br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-size: 14pt;"><span style="font-family: Calibri;">Hand surgeons hate it when
people use hands to clear the blades of a snow blower!</span></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-size: 14pt;"><span style="font-family: Calibri;">Okay. That out of the way,
let’s move on to the considerations for your scenario.</span></span></div>
<span style="font-size: 14pt;"><span style="font-family: Calibri;">It sounds like the machine in
your manuscript isn’t jammed. When the operator lets go of the handles, the
blades will quit turning. The damage will have to be inflicted by stationary
blades.<o:p></o:p></span></span><br />
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-size: 14pt;"><span style="font-family: Calibri;">--The size of the snow blower.
The average home use snow blower could cause damage to the arm—not to the
extent of a hand, though. The blower might become jammed by clothing.<o:p></o:p></span></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-size: 14pt;"><span style="font-family: Calibri;">--The weight of the snow
blower. This can range from 25 lb. to upwards of 150 lb. depending on the type.
The average man weighs ~155 lb. Unless the victim is elderly, sick, or
debilitated, he could probably shove the snow blower off.<o:p></o:p></span></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-size: 14pt;"><span style="font-family: Calibri;">--The operator’s clothing. If
it’s very cold, he may have on several layers. The blades would have to cut
through the clothing to injure him.<o:p></o:p></span></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-size: 14pt;"><span style="font-family: Calibri;">--Whether you want blood
loss. If you want your victim to bleed, he’ll need to get a lot of muscle
damage or cut a blood vessel.<o:p></o:p></span></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-size: 14pt;"><span style="font-family: Calibri;">Consider the possibility he’s
clearing snow with a bobcat skid loader—a small tractor for home/ranch use.
They are prone to tipping over if used on a slope, and can weigh over a
thousand pounds—hard to get out from under.<o:p></o:p></span></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-size: 14pt;"><span style="font-family: Calibri;">You can write the trauma to
the victim any way you like as far as injuries and bleeding. A crush injury to
the arm can be severe enough to require amputation or just cause a lot of
bruising—depends on how the extremity is trapped.</span></span></div>
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-size: 14pt;"><span style="font-family: Calibri;">Bleeding would be believable
and easy to add.<o:p></o:p></span></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-size: 14pt;"><span style="font-family: Calibri;">Hope this helps. Let me know
if you have further questions!</span></span></div>
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<i><span lang="EN" style="color: black; font-size: 14pt; mso-ansi-language: EN; mso-bidi-font-family: "Courier New"; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Calibri;">Comments?</span></span></i><span style="color: black; font-size: 14pt; mso-bidi-font-family: "Courier New"; mso-fareast-font-family: "Times New Roman";"><br /><span style="font-family: Calibri;">
</span></span><span lang="EN" style="color: black; font-size: 14pt; mso-ansi-language: EN; mso-bidi-font-family: "Courier New"; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Calibri;">~*~</span></span><span style="color: black; font-size: 14pt; mso-bidi-font-family: "Courier New"; mso-fareast-font-family: "Times New Roman";"><br /><span style="font-family: Calibri;">
K</span></span><span style="font-family: Calibri;"><span style="color: black; font-size: 14pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";">elly has worked in the medical field
for over twenty years, mainly at large medical centers. With experience in a
variety of settings, chances are Kelly may have seen it. <br />
Sometimes truth seems stranger than fiction in medicine, but accurate medicine
in fiction is fabulous. </span></span><span style="font-family: Calibri;"><span style="color: black; font-size: 14pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";">Find Kelly’s fiction at </span><span style="color: blue; font-size: 14pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";"><a href="http://www.kellywhitley.com/"><span style="color: #0068c6; text-decoration: none; text-underline: none;">www.kellywhitley.com</span></a></span><span style="color: black; font-size: 14pt; mso-bidi-font-family: "Courier New"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-size: 14pt;"><o:p><span style="font-family: Calibri;"> </span></o:p></span></div>
</div>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8255935895272962129.post-63742540326477977022013-11-13T01:30:00.000-08:002013-11-13T01:30:04.583-08:00Death by Compressive Asphyxia<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="font-size: 14pt; mso-bidi-font-family: Tahoma;"><span style="font-family: Calibri;">Can an adult
die from having weight on the chest?<o:p></o:p></span></span></i></b><br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjQQ-3WUTXtsAWyHcrdKJ5wNvremuEa-JXZTiZz5M9s0J1vjMPdKbb6mhwSP6urT8yUzKGhdNc3BLz3tb_Y60Y_Eq-3Y3DfqYmpwxPF-oKbgtRQMNkZw-5EokVN1qo8x2bte7puh55Wuls/s1600/stethoscope.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjQQ-3WUTXtsAWyHcrdKJ5wNvremuEa-JXZTiZz5M9s0J1vjMPdKbb6mhwSP6urT8yUzKGhdNc3BLz3tb_Y60Y_Eq-3Y3DfqYmpwxPF-oKbgtRQMNkZw-5EokVN1qo8x2bte7puh55Wuls/s200/stethoscope.jpg" width="200" /></a></div>
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-size: 14pt; mso-bidi-font-family: Tahoma;"><span style="font-family: Calibri;">Absolutely.
It’s called compressive asphyxia.<o:p></o:p></span></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-size: 14pt; mso-bidi-font-family: Tahoma;"><span style="font-family: Calibri;">The
lungs work like a bellows. The muscles between the ribs and the diaphragm
operate together to expand the chest cavity and draw in air—inhalation.
Relaxation of these muscles results in exhalation. Anything that restricts this
movement leads to decreased oxygen coming into the lungs and then into the
bloodstream. Carbon dioxide builds up, oxygen levels drop; the victim passes
out and eventually dies from lack of oxygen.<o:p></o:p></span></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-size: 14pt; mso-bidi-font-family: Tahoma;"><span style="font-family: Calibri;">Anything
else that depresses the respiratory center in the brain makes it more likely
asphyxia will occur—alcoholic intoxication, sedatives, extreme cold exposure,
illness, and extremes of age.<o:p></o:p></span></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-size: 14pt; mso-bidi-font-family: Tahoma;"><span style="font-family: Calibri;">Examples include: <o:p></o:p></span></span></b></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-size: 14pt; mso-bidi-font-family: Tahoma;"><span style="font-family: Calibri;">Constrictor
snake—like a python<o:p></o:p></span></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-size: 14pt; mso-bidi-font-family: Tahoma;"><span style="font-family: Calibri;">An
adult sharing a bed with a small child or infant rolls over on them<o:p></o:p></span></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-size: 14pt; mso-bidi-font-family: Tahoma;"><span style="font-family: Calibri;">Crowds
and panic, resulting in individuals crushed and unable to breathe<o:p></o:p></span></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-size: 14pt; mso-bidi-font-family: Tahoma;"><span style="font-family: Calibri;">Pinned
by a large weight, such as becoming trapped under a heavy box or piece of
equipment<o:p></o:p></span></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-size: 14pt; mso-bidi-font-family: Tahoma;"><span style="font-family: Calibri;">Restraint—the
victim is facedown and the individual doing the restraining may press or kneel<o:p></o:p></span></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<b><span style="color: black; font-size: 14pt; mso-bidi-font-family: Tahoma; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Calibri;">Burking<o:p></o:p></span></span></b></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-size: 14pt; mso-bidi-font-family: Tahoma;"><span style="font-family: Calibri;">A
combination of compression and smothering (occluding the airway) was utilized
by William Burke and William Hare in 1828 in a series of homicides. The two men
got their victim intoxicated and sat on the chest of the victim (compression)
while occluding the mouth and nose (smothering).<o:p></o:p></span></span></div>
<br />
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<i><span lang="EN" style="color: black; font-size: 14pt; mso-ansi-language: EN; mso-bidi-font-family: "Courier New"; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Calibri;">Questions? Comments?</span></span></i><span style="color: black; font-size: 14pt; mso-bidi-font-family: "Courier New"; mso-fareast-font-family: "Times New Roman";"><br /><span style="font-family: Calibri;">
</span></span><span lang="EN" style="color: black; font-size: 14pt; mso-ansi-language: EN; mso-bidi-font-family: "Courier New"; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Calibri;">~*~</span></span><span style="color: black; font-size: 14pt; mso-bidi-font-family: "Courier New"; mso-fareast-font-family: "Times New Roman";"><br /><span style="font-family: Calibri;">
K</span></span><span style="font-family: Calibri;"><span style="color: black; font-size: 14pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";">elly has worked in the medical field
for over twenty years, mainly at large medical centers. With experience in a
variety of settings, chances are Kelly may have seen it. <br />
Sometimes truth seems stranger than fiction in medicine, but accurate medicine
in fiction is fabulous.</span></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-family: Calibri;"><span style="color: black; font-size: 14pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";">Find Kelly’s fiction at </span><span style="color: blue; font-size: 14pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";"><a href="http://www.kellywhitley.com/"><span style="color: #0068c6; text-decoration: none; text-underline: none;">www.kellywhitley.com</span></a></span><span style="color: black; font-size: 14pt; mso-bidi-font-family: "Courier New"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-size: 14pt; mso-bidi-font-family: Tahoma;"><o:p><span style="font-family: Calibri;"> Photo courtesy of </span></o:p></span></div>
Unknownnoreply@blogger.com4tag:blogger.com,1999:blog-8255935895272962129.post-33244233496594914982013-11-04T02:00:00.000-08:002013-11-04T02:00:05.873-08:00Plausible Reasons for Collapse
<span style="font-size: 14pt;"><span style="font-family: Calibri;"><em>I have a character in his
fifties. He’s in good health. In the scene he’s walking along, then just
crumples to the ground and is unresponsive. It can’t be a cardiac arrest. What
are the possibilities?</em></span></span><br />
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh-SkY_Pm3dxeeJv0L56UkTOprYeE-RLfUqrHpaXC5IRRYNp4_KMX4tEPzYskwPdJa0M5Jk1s_m0f3lQn1HxZrbOBt9rT_BBMgt1OstSaGgFmmW63quAoN82qrgFmse4jbcKHVaawx8ZXQ/s1600/stethoscope.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh-SkY_Pm3dxeeJv0L56UkTOprYeE-RLfUqrHpaXC5IRRYNp4_KMX4tEPzYskwPdJa0M5Jk1s_m0f3lQn1HxZrbOBt9rT_BBMgt1OstSaGgFmmW63quAoN82qrgFmse4jbcKHVaawx8ZXQ/s200/stethoscope.jpg" width="200" /></a><br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-size: 14pt;"><span style="font-family: Calibri;">There are quite a few. Here are some easy ones to consider:</span></span></div>
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-size: 14pt;"><span style="font-family: Calibri;"></span></span> </div>
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-size: 14pt;"><span style="font-family: Calibri;"><strong>Simple faint</strong> is the easiest.<o:p></o:p></span></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-family: Calibri;"><b style="mso-bidi-font-weight: normal;"><span style="font-size: 14pt;">Heart-wise</span></b><span style="font-size: 14pt;">,
there can be problems like a very slow heart rate or a very fast heart rate,
either of which can cause the blood pressure to be low. If it’s low enough,
there isn’t good circulation to the brain and the victim collapses. There may
be little to no warning.<o:p></o:p></span></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-family: Calibri;"><b style="mso-bidi-font-weight: normal;"><span style="font-size: 14pt;">Severe pain</span></b><span style="font-size: 14pt;">
can cause a victim to pass out.<o:p></o:p></span></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-family: Calibri;"><b style="mso-bidi-font-weight: normal;"><span style="font-size: 14pt;">A blood clot to the lung</span></b><span style="font-size: 14pt;"> (pulmonary embolus) can cause the victim to pass out.
Associated symptoms include chest pain and shortness of breath. A risk factor
for this is immobility, like prolonged sitting with travel or staying in a
position like a crouch for a prolonged time. Surgery, especially of the pelvis
or hip is a risk factor. Uncommonly a clotting disorder that makes the blood
clot too well (hypercoagulability) can be the cause.<o:p></o:p></span></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-family: Calibri;"><b style="mso-bidi-font-weight: normal;"><span style="font-size: 14pt;">Low blood oxygen</span></b><span style="font-size: 14pt;"> can cause collapse, but generally this would be due to something going
on, like worsening lung disease or infection.<o:p></o:p></span></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-family: Calibri;"><b style="mso-bidi-font-weight: normal;"><span style="font-size: 14pt;">Low blood sugar</span></b><span style="font-size: 14pt;">
can cause collapse—like a diabetic who has taken too much insulin (or an oral
medication for diabetes) and not taken in adequate food.<o:p></o:p></span></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-family: Calibri;"><b style="mso-bidi-font-weight: normal;"><span style="font-size: 14pt;">Infection</span></b><span style="font-size: 14pt;">
that gets into the blood stream can do it, but again, the victim is going to
have symptoms beforehand.<o:p></o:p></span></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-family: Calibri;"><b style="mso-bidi-font-weight: normal;"><span style="font-size: 14pt;">Seizure</span></b><span style="font-size: 14pt;">—a big
one—can look like collapse if not seen close up.<o:p></o:p></span></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-family: Calibri;"><b style="mso-bidi-font-weight: normal;"><span style="font-size: 14pt;">Dehydration</span></b><span style="font-size: 14pt;">—due
to low volume in the vascular system—causes low blood pressure and collapse.<o:p></o:p></span></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-family: Calibri;"><b style="mso-bidi-font-weight: normal;"><span style="font-size: 14pt;">Internal bleeding</span></b><span style="font-size: 14pt;">—similar mechanism to dehydration. Ulcer, ruptured abdominal aortic
aneurysm (the aorta is the major artery leaving the heart and descending along
the spine. An aneurysm is an enlargement of the vessel, is under increased wall
pressure, and can rupture).<o:p></o:p></span></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-size: 14pt;"><span style="font-family: Calibri;">If there are other details
that might aid in tailoring the scenario, please let me know!<o:p></o:p></span></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-size: 14pt;"><span style="font-family: Calibri;">Good luck.<o:p></o:p></span></span></div>
<br />
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<i><span lang="EN" style="color: black; font-size: 14pt; mso-ansi-language: EN; mso-ascii-font-family: Calibri; mso-bidi-font-family: "Courier New"; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: Calibri;"><span style="font-family: Calibri;">Questions? Comments?</span></span></i><span style="color: black; font-family: "Courier New"; font-size: 14pt; mso-fareast-font-family: "Times New Roman";"><br />
</span><span lang="EN" style="color: black; font-size: 14pt; mso-ansi-language: EN; mso-ascii-font-family: Calibri; mso-bidi-font-family: "Courier New"; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: Calibri;"><span style="font-family: Calibri;">~*~</span></span><span style="color: black; font-family: "Courier New"; font-size: 14pt; mso-fareast-font-family: "Times New Roman";"><br />
</span><span style="color: black; font-size: 14pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: "Courier New"; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: Calibri;"><span style="font-family: Calibri;">K</span></span><span style="font-family: Calibri;"><span style="color: black; font-size: 14pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: Calibri;">elly has worked in the medical field
for over twenty years, mainly at large medical centers. With experience in a
variety of settings, chances are Kelly may have seen it. <br />
Sometimes truth seems stranger than fiction in medicine, but accurate medicine
in fiction is fabulous.</span></span></div>
<br />
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<span style="font-family: Calibri;"><span style="color: black; font-size: 14pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: Calibri;">Find Kelly’s fiction at </span><span style="color: blue; font-size: 14pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: Calibri;"><a href="http://www.kellywhitley.com/"><span style="color: #0068c6; text-decoration: none; text-underline: none;">www.kellywhitley.com</span></a></span><span style="color: black; font-family: "Courier New"; font-size: 14pt; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></span></div>
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<span style="font-size: 14pt;"><o:p><span style="font-family: Calibri;"> *Photo courtesy of Photobucket/amoore36846*</span></o:p></span></div>
Unknownnoreply@blogger.com2tag:blogger.com,1999:blog-8255935895272962129.post-61835702610772168772013-10-28T14:54:00.001-07:002013-10-28T14:54:27.104-07:00Bleeding a Victim to Death--Intentional Hemorrhage
<i style="mso-bidi-font-style: normal;"><span style="font-size: 14pt;"><span style="font-family: Calibri;">I have a kidnapper that wants to slowly bleed his
victim to death. How long will it </span></span></i><i style="mso-bidi-font-style: normal;"><span style="font-size: 14pt;"><span style="font-family: Calibri;">take, and how much blood loss (the villain is
collecting the blood in a jar).<o:p></o:p></span></span></i><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgcjNtFVfm2Zy9DSEJ9v9gYiO9tQdq_usbduScXmfKhSK8qjqE-7OqwQB7eCHLBR7jI8t8xKoHewhhbHTB9TOths5W97W2ojXBMINleoB4myB01Dn4TpWcTE6TCn04-AD7gcs6aq87n6DY/s1600/blood+unit.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgcjNtFVfm2Zy9DSEJ9v9gYiO9tQdq_usbduScXmfKhSK8qjqE-7OqwQB7eCHLBR7jI8t8xKoHewhhbHTB9TOths5W97W2ojXBMINleoB4myB01Dn4TpWcTE6TCn04-AD7gcs6aq87n6DY/s320/blood+unit.jpg" width="240" /></a></div>
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<span style="font-family: Calibri;"><b style="mso-bidi-font-weight: normal;"><span style="font-size: 14pt;">First, let’s consider how much blood the average adult
has.</span></b><span style="font-size: 14pt;"> Ten to twelve units, or pints. A
substantial portion will have to be lost to kill a healthy adult.<o:p></o:p></span></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-family: Calibri;"><b style="mso-bidi-font-weight: normal;"><span style="font-size: 14pt;">Second,</span></b><span style="font-size: 14pt;"> the
rate of blood loss is important—acute versus chronic. <o:p></o:p></span></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-size: 14pt;"><span style="font-family: Calibri;">When lost slowly (chronic),
the blood count can drop to half normal and the individual may still be upright
and walking around. This is something that happens over weeks to months, like
with an ulcer in the stomach.<o:p></o:p></span></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-size: 14pt;"><span style="font-family: Calibri;">The proposed scenario is
acute—rapid loss of blood—otherwise known as hemorrhage. The speed at which the
blood is lost will depend on what’s bleeding and how. If it’s an artery, the
blood loss will be faster; the flow is under pressure. With a vein, the loss is
slower. There is a chance of clotting off whatever you’re using to extract the
blood. An IV line in a vein in the arm is likely to clot off, and not yield
much blood flow before this happens.<o:p></o:p></span></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-size: 14pt;"><span style="font-family: Calibri;">Sticking a large IV line in
the carotid artery (in the neck) would give rise to a lot of blood loss; the
velocity (due to the pressure) helps prevent clotting.<o:p></o:p></span></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-size: 14pt;"><span style="font-family: Calibri;">Loss of forty percent of the
blood volume is usually fatal, so four to four-and-a-half units. The collection
jar will need to hold that much if all the blood is to be collected. Consider
using an IV line in the carotid artery, and have the line attach to a vacuum
jar. The suction accelerates the blood loss, it has markings on it for volume
collected, and it keeps the area clean. Four units can be extracted perhaps as
rapidly as fifteen minutes.<o:p></o:p></span></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-size: 14pt;"><span style="font-family: Calibri;">With regard to the victim, if
the blood loss proceeds over hours, he/she may experience racing heart,
shortness of breath, dizziness, and tingling in the extremities. Upright
posture is poorly tolerated and may lead to fainting. As the blood loss
approaches forty percent, the victim may feel cold and anxious, or may become
sleepy. With continued blood loss, the patient will go into cardiac arrest and
die due to lack of volume in the vascular system (hypovolemic shock).<o:p></o:p></span></span></div>
<br />
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<span style="font-size: 14pt;"><span style="font-family: Calibri;">Good luck!<o:p></o:p></span></span></div>
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<i><span lang="EN" style="color: black; font-size: 14pt; mso-ansi-language: EN; mso-ascii-font-family: Calibri; mso-bidi-font-family: "Courier New"; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: Calibri;"><span style="font-family: Calibri;">Questions? Comments?</span></span></i><span style="color: black; font-family: "Courier New"; font-size: 14pt; mso-fareast-font-family: "Times New Roman";"><br />
</span><span lang="EN" style="color: black; font-size: 14pt; mso-ansi-language: EN; mso-ascii-font-family: Calibri; mso-bidi-font-family: "Courier New"; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: Calibri;"><span style="font-family: Calibri;">~*~</span></span><span style="color: black; font-family: "Courier New"; font-size: 14pt; mso-fareast-font-family: "Times New Roman";"><br />
</span><span style="color: black; font-size: 14pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: "Courier New"; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: Calibri;"><span style="font-family: Calibri;">K</span></span><span style="font-family: Calibri;"><span style="color: black; font-size: 14pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: Calibri;">elly has worked in the medical field
for over twenty years, mainly at large medical centers. With experience in a
variety of settings, chances are Kelly may have seen it. <br />
Sometimes truth seems stranger than fiction in medicine, but accurate medicine
in fiction is fabulous.</span><span style="color: black; font-family: "Courier New"; font-size: 14pt; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></span></div>
<br />
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<span style="font-family: Calibri;"><span style="color: black; font-size: 14pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: Calibri;">Find Kelly’s fiction at </span><span style="color: blue; font-size: 14pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: Calibri;"><a href="http://www.kellywhitley.com/"><span style="color: #0068c6; text-decoration: none; text-underline: none;">www.kellywhitley.com</span></a></span><span style="color: black; font-family: "Courier New"; font-size: 14pt; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></span></div>
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<span style="font-size: 14pt;"><o:p><span style="font-family: Calibri;"> </span></o:p></span></div>
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<span style="font-size: 14pt;"><o:p><span style="font-family: Calibri;"> </span></o:p></span></div>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8255935895272962129.post-87108563375067480242013-10-22T02:00:00.000-07:002013-10-22T02:00:08.295-07:00Killing Someone With a Pumpkin<span style="font-family: Calibri;"></span><blockquote class="tr_bq">
<span style="font-family: Calibri;"><em><strong><span style="font-size: large;">Can a pumpkin be used to kill someone?</span></strong></em></span></blockquote>
<span style="font-family: Calibri;"><o:p></o:p></span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh4A-uJSXQOQEbF_TIgpfR0zQe28HPpJxub5EPOy9O7Ykobu66dTriSil5fOCNd3NiuItjR9GInLaBQZX0sOxBP7Ii6-a66VWuJkh7RRqKqbrUIUuE2WvAaZDCSHcmxROJajWj4gTSIkzg/s1600/Pumpkins.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="164" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh4A-uJSXQOQEbF_TIgpfR0zQe28HPpJxub5EPOy9O7Ykobu66dTriSil5fOCNd3NiuItjR9GInLaBQZX0sOxBP7Ii6-a66VWuJkh7RRqKqbrUIUuE2WvAaZDCSHcmxROJajWj4gTSIkzg/s320/Pumpkins.jpg" width="320" /></a></div>
<span style="font-family: Calibri;"><span style="font-size: large;">Short answer: yes.<o:p></o:p></span></span><br />
<span style="font-size: large;">
<span style="font-family: Calibri;">Long answer: Yes, but it takes some planning about <i style="mso-bidi-font-style: normal;">how</i> you want the pumpkin to be deadly.<o:p></o:p></span></span><br />
<span style="font-size: large;">
</span><br />
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<span style="font-family: Calibri;"><span style="font-size: large;"><b style="mso-bidi-font-weight: normal;">My first thought was
trauma</b>. A pumpkin dropped off a bridge has the potential to kill someone.<o:p></o:p></span></span></div>
<span style="font-size: large;">
<span style="font-family: Calibri;">It’s that time of year. The big orange gourds are everywhere
from supermarkets to front porches. <o:p></o:p></span></span><br />
<span style="font-size: large;">
</span><br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-family: Calibri;"><span style="font-size: large;">Unfortunately, a pumpkin combined with gravity can be lethal—or
not, depending on the scenario. <o:p></o:p></span></span></div>
<span style="font-size: large;">
</span><br />
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<span style="font-family: Calibri;"><span style="font-size: large;">There are multiple reports of pumpkins being dropped onto
moving vehicles resulting in accident. With adequate height and a large
pumpkin, the windshield can cave in. Depending on what happens to the car after
impact, yes, a deadly accident can result.<o:p></o:p></span></span></div>
<span style="font-size: large;">
</span><br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-family: Calibri;"><span style="font-size: large;">A dropped pumpkin striking a person directly—such as on the
head—would be tougher to pull off, but could be done. The timing and placement
of the injury would be somewhat difficult to write in a plausible manner. Of
course, if the impact resulted in the victim falling and hitting a hard surface
with the head, a more serious injury would occur.<o:p></o:p></span></span></div>
<span style="font-size: large;">
</span><br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-family: Calibri;"><span style="font-size: large;">There are competitions with catapults and pumpkins; these
missiles can be dangerous. This would make a possible scenario.<o:p></o:p></span></span></div>
<span style="font-size: large;">
</span><br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-family: Calibri;"><span style="font-size: large;">An anaphylactic (a dangerous allergic reaction) to touching
or eating pumpkin could work.<o:p></o:p></span></span></div>
<span style="font-size: large;">
</span><br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-family: Calibri;"><span style="font-size: large;">Last, there’s always choking to death on pumpkin pie, pumpkin
seeds, or pumpkin soup.<o:p></o:p></span></span></div>
<span style="font-size: large;">
</span><br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="color: black; mso-ascii-font-family: Calibri; mso-bidi-font-family: "Courier New"; mso-hansi-font-family: Calibri;"><span style="font-family: Calibri;"><span style="font-size: large;">Good luck!<u1:p></u1:p></span></span></span><span style="color: black; font-family: "Courier New";"><br /><span style="font-size: large;">
<br />
</span></span><i><span lang="EN" style="color: black; mso-ansi-language: EN; mso-ascii-font-family: Calibri; mso-bidi-font-family: "Courier New"; mso-bidi-font-weight: bold; mso-hansi-font-family: Calibri;"><span style="font-family: Calibri; font-size: large;">Questions? Comments?</span></span></i><span style="color: black; font-family: "Courier New";"><u1:p></u1:p><br /><span style="font-size: large;">
</span></span><span lang="EN" style="color: black; mso-ansi-language: EN; mso-ascii-font-family: Calibri; mso-bidi-font-family: "Courier New"; mso-bidi-font-weight: bold; mso-hansi-font-family: Calibri;"><span style="font-family: Calibri; font-size: large;">~*~</span></span><span style="color: black; font-family: "Courier New";"><u1:p></u1:p><br /><span style="font-size: large;">
</span></span><span style="color: black; mso-ascii-font-family: Calibri; mso-bidi-font-family: "Courier New"; mso-hansi-font-family: Calibri;"><span style="font-family: Calibri; font-size: large;">K</span></span><span style="font-family: Calibri; font-size: large;"><span style="color: black; mso-ascii-font-family: Calibri; mso-bidi-font-family: Arial; mso-hansi-font-family: Calibri;">elly
has worked in the medical field for over twenty years, mainly at large medical
centers. With experience in a variety of settings, chances are Kelly may have
seen it. <br />
Sometimes truth seems stranger than fiction in medicine, but accurate medicine
in fiction is fabulous.<br />
</span></span></div>
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-family: Calibri;"><span style="font-size: large;"><span style="color: black; mso-ascii-font-family: Calibri; mso-bidi-font-family: Arial; mso-hansi-font-family: Calibri;">Find Kelly’s fiction at </span><span style="color: blue; mso-ascii-font-family: Calibri; mso-bidi-font-family: Arial; mso-hansi-font-family: Calibri;"><a href="http://www.kellywhitley.com/"><span style="color: #0068c6;">www.kellywhitley.com</span></a></span><o:p></o:p></span></span></div>
<u1:p></u1:p>Unknownnoreply@blogger.com7tag:blogger.com,1999:blog-8255935895272962129.post-63260402783854008032013-10-16T15:32:00.000-07:002013-10-16T15:32:01.451-07:00Death by Black Widow Spider Bite
<span style="font-size: 12pt;"><span style="font-family: Calibri;">I<em> want to set up a scenario
where my victim dies from black widow spider bites. I’d like it to look “natural.”
How many bites would it take? Would this work?<o:p></o:p></em></span></span><br />
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-size: 12pt;"><span style="font-family: Calibri;">A tricky question.<o:p></o:p></span></span></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiab8fPnz5E0nIJir9iovWQ3hGhoOkOgvz78v8sYawyz3m7heNocWqjWOvh2h1Tm2UkBhIGme3VQUYFoynO839cAEJvjD5jxaXRrTP7bpjzJQB-4HZpVW_EQNe0NYmd1UwcS4cRV7ywaQo/s1600/Black_Widow.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiab8fPnz5E0nIJir9iovWQ3hGhoOkOgvz78v8sYawyz3m7heNocWqjWOvh2h1Tm2UkBhIGme3VQUYFoynO839cAEJvjD5jxaXRrTP7bpjzJQB-4HZpVW_EQNe0NYmd1UwcS4cRV7ywaQo/s1600/Black_Widow.jpg" /></a></div>
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-size: 12pt;"><span style="font-family: Calibri;">Black widow spiders are recognizable
by their glossy, bulbous black bodies and the red hourglass mark on the
abdomen. Their legs are long and slender. They are found all over the world, and
are everywhere in the USA. These creatures prefer dark, quiet, undisturbed areas
like woodpiles and unfinished basements—places where “food” is plentiful. They
will bite if disturbed/provoked.<o:p></o:p></span></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-size: 12pt;"><span style="font-family: Calibri;">There are multiple factors
that go into how severe a person’s reaction to a bite might be.</span></span></div>
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-size: 12pt;"><span style="font-family: Calibri;">--The evenomation (bite): how
much venom is injected.</span></span></div>
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-size: 12pt;"><span style="font-family: Calibri;">--The health and size of the
victim: children, the chronically ill, and the elderly are more susceptible.</span></span></div>
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-size: 12pt;"><span style="font-family: Calibri;">--The reaction of the
individual to the bite: some people have minimal reaction, some have much more.</span></span></div>
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-size: 12pt;"><span style="font-family: Calibri;"></span></span> </div>
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-size: 12pt;"><span style="font-family: Calibri;"><strong>Let’s take for example a
single bite in an adult male, and a general reaction.<o:p></o:p></strong></span></span></div>
<span style="font-size: 12pt;"><span style="font-family: Calibri;">The bite itself is likely to
feel like a pinprick. Within an hour, a localized reaction of pain, swelling,
and redness develops at the site of the evenomation. These symptoms can be
treated at home by washing the wound and elevating the extremity (if possible).
Ice at the site may help.<o:p></o:p></span></span><br />
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-size: 12pt;"><span style="font-family: Calibri;"><strong>More severe symptoms require
a trip to the Emergency Department:<o:p></o:p></strong></span></span></div>
<span style="font-size: 12pt;"><span style="font-family: Calibri;">Sweating, along with muscle
cramps and abdominal pain, which can be severe (patients with unrecognized
bites may seem to have appendicitis). Backache can be a problem. Sweating,
elevated heart rate and blood pressure, and chest pain can occur. Fainting is
occasionally seen.<o:p></o:p></span></span><br />
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-size: 12pt;"><span style="font-family: Calibri;"><strong>Life-threatening symptoms</strong>
include shortness of breath and seizures.<o:p></o:p></span></span></div>
<span style="font-size: 12pt;"><span style="font-family: Calibri;">Pregnant women may go into
labor.<o:p></o:p></span></span><br />
<span style="font-size: 12pt;"><span style="font-family: Calibri;"></span></span><br />
<span style="font-size: 12pt;"><span style="font-family: Calibri;"><strong>Treatment in the ED:<o:p></o:p></strong></span></span><br />
<span style="font-size: 12pt;"><span style="font-family: Calibri;">Pain control—generally with
morphine.<o:p></o:p></span></span><br />
<span style="font-size: 12pt;"><span style="font-family: Calibri;">Anxiety control—with a
valium-like drug for sedation.<o:p></o:p></span></span><br />
<span style="font-size: 12pt;"><span style="font-family: Calibri;">Antivenin—like a snake bite,
antivenin may be given for a severe reaction to a black widow bite. Because
this is a “horse serum,” (produced by making a horse produce antibodies to the
venom) there is a chance of an allergic reaction. Therefore a skin test is
recommended before administration. Giving the antivenin results in significant
improvement within a day.<o:p></o:p></span></span><br />
<span style="font-size: 12pt;"><span style="font-family: Calibri;"></span></span><br />
<span style="font-size: 12pt;"><span style="font-family: Calibri;"><strong>For death by black widow</strong>, the
best scenario would be an ill individual suffering multiple untreated bites.
How many bites and how long untreated is up to you. As there’s no good data
about multiple bites, I think you can pretty much create what you’d like. If
you intend to kill a healthy adult male, it may take lots of bites—more than
the number of spiders likely to be at the location by chance. An underlying
heart condition would work for having the bites kill your victim. That scenario
could even look like a heart attack, but the bites will be noted at autopsy.<o:p></o:p></span></span><br />
<span style="font-size: 12pt;"><span style="font-family: Calibri;"></span></span><br />
<span style="font-size: 12pt;"><span style="font-family: Calibri;">Good
luck!<o:p></o:p></span></span><br />
<span style="font-family: Calibri;"><i><span lang="EN" style="color: black; font-size: 12pt; line-height: 115%; mso-ansi-language: EN; mso-bidi-font-family: "Courier New"; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"></span></i></span><br />
<span style="font-family: Calibri;"><i><span lang="EN" style="color: black; font-size: 12pt; line-height: 115%; mso-ansi-language: EN; mso-bidi-font-family: "Courier New"; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">Questions? Comments?</span></i><span style="color: black; font-family: "Courier New"; font-size: 12pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></span><br />
<span style="font-family: Calibri;"><span lang="EN" style="color: black; font-size: 12pt; line-height: 115%; mso-ansi-language: EN; mso-bidi-font-family: "Courier New"; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">~*~</span><span style="color: black; font-family: "Courier New"; font-size: 12pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></span><br />
<span style="color: black; font-size: 12pt; mso-bidi-font-family: "Courier New"; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Calibri;">K</span></span><span style="font-family: Calibri;"><span style="color: black; font-size: 12pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";">elly has worked in the medical field for over twenty years, mainly
at large medical centers. With experience in a variety of settings, chances are
Kelly may have seen it. <br />
Sometimes truth seems stranger than fiction in medicine, but accurate medicine
in fiction is fabulous.<br />
Find Kelly’s fiction at </span><span style="color: blue; font-size: 12pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";"><a href="http://www.kellywhitley.com/"><span style="color: #0068c6; text-decoration: none; text-underline: none;">www.kellywhitley.com</span></a></span><span style="font-size: 12pt;"><o:p></o:p></span></span><br />
Unknownnoreply@blogger.com12tag:blogger.com,1999:blog-8255935895272962129.post-62992343960672334642013-05-20T12:36:00.002-07:002013-05-20T12:36:54.515-07:00Rattlesnake Attack--All About It
<span style="font-family: "Arial","sans-serif"; font-size: 10pt;"><strong>A
rattlesnake</strong> is a “pit viper,” so named because of the pits on the nose.<o:p></o:p></span><br />
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhVAjThL-pDROtgBuykIPxO2bvoB6tV32q0cIF4Bh-ArFcdY81UhyphenhyphenQlgKOJQpDIWJXtRc7eA4buINVMdCZpqDLAx0nIB8VsRmQscnqesPTy22B9VogoSL24sytYxsa4pj3faRU4zjR_3fQ/s1600/+western-diamondback-rattlesnake-crotalus-atrox.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhVAjThL-pDROtgBuykIPxO2bvoB6tV32q0cIF4Bh-ArFcdY81UhyphenhyphenQlgKOJQpDIWJXtRc7eA4buINVMdCZpqDLAx0nIB8VsRmQscnqesPTy22B9VogoSL24sytYxsa4pj3faRU4zjR_3fQ/s320/+western-diamondback-rattlesnake-crotalus-atrox.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><strong><em>Western Diamondback Rattelsnake</em></strong></td></tr>
</tbody></table>
<span style="font-family: "Arial","sans-serif"; font-size: 10pt;">These
snakes are commonly found in the Midwest and Western United States. As the
weather moves into the high seventies, rattlesnakes become active and often
seek out heated surfaces to warm themselves. These snakes may be encountered by
the unsuspecting hiker, rancher, or in some rural areas, close to the house sunning
on the driveway.<o:p></o:p></span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 10pt;">A
coiled rattlesnake will shake its tail, making the hissing rattle the snake is
known for. Because of the length and strength of the body, the snake can launch
(ie, strike) at a distance of several feet, making the strike zone larger than
might be obvious.<o:p></o:p></span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 10pt;"></span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 10pt;">About
75% of bites contain some venom. 25% are so-called “dry” bites with little or
no venom, but these are still potentially dangerous.<o:p></o:p></span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 10pt;">Bites
by vipers are painful and tender. They can become severely swollen, bleed and
blister. More systemic effects of the venom include changes in the victim’s
ability to clot.<o:p></o:p></span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 10pt;">A
bite by any snake—venomous or otherwise—should be treated by a medical
professional. Even non-venomous bites can contain teeth and/or dirt, and be at
risk for infection. <o:p></o:p></span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 10pt;">Identification
of the snake is important, but not at the risk of another individual being bit.
Rattlesnakes can continue to bite and inject venom until they deplete their
supply.<o:p></o:p></span><br />
<br />
<span style="font-family: "Arial","sans-serif"; font-size: 10pt;"><strong><u>WHAT
TO DO IN CASE OF SNAKE BITE:<o:p></o:p></u></strong></span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 10pt;">Calling
ahead to the Emergency Department helps them to prepare and obtain antivenin if
needed. <o:p></o:p></span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 10pt;">Transport
the victim to the hospital, keeping the heart above the level of the wound if
possible. Remove rings or other potentially constricting items.<o:p></o:p></span><br />
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 10pt;"><strong><u>WHAT
NOT TO DO:<o:p></o:p></u></strong></span></div>
<span style="font-family: "Arial","sans-serif"; font-size: 10pt;">Do not cut into and/or attempt to “suck out
the venom.” This includes not using older snakebite kits that contain suction
devices.<o:p></o:p></span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 10pt;">Do not use ice on the bite site.<o:p></o:p></span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 10pt;">Do not attempt to sterile/neutralize the bite
with alcohol. This increases tissue damage and increases venom absorption.<o:p></o:p></span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 10pt;">Do not apply a tourniquet. This can lead to
limb-threatening damage.<o:p></o:p></span><br />
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 10pt;">The
Emergency Department will examine the bite and make a determination if
antivenin should be given. Some locations will stock antivenin if rattlesnake
bites occur with any frequency. Some zoos or other animal exhibits that feature
rattlesnakes have the antivenin on hand.<o:p></o:p></span></div>
<span style="font-family: "Arial","sans-serif"; font-size: 10pt;">Antivenin
can cause its own set of complications, including fever, joint and muscle
aches, fatigues and swollen lymph nodes.<o:p></o:p></span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 10pt;">Antibiotics
are often given to prevent infection, but have no effect on the venom. All
snakebite victims should receive a tetanus booster if none has been given in
the last five years. <o:p></o:p></span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 10pt;">Blood
clotting abnormalities can continue for a few weeks after a bite. It’s
important to let any healthcare professional know about the history of the
bite.<o:p></o:p></span><br />
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 10pt;"><strong><u>PREVENTION:</u></strong>
Wear boots and long pants when hiking. Be aware of your surroundings. </span><o:p></o:p></div>
<br />
<div class="MsoNormal" style="line-height: 115%; margin: 0in 0in 0pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; mso-outline-level: 2;">
<span lang="EN" style="font-size: 12pt; line-height: 115%; mso-ansi-language: EN; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Calibri;"><em>Questions?
Comments?</em></span></span></div>
<div class="MsoNormal" style="line-height: 115%; margin: 0in 0in 0pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; mso-outline-level: 2;">
<span lang="EN" style="font-size: 12pt; line-height: 115%; mso-ansi-language: EN; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Calibri;">~*~<o:p></o:p></span></span></div>
<span style="color: black; font-size: 12pt; line-height: 115%; mso-bidi-font-family: "Courier New";"><span style="font-family: Calibri;">K</span></span><span style="color: black; font-size: 12pt; line-height: 115%; mso-bidi-font-family: Arial;"><span style="font-family: Calibri;">elly has worked in the medical field for over
twenty years, mainly at large medical centers. With experience in a variety of
settings, chances are Kelly may have seen it. <br />Sometimes truth seems stranger
than fiction in medicine, but accurate medicine in fiction is fabulous.<br />Find
Kelly’s fiction at </span><span style="color: blue; font-family: Calibri;"><a href="http://www.kellywhitley.com/"><span style="color: #0068c6;">www.kellywhitley.com</span></a></span></span>Unknownnoreply@blogger.com14tag:blogger.com,1999:blog-8255935895272962129.post-44424483924201792232013-04-12T10:33:00.004-07:002014-01-08T18:30:24.032-08:00Hypothermia--Slowly Freezing to Death<span lang="EN" style="font-size: 12pt; line-height: 115%; mso-ansi-language: EN; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Calibri;">A normal internal (core) body temperature is 98.6
F (37 C). </span></span><span lang="EN" style="font-size: 12pt; line-height: 115%; mso-ansi-language: EN; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Calibri;">Hypothermia occurs when the body is subjected to
a cold environment for a long enough period of time that the internal body
temperature drops to less than 95 F (35 C). Hypothermia can also occur when the
body’s temperature regulation system is deranged.<o:p></o:p></span></span><br />
<br />
<div class="MsoNormal" style="line-height: 115%; margin: 0in 0in 0pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; mso-outline-level: 2;">
<span lang="EN" style="font-size: 12pt; line-height: 115%; mso-ansi-language: EN; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Calibri;">Inside the brain, the hypothalamus (a primitive part
of the brain) is responsible for temperature control. Normal metabolic
processes generate the body’s heat. When too much heat is lost through the skin
(or in the case of fever) shivering produces heat through muscle action.<o:p></o:p></span></span></div>
<br />
<div class="MsoNormal" style="line-height: 115%; margin: 0in 0in 0pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; mso-outline-level: 2;">
<span lang="EN" style="font-size: 12pt; line-height: 115%; mso-ansi-language: EN; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Calibri;">Continued heat loss results in shunting of blood
away from the skin internally, to support the internal organs—especially heart
and brain. As the body’s core temperature drops, metabolic processes slow, and
the heart rate, respiratory rate, and brain waves all slow down. As the internal
temperature continues to drop, death will ensue.<o:p></o:p></span></span></div>
<br />
<div class="MsoNormal" style="line-height: 115%; margin: 0in 0in 0pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; mso-outline-level: 2;">
<span lang="EN" style="font-size: 12pt; line-height: 115%; mso-ansi-language: EN; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Calibri;">Environmental exposure accounts for the vast
majority of hypothermia. Individuals with alcohol on board are more susceptible
as alcohol dilates the skin vessels and accelerates heat loss; drinking brandy
to “stay warm” while scooping snow is a bad idea! </span></span><span lang="EN" style="font-size: 12pt; line-height: 115%; mso-ansi-language: EN; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Calibri;">Low thyroid, advanced age, drug abuse, and some
medications (vasodilator drugs) increase the likelihood of
environmentally-induced hypothermia. Psychiatric conditions like dementia—that might
cause an individual to wander away without a defined destination—are a risk
factor.<o:p></o:p></span></span></div>
<br />
<div class="MsoNormal" style="line-height: 115%; margin: 0in 0in 0pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; mso-outline-level: 2;">
<span lang="EN" style="font-size: 12pt; line-height: 115%; mso-ansi-language: EN; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Calibri;">Brain conditions that affect thermoregulation
ability can put someone at risk.<o:p></o:p></span></span></div>
<br />
<div class="MsoNormal" style="line-height: 115%; margin: 0in 0in 0pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; mso-outline-level: 2;">
<span lang="EN" style="font-size: 12pt; line-height: 115%; mso-ansi-language: EN; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Calibri;">The gradual onset of hypothermia makes it harder
for someone to know what’s happening. Onset may lead to a phenomenon known as
paradoxical undressing, where the person sheds clothing even though they’re
freezing to death. Drowsiness, followed by drifting into sleep and death
follows.<o:p></o:p></span></span></div>
<br />
<div class="MsoNormal" style="line-height: 115%; margin: 0in 0in 0pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; mso-outline-level: 2;">
<span lang="EN" style="font-size: 12pt; line-height: 115%; mso-ansi-language: EN; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Calibri;">Treatment involves getting the person to a warm
environment, out of wet clothes (if applicable) and rewarming. External warmth—hot
water bottles, warming blanket, even body-to-body contact—is applied. In a
medical setting, warm IV fluids, warmed air, and heated blankets can be used.
Warm fluid can be infused into the abdominal cavity.<o:p></o:p></span></span></div>
<br />
<div class="MsoNormal" style="line-height: 115%; margin: 0in 0in 0pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; mso-outline-level: 2;">
<span lang="EN" style="font-size: 12pt; line-height: 115%; mso-ansi-language: EN; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Calibri;">In worst-case scenarios, the patient can be
rewarmed using heart-lung bypass, warming the blood as it goes through the
machine. <o:p></o:p></span></span></div>
<br />
<div class="MsoNormal" style="line-height: 115%; margin: 0in 0in 0pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; mso-outline-level: 2;">
<span lang="EN" style="font-size: 12pt; line-height: 115%; mso-ansi-language: EN; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Calibri;">Caution for heart rhythm disturbances involves
avoiding moving the patient more than necessary. As people with profound
hypothermia have been successfully resuscitated, most doctors consider a
hypothermic patient to be potentially salvageable until they are warm. <o:p></o:p></span></span></div>
<br />
<div class="MsoNormal" style="line-height: 115%; margin: 0in 0in 0pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; mso-outline-level: 2;">
<span lang="EN" style="font-size: 12pt; line-height: 115%; mso-ansi-language: EN; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Calibri;">The biggest consideration is to avoid situations
that may lead to hypothermia, primarily avoiding prolonged exposure to cold
weather.</span></span></div>
<div class="MsoNormal" style="line-height: 115%; margin: 0in 0in 0pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; mso-outline-level: 2;">
<span lang="EN" style="font-size: 12pt; line-height: 115%; mso-ansi-language: EN; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Calibri;"></span></span> </div>
<div class="MsoNormal" style="line-height: 115%; margin: 0in 0in 0pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; mso-outline-level: 2;">
<span lang="EN" style="font-size: 12pt; line-height: 115%; mso-ansi-language: EN; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Calibri;">Questions? Comments?</span></span></div>
<div class="MsoNormal" style="line-height: 115%; margin: 0in 0in 0pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; mso-outline-level: 2;">
<span lang="EN" style="font-size: 12pt; line-height: 115%; mso-ansi-language: EN; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Calibri;">~*~<o:p></o:p></span></span></div>
<br />
<div class="MsoNormal" style="line-height: 115%; margin: 0in 0in 0pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; mso-outline-level: 2;">
<span style="color: black; font-size: 12pt; line-height: 115%; mso-bidi-font-family: "Courier New";"><span style="font-family: Calibri;">K</span></span><span style="color: black; font-size: 12pt; line-height: 115%; mso-bidi-font-family: Arial;"><span style="font-family: Calibri;">elly
has worked in the medical field for over twenty years, mainly at large medical
centers. With experience in a variety of settings, chances are Kelly may have
seen it. <br />
Sometimes truth seems stranger than fiction in medicine, but accurate medicine
in fiction is fabulous.<br />
Find Kelly’s fiction at </span><span style="color: blue; font-family: Calibri;"><a href="http://www.kellywhitley.com/">www.kellywhitley.com</a></span></span></div>
Unknownnoreply@blogger.com12tag:blogger.com,1999:blog-8255935895272962129.post-2811538876326170402013-04-08T18:57:00.000-07:002013-09-11T10:58:54.938-07:00Frostbite and the Frozen Character<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-size: 12pt; mso-bidi-font-family: Arial;"><span style="font-family: Calibri;"><em>In honor of April blizzards, here's a bit about what would happen if your character got stranded and had to walk a distance through snow.</em></span></span></b></div>
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-size: 12pt; mso-bidi-font-family: Arial;"><span style="font-family: Calibri;"></span></span></b> </div>
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-size: 12pt; mso-bidi-font-family: Arial;"><span style="font-family: Calibri;">Mechanism of Frostbite<o:p></o:p></span></span></b></div>
<span style="font-size: 12pt; mso-bidi-font-family: Arial;"><span style="font-family: Calibri;"></span></span><br />
<span style="font-size: 12pt; mso-bidi-font-family: Arial;"><span style="font-family: Calibri;">A
normal body temperature is 98.6 F or 37 C. Frostbite occurs when body tissue is
exposed to temperatures below the freezing point of water (32 F or 0 C). <o:p></o:p></span></span><br />
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-size: 12pt; mso-bidi-font-family: Arial;"><span style="font-family: Calibri;">The
majority of cases of hypothermia occur due to exposure outdoors. Alcohol
worsens the problem, as does malnutrition, dehydration, and physical
exhaustion.<o:p></o:p></span></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-size: 12pt; mso-bidi-font-family: Arial;"><span style="font-family: Calibri;">The
areas farthest from the heart are most susceptible: fingers, toes, nose, ears,
and the face in general. <span style="mso-spacerun: yes;"> </span><o:p></o:p></span></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-size: 12pt; mso-bidi-font-family: Arial;"><span style="font-family: Calibri;">With
cold exposure, blood vessels constrict in the extremities (arms and legs) to
centralize blood flow to the vital organs and maintain core temperature. These
remote areas get progressively colder. Brief dilatation of extremity vessels
alternates with constriction. As the body temperature begins to drop, the
vessels remain constricted. This is the point at which frostbite begins.<o:p></o:p></span></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-size: 12pt; mso-bidi-font-family: Arial;"><span style="font-family: Calibri;">The
damage from cold is of two types: ice crystals form between cells, leading to cellular
dehydration, and blood vessel damage leading to lack of oxygen to cells.<o:p></o:p></span></span></div>
<br />
<h3 style="margin: 1em 0in;">
<span class="mw-headline"><span lang="EN" style="font-family: "Calibri","sans-serif"; font-size: 12pt; mso-ansi-language: EN; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Degrees of frostbite</span></span></h3>
<h3 style="margin: 1em 0in;">
<span class="mw-headline"><span lang="EN" style="font-family: "Calibri","sans-serif"; font-size: 12pt; mso-ansi-language: EN; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">First degree: </span></span><span class="mw-headline"><span lang="EN" style="font-family: "Calibri","sans-serif"; font-size: 12pt; font-weight: normal; mso-ansi-language: EN; mso-ascii-theme-font: minor-latin; mso-bidi-font-weight: bold; mso-hansi-theme-font: minor-latin;">Freezing of the top layer of
the skin, but still gives to pressure. Numbness, itching, and some pain. No
permanent damage.</span></span></h3>
<h3 style="margin: 1em 0in;">
<span class="mw-headline"><span lang="EN" style="font-family: "Calibri","sans-serif"; font-size: 12pt; mso-ansi-language: EN; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Second degree</span><span style="font-size: medium;">: </span></span><span class="mw-headline"><span lang="EN" style="font-family: "Calibri","sans-serif"; font-size: 12pt; font-weight: normal; mso-ansi-language: EN; mso-ascii-theme-font: minor-latin; mso-bidi-font-weight: bold; mso-hansi-theme-font: minor-latin;">The skin hardens as it
freezes. Blisters form. Usually heals, but may have some insensitivity to
temperature long term.</span></span></h3>
<h3 style="margin: 1em 0in;">
<span class="mw-headline"><span lang="EN" style="font-family: "Calibri","sans-serif"; font-size: 12pt; mso-ansi-language: EN; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Third degree: </span></span><span class="mw-headline"><span lang="EN" style="font-family: "Calibri","sans-serif"; font-size: 12pt; font-weight: normal; mso-ansi-language: EN; mso-ascii-theme-font: minor-latin; mso-bidi-font-weight: bold; mso-hansi-theme-font: minor-latin;">Freezing into the deeper
layers—the skin, muscles, nerves and vessels are affected. Blisters form, which
are blood-filled. Permanent damage leading to the need for amputation can
occur. The situation is a complicated mix of clotting in small blood vessels,
inflammation, and tissue damage.</span></span></h3>
<h3 style="margin: 1em 0in;">
<span class="mw-headline"><span lang="EN" style="font-family: "Calibri","sans-serif"; font-size: 12pt; mso-ansi-language: EN; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Fourth degree: </span></span><span class="mw-headline"><span lang="EN" style="font-family: "Calibri","sans-serif"; font-size: 12pt; font-weight: normal; mso-ansi-language: EN; mso-ascii-theme-font: minor-latin; mso-bidi-font-weight: bold; mso-hansi-theme-font: minor-latin;">Irreversible cell death. The
tissue is dead, and must be removed.</span></span></h3>
<h3 style="margin: 1em 0in;">
<span class="mw-headline"><span lang="EN" style="font-family: "Calibri","sans-serif"; font-size: 12pt; font-weight: normal; mso-ansi-language: EN; mso-ascii-theme-font: minor-latin; mso-bidi-font-weight: bold; mso-hansi-theme-font: minor-latin;">It’s
common for the complete extent of the damage to take several months to become
clear, and therefore the need for medical treatment extends beyond the initial
care.</span></span></h3>
<h3 style="margin: 1em 0in;">
<span class="mw-headline"><span lang="EN" style="font-family: "Calibri","sans-serif"; font-size: 12pt; mso-ansi-language: EN; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Treatment</span></span></h3>
<h3 style="margin: 1em 0in;">
<span class="mw-headline"><span lang="EN" style="font-family: "Calibri","sans-serif"; font-size: 12pt; font-weight: normal; mso-ansi-language: EN; mso-ascii-theme-font: minor-latin; mso-bidi-font-weight: bold; mso-hansi-theme-font: minor-latin;">The
first assessment involves evaluation for hypothermia—pulse, respiratory rate,
and blood pressure. Level of consciousness is next, and then the initial
evaluation of the frostbitten areas, based on the degree of frostbite.</span></span></h3>
<h3 style="margin: 1em 0in;">
<span class="mw-headline"><u><span lang="EN" style="font-family: "Calibri","sans-serif"; font-size: 12pt; mso-ansi-language: EN; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Treatment of hypothermia always takes
priority. Save the person first, the extremities next.</span></u></span></h3>
<h3 style="margin: 1em 0in;">
<span class="mw-headline"><span lang="EN" style="font-family: "Calibri","sans-serif"; font-size: 12pt; font-weight: normal; mso-ansi-language: EN; mso-ascii-theme-font: minor-latin; mso-bidi-font-weight: bold; mso-hansi-theme-font: minor-latin;">Next
is rewarming of the frostbitten areas, which can be quite uncomfortable (read:
painful!) and require pain meds. IV fluids are commonly given as part of this
process. Several methods can be used:<o:p></o:p></span></span></h3>
<span class="mw-headline"><span lang="EN" style="font-family: "Calibri","sans-serif"; font-size: 12pt; font-weight: normal; mso-ansi-language: EN; mso-ascii-theme-font: minor-latin; mso-bidi-font-weight: bold; mso-hansi-theme-font: minor-latin;">Warm
water bath—most suitable for first and second degree frostbite. Remove clear
blisters. In third degree frostbite, blood blisters are left undisturbed. Pink
skin, return of feeling and motion are good signs. Observe for evidence of
infection. Some practitioners give a tetanus booster.<o:p></o:p></span></span><br />
<br />
<span class="mw-headline"><span lang="EN" style="font-family: "Calibri","sans-serif"; font-size: 12pt; font-weight: normal; mso-ansi-language: EN; mso-ascii-theme-font: minor-latin; mso-bidi-font-weight: bold; mso-hansi-theme-font: minor-latin;">External
warming with heated blankets—suitable for any degree of frostbite.<o:p></o:p></span></span><br />
<span class="mw-headline"><span lang="EN" style="font-family: "Calibri","sans-serif"; font-size: 12pt; font-weight: normal; mso-ansi-language: EN; mso-ascii-theme-font: minor-latin; mso-bidi-font-weight: bold; mso-hansi-theme-font: minor-latin;">Internal
warming with warm fluids infused into the abdominal cavity—may be utilized in
cases where hypothermia complicates the situation.<o:p></o:p></span></span><br />
<span class="mw-headline"><span lang="EN" style="font-family: "Calibri","sans-serif"; font-size: 12pt; font-weight: normal; mso-ansi-language: EN; mso-ascii-theme-font: minor-latin; mso-bidi-font-weight: bold; mso-hansi-theme-font: minor-latin;">In
critical cases where hypothermia is life-threatening, the most aggressive
rewarming is done with a heart-lung bypass machine.<o:p></o:p></span></span><br />
<span class="mw-headline"><span lang="EN" style="font-family: "Calibri","sans-serif"; font-size: 12pt; font-weight: normal; mso-ansi-language: EN; mso-ascii-theme-font: minor-latin; mso-bidi-font-weight: bold; mso-hansi-theme-font: minor-latin;">As
with most injuries of this type, prevention is key.<o:p></o:p></span></span><br />
<span class="mw-headline"><span lang="EN" style="font-family: "Calibri","sans-serif"; font-size: 12pt; font-weight: normal; mso-ansi-language: EN; mso-ascii-theme-font: minor-latin; mso-bidi-font-weight: bold; mso-hansi-theme-font: minor-latin;">Questions?
Comments?</span></span><br />
<span class="mw-headline"><span lang="EN" style="font-family: "Calibri","sans-serif"; font-size: 12pt; font-weight: normal; mso-ansi-language: EN; mso-ascii-theme-font: minor-latin; mso-bidi-font-weight: bold; mso-hansi-theme-font: minor-latin;"><o:p></o:p></span></span><br />
<span class="mw-headline"><span lang="EN" style="font-family: "Calibri","sans-serif"; font-size: 12pt; font-weight: normal; mso-ansi-language: EN; mso-ascii-theme-font: minor-latin; mso-bidi-font-weight: bold; mso-hansi-theme-font: minor-latin;">~*~</span></span><br />
<h3 style="margin: 1em 0in;">
<span class="mw-headline"><span lang="EN" style="font-family: "Calibri","sans-serif"; font-size: 12pt; font-weight: normal; mso-ansi-language: EN; mso-ascii-theme-font: minor-latin; mso-bidi-font-weight: bold; mso-hansi-theme-font: minor-latin;"></span></span><span style="color: black; font-family: "Calibri","sans-serif"; font-size: 12pt; font-weight: normal; mso-ascii-theme-font: minor-latin; mso-bidi-font-weight: bold; mso-hansi-theme-font: minor-latin;">K</span><span style="color: black; font-family: "Calibri","sans-serif"; font-size: 12pt; font-weight: normal; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-bidi-font-weight: bold; mso-hansi-theme-font: minor-latin;">elly has worked in the medical
field for over twenty years, mainly at large medical centers. With experience
in a variety of settings, chances are Kelly may have seen it. <br />
<br />
Sometimes truth seems stranger than fiction in medicine, but accurate medicine
in fiction is fabulous.<br />
Find Kelly’s fiction at <a href="http://www.kellywhitley.com/"><span style="color: blue;">www.kellywhitley.com</span></a>.<o:p></o:p></span><span class="mw-headline"><span lang="EN" style="font-family: "Calibri","sans-serif"; font-size: 12pt; font-weight: normal; mso-ansi-language: EN; mso-ascii-theme-font: minor-latin; mso-bidi-font-weight: bold; mso-hansi-theme-font: minor-latin;"><o:p></o:p></span></span></h3>
<br />
<h3 style="margin: 1em 0in;">
<span class="mw-headline"><span lang="EN" style="font-family: "Calibri","sans-serif"; font-size: 12pt; font-weight: normal; mso-ansi-language: EN; mso-ascii-theme-font: minor-latin; mso-bidi-font-weight: bold; mso-hansi-theme-font: minor-latin;"><o:p> </o:p></span></span></h3>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-size: 12pt;"><o:p><span style="font-family: Calibri;"> </span></o:p></span></div>
Unknownnoreply@blogger.com11tag:blogger.com,1999:blog-8255935895272962129.post-84692217781665849602013-03-19T17:43:00.003-07:002013-03-19T17:43:54.554-07:00Killing a Patient Using an Air Embolism
<span style="font-size: 12pt; mso-bidi-font-family: Arial;"><span style="font-family: Calibri;"><strong>My
villain approaches a patient in the hospital and injects a syringeful of air,
killing the patient. How would this be done, and how much air would it take?<o:p></o:p></strong></span></span><br />
<span style="font-size: 12pt; mso-bidi-font-family: Arial;"><span style="font-family: Calibri;"></span></span><br />
<span style="font-size: 12pt; mso-bidi-font-family: Arial;"><span style="font-family: Calibri;">An
air embolism is a quantity of air traveling as a single mass within the
vascular system.<o:p></o:p></span></span><br />
<span style="font-size: 12pt; mso-bidi-font-family: Arial;"><span style="font-family: Calibri;">There
are several factors at work when writing your scenario.<o:p></o:p></span></span><br />
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-size: 12pt; mso-bidi-font-family: Arial;"><span style="font-family: Calibri;">The
first is whether it’s a venous air embolism, an arterial air embolism, or a
paradoxical air embolism:</span></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-family: Calibri;"><b style="mso-bidi-font-weight: normal;"><u><span style="font-size: 12pt; mso-bidi-font-family: Arial;">Venous air embolism</span></u></b><span style="font-size: 12pt; mso-bidi-font-family: Arial;">: An IV (intravenous) line
in a peripheral vein—like an arm vein—is unlikely to accommodate enough air in
a rapid enough fashion to cause much trouble. Air bubbles that go in through
such an IV are filtered out by the lungs, and generally cause no problems.<o:p></o:p></span></span></div>
<span style="font-size: 12pt; mso-bidi-font-family: Arial;"><span style="font-family: Calibri;"></span></span><br />
<span style="font-size: 12pt; mso-bidi-font-family: Arial;"><span style="font-family: Calibri;">You’d
need a very large syringe—fifty cc’s—and need to blow in several boluses of air
in quick succession. The air takes up space in the right side of the heart, and
restricts blood flow to the lungs.<o:p></o:p></span></span><br />
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-size: 12pt; mso-bidi-font-family: Arial;"><span style="font-family: Calibri;">If
the patient has a large IV line in the internal jugular vein (called a central
venous line), it’d be fairly easy to blow in a lot of air quickly and within a
few centimeters of the heart. This is your best bet for this scenario. Patients
with central lines aren’t necessarily confined to ICU. Temporary dialysis
catheters are placed in the internal jugular, for instance.<o:p></o:p></span></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-family: Calibri;"><b style="mso-bidi-font-weight: normal;"><u><span style="font-size: 12pt; mso-bidi-font-family: Arial;">Arterial air embolism</span></u></b><span style="font-size: 12pt; mso-bidi-font-family: Arial;">: Access to an artery would
be necessary. An artery is under pressure, and the air injected will meet more
resistance than on the venous side. A few cc’s of air in the carotid artery can
cause a stroke. The drawback is as soon as the killer pulls the needle out of
the carotid artery, it’ll bleed profusely as the blood is under pressure. The
killer’s method would be obvious right away if he left the bedside. Air to the
brain isn’t uniformly fatal.<o:p></o:p></span></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-family: Calibri;"><b style="mso-bidi-font-weight: normal;"><u><span style="font-size: 12pt; mso-bidi-font-family: Arial;">Paradoxical embolism</span></u></b><span style="font-size: 12pt; mso-bidi-font-family: Arial;">: Air injected into the right
sided venous circulation travels to the arterial left side of the heart without
going through the lungs. This occurs via a hole between the right (venous) and
left (arterial) sides of the heart, usually between the top two chambers (the
atria), but can be between the bottom two chambers (the ventricles). <o:p></o:p></span></span></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgGzS9ocY2zLsKB7ByBXEu9jAXdNsrm-3uothMumMHKHrRJOaJnXwQDJ_PW7uiY9aLRL9qMoGlD_qxfO1bC-7sl-D1yBpWnyNh8dS-4CwbYRMknskuek_blqzljwnfsVTj2SJ4ALwKFC8Q/s1600/ASD.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="203" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgGzS9ocY2zLsKB7ByBXEu9jAXdNsrm-3uothMumMHKHrRJOaJnXwQDJ_PW7uiY9aLRL9qMoGlD_qxfO1bC-7sl-D1yBpWnyNh8dS-4CwbYRMknskuek_blqzljwnfsVTj2SJ4ALwKFC8Q/s320/ASD.jpg" width="320" /></a></div>
<span style="font-size: 12pt; mso-bidi-font-family: Arial;"><span style="font-family: Calibri;">For
a paradoxical embolism to work, the killer would need knowledge beforehand that
the patient had such a hole, or he’d have to be very lucky to have selected a
victim with an undiagnosed defect. <o:p></o:p></span></span><br />
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-size: 12pt; mso-bidi-font-family: Arial;"><span style="font-family: Calibri;">Since
the arteries that supply blood to the heart originate where the arterial blood
leaves the heart, air can travel down these coronary arteries and cause a heart
attack and/or cardiac arrest. <o:p></o:p></span></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-size: 12pt; mso-bidi-font-family: Arial;"><span style="font-family: Calibri;">The
air can travel straight up into the carotid arteries (that supply the blood to
the brain) and cause a stroke.<o:p></o:p></span></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-size: 12pt; mso-bidi-font-family: Arial;"><span style="font-family: Calibri;">Hope
this helps!<o:p></o:p></span></span></div>
<span style="font-size: 12pt; mso-bidi-font-family: Arial;"><span style="font-family: Calibri;">Cheers,
Kelly<o:p></o:p></span></span><br />
<br />
Diagram: Dr. R. Singer, heartlungdoc.com<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-size: 12pt; mso-bidi-font-family: Arial;"><span style="font-family: Calibri;">~*~<o:p></o:p></span></span></div>
<span style="color: black; font-size: 12pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Calibri;"><span style="font-family: Times New Roman;">K</span>elly has worked in the medical field
for over twenty years, mainly at large medical centers. With experience in a
variety of settings, chances are Kelly may have seen it. <br />
<br />
Sometimes truth seems stranger than fiction in medicine, but accurate medicine
in fiction is fabulous.<br />
Find Kelly’s fiction at </span><a href="http://www.kellywhitley.com/"><span style="color: blue; text-decoration: none; text-underline: none;"><span style="font-family: Calibri;">www.kellywhitley.com</span></span></a><span style="font-family: Calibri;">.<o:p></o:p></span></span><br />
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-size: 12pt; mso-bidi-font-family: Arial;"><o:p><span style="font-family: Calibri;"> </span></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-size: 12pt; mso-bidi-font-family: Arial;"><o:p><span style="font-family: Calibri;"> </span></o:p></span></div>
Unknownnoreply@blogger.com6tag:blogger.com,1999:blog-8255935895272962129.post-56676904797687073502013-03-09T16:33:00.000-08:002013-03-09T16:33:00.463-08:00Writing A Child With Fragile Bones
<strong><span style="font-family: Arial, Helvetica, sans-serif;">I have a character who is a young child with a broken bone.
When the parents take her to the ER, they’re accused of child abuse, but they’re
not abusive. They claim the kid’s leg broke as they changed her diaper. What
kind of disease might a kid have that would lead to easy fracture without
abuse?<o:p></o:p></span></strong><br />
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-family: Arial, Helvetica, sans-serif;">I'd suggest Osteogenesis Imperfecta, or brittle bone disease.<o:p></o:p></span></div>
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">This genetic disorder affects boys and girls equally; it is
generally inherited as a dominant trait (at least one parent has the disease)
although a few are the result of both parents having a recessive gene (they don’t
exhibit the characteristics of the disease). Regardless of the origin, the
disease is caused by abnormal collagen.<o:p></o:p></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-family: Arial, Helvetica, sans-serif;">Bones are initially formed of collagen. Crystals of calcium
hydroxyapatite are deposited on the collagen framework, giving the bones strength. An
abnormal framework leads to “imperfect” deposition of calcium, and the bones
are weak. Although this is an inherited disease, about one third of patients
have no family history of the disease, and represent new genetic mutations.<o:p></o:p></span></div>
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-family: Arial, Helvetica, sans-serif;">There are several different types of Osteogenesis Imperfecta. The first three are the most common and would be the options for your scenario.</span></div>
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-family: Arial, Helvetica, sans-serif;"><b style="mso-bidi-font-weight: normal;">**In Type I</b>, the
collagen is normal but isn’t produced in enough quantity. Bones break easily.
The patient may have increased joint flexibility, ie, “double-jointed.” The
whites of the eyes may be bluish gray in color due to thin collagen. The teeth
may or may not be abnormal. Hearing loss is common.<o:p></o:p></span></div>
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-family: Arial, Helvetica, sans-serif;"><b style="mso-bidi-font-weight: normal;">**Type II </b>victims
have very abnormal collagen and usually die within the first year of life.
Death is due to respiratory failure (due to chest wall deformity) or bleeding
inside the head.<o:p></o:p></span></div>
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-family: Arial, Helvetica, sans-serif;"><b style="mso-bidi-font-weight: normal;">**In Type III</b>,
the collagen is insufficient in quantity and abnormal. Fractures before birth
can be detected, and the bones fracture easily with minimal stress. The
affected kids are often short, with wide ribcages and the abnormal blue-gray
color of the whites of the eyes. Frequent hearing loss.<o:p></o:p></span></div>
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-family: Arial, Helvetica, sans-serif;">Type III would be the most likely type to fit your scenario.</span></div>
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-family: Arial, Helvetica, sans-serif;">For more information, I suggest the Osteogenesis Imperfecta Foundation: </span><a href="http://www.oif.org/site/PageServer/"><span style="font-family: Arial, Helvetica, sans-serif;">http://www.oif.org/site/PageServer/</span></a></div>
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Hope this helps.<o:p></o:p></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">
Cheers, Kelly</span><br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-family: Arial, Helvetica, sans-serif;">~*~</span></div>
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="color: black; font-family: "Courier New";"><span style="font-family: Arial, Helvetica, sans-serif;">Kelly
has worked in the medical field for over twenty years, mainly at large medical
centers. With experience in a variety of settings, chances are Kelly may have
seen it. <br />
<br />
Sometimes truth seems stranger than fiction in medicine, but accurate medicine
in fiction is fabulous.<br />
Find her fiction at </span><a href="http://www.kellywhitley.com/"><span style="color: blue; font-family: Arial, Helvetica, sans-serif;">www.kellywhitley.com</span></a><span style="font-family: Arial, Helvetica, sans-serif;">.</span></span><o:p></o:p></div>
<span style="font-family: Arial, Helvetica, sans-serif;">
<o:p></o:p>
</span><br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<o:p><span style="font-family: Arial, Helvetica, sans-serif;"> </span></o:p></div>
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<o:p><span style="font-family: Arial, Helvetica, sans-serif;"> </span></o:p></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<o:p><span style="font-family: Calibri;"> </span></o:p></div>
Unknownnoreply@blogger.com3tag:blogger.com,1999:blog-8255935895272962129.post-49282269820482367202013-02-28T13:43:00.001-08:002013-02-28T13:43:15.376-08:00Vital Signs During a Cardiac Arrest Scene
<br />
<div class="comment-content1" style="background: rgb(191, 191, 191); margin: 0in 0in 6pt; mso-background-themecolor: background1; mso-background-themeshade: 191;">
<span style="color: black; font-family: "Courier New";"></span><blockquote class="tr_bq">
I am writing a scene in which a patient goes into cardiac arrest
and eventually flatlines. Can you provide a blow by blow of the vitals? What is
a bad BP level and how does that progress from caridac arrest to flatline. For
example, it might start BP at 110 over 50 and then go above 180. How might a
doctor or a member of the crash team say them (e.g., "BP is 180 over 50.
Heart rate is 92 and climbing.") Are there other vital signs to look out for?</blockquote>
<o:p></o:p><br />
<span style="font-family: "Courier New", Courier, monospace;">Hello, Paco.<o:p></o:p></span><br />
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<span style="font-family: "Courier New", Courier, monospace;">It’s A, B, C, D. Airway, Breathing, Circulation,
Defibrillation.<o:p></o:p></span></div>
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<span style="font-family: "Courier New", Courier, monospace;">In a cardiac arrest, the vitals we’re interested
in are: respirations—is the patient breathing or not? Pulse—is there one, and
what is the heart rate if there is? Blood pressure—which is only present when
there’s a pulse. If your patient has no pulse, no need to check a blood
pressure—you can’t get one!<o:p></o:p></span></div>
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<span style="font-family: "Courier New", Courier, monospace;">During the cardiac arrest, the rhythm will be
asystole (“flatline”—no heart beats) ventricular fibrillation (a jerky
irregular rhythm) or ventricular tachycardia (a very fast rhythm that generally
produces no effective blood pumping action). <o:p></o:p></span></div>
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<span style="font-family: "Courier New", Courier, monospace;">As the code blue starts, the person in charge of
the resuscitation will keep their fingers on the pulse—often at the groin.
Someone will be doing CPR. If the patient doesn’t have a breathing tube down,
someone should be holding a mask over the patient’s face and be pushing air in
with a bag—(“bagging the patient”)<o:p></o:p></span></div>
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<span style="font-family: "Courier New", Courier, monospace;">For any of the above rhythms, the defibrillator
will be tried first, at a charge of 300 joules, to shock the heart into rhythm.
<o:p></o:p></span></div>
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<span style="font-family: "Courier New", Courier, monospace;">So, you’d have: <o:p></o:p></span></div>
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<span style="font-family: "Courier New", Courier, monospace;">“No pulse. Start CPR.” (someone starts CPR)<o:p></o:p></span></div>
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<span style="font-family: "Courier New", Courier, monospace;">“Charge to three hundred Joules.” (High-pitched
whine as defibrillator charges, beeps when charged)<o:p></o:p></span></div>
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<span style="font-family: "Courier New", Courier, monospace;">“Everybody clear.” (everyone steps away from the
patient and the bed. The person in charge of the code gets the paddles and places
one in the center of the patient’s chest, one on the left). “Clear.” (the shock
is delivered). “Rhythm is bradycardia at thirty.” (slow pulse, 30 beats a
minutes)<o:p></o:p></span></div>
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<span style="font-family: "Courier New", Courier, monospace;">Check to see if there’s a pulse. If yes, try to
get a blood pressure. It can be low. For simplicity, consider 90/50. Turn up
the IV fluids to expand blood volume. If patient is breathing on his own,
transfer to ICU if patient not in ICU. A normal pulse is 60-100. A normal BP is
120/70. Too low is 80’s on the top number.<o:p></o:p></span></div>
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<span style="font-family: "Courier New", Courier, monospace;">If the shock isn’t successful:<o:p></o:p></span></div>
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<span style="font-family: "Courier New", Courier, monospace;">“Resume CPR.” <o:p></o:p></span></div>
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<span style="font-family: "Courier New", Courier, monospace;">Epinephrine will be given IV:<o:p></o:p></span></div>
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<span style="font-family: "Courier New", Courier, monospace;">“Give an amp of epi!” (CPR continues while this
is happening; wait a few seconds for drug to kick in)<o:p></o:p></span></div>
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<span style="font-family: "Courier New", Courier, monospace;">“Charge to three sixty.” (360 joules)<o:p></o:p></span></div>
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<span style="font-family: "Courier New", Courier, monospace;">If successful, as above. If not, continue CPR,
bagging, and give an amp of bicarb (helps correct pH), an amp of atropine
(speeds up heart) and another amp of epi. Another shock.<o:p></o:p></span></div>
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<span style="font-family: "Courier New", Courier, monospace;">At some point, the person in charge of the code
is going to “call the code,” meaning stop due to no success and little
likelihood of succeeding with continued effort.<o:p></o:p></span></div>
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<o:p><span style="font-family: "Courier New", Courier, monospace;">~*~ </span></o:p></div>
<span style="font-family: "Courier New", Courier, monospace;">
</span><span style="color: black; font-family: "Courier New";"><span style="font-family: "Courier New", Courier, monospace;">Kelly has worked in the medical field for over twenty years,
mainly at large medical centers. With experience in a variety of settings,
chances are Kelly may have seen it. <br />
<br />
Sometimes truth seems stranger than fiction in medicine, but accurate medicine
in fiction is fabulous.<br />
Find her fiction at </span><a href="http://www.kellywhitley.com/"><span style="color: #0068c6; font-family: "Courier New", Courier, monospace;">www.kellywhitley.com</span></a><span style="font-family: "Courier New", Courier, monospace;">.</span></span><o:p></o:p><br />
</div>
Unknownnoreply@blogger.com1tag:blogger.com,1999:blog-8255935895272962129.post-62996878317388335952013-02-23T18:23:00.001-08:002013-02-23T18:23:20.742-08:00Guarding a Surgeon in the Hospital
<span style="font-family: Calibri;"><span style="background-color: #cccccc;"><strong><span style="font-size: 12pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">My
heroine is a surgeon. Someone has made several attempts on her life. The
hospital has insisted she have a bodyguard. Here are my questions: 1) Would he
be allowed to carry a weapon?</span><span style="font-size: 14pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-size: 12pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">2)</span><span style="font-size: 14pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"> </span></strong><span style="font-size: 12pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><strong>Would the bodyguard be allowed to be in the OR with her, or would
he be stationed outside the OR doors?</strong> </span><span style="font-size: 14pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></span></span><br />
<span style="background-color: #cccccc;">
</span><br />
<span style="background-color: #cccccc; font-family: Calibri;"><span style="font-size: 12pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Most
hospitals don’t allow “carrying” unless the person is a law enforcement officer
(LEO) there on law enforcement business. Hospital security guards don’t carry
guns. When a prisoner has to be hospitalized, the LEO guarding him/her would
have their service weapon with them.<br />
</span></span><br />
<span style="font-family: Calibri;"><span style="background-color: #cccccc;"><span style="font-size: 12pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">These days, with HIPAA, the patient/family would likely have to give permission
unless the bodyguard works for the hospital as an employee. When someone is
admitted to the hospital, they sign a blanket paper that allows hospital personnel
to treat them—like nurses and X-ray techs. Still, he’s not going to be involved
in patient care, so he’s treated more like an administrator—someone who may be
in on patient-related conversations and must keep them confidential. </span></span></span><span style="font-size: 12pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Calibri;"><span style="background-color: #cccccc;">It’s
a potential liability for the hospital to have him in the OR if he gets hurt
(ie, passes out and hits his head, for example). The hospital might hire him as
an independent contractor and require him to provide his own liability
insurance.</span></span></span><br />
<span style="font-size: 12pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"></span><span style="font-family: Calibri;"><span style="background-color: #cccccc;"><span style="font-size: 12pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Chances
are he’d be asked to station himself outside the OR doors—but there are two
sets. </span></span></span><span style="font-family: Calibri;"><span style="background-color: #cccccc;"><span style="font-size: 12pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Most
ORs have a door to the main hall and a door to the supply hall (usually on the
opposite side). Two doors to guard, in other words. </span></span></span><br />
<span style="font-family: Calibri;"><span style="background-color: #cccccc;"><span style="font-size: 12pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"></span></span></span><span style="font-size: 12pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><span style="background-color: #cccccc; font-family: Calibri;">Assuming
you cover both doors, you’d have to check ID on anyone entering the room. It’s
amazing how much of a “disguise” scrubs and a surgical hat and booties provide.
<br style="mso-special-character: line-break;" />
</span></span><span style="font-family: Calibri;"><span style="background-color: #cccccc;"><span style="font-size: 12pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><strong>3)
During the operation, a poisonous gas is funneled into the OR through the
ventilation.<br />
Heroine passes out; the hero manages to get heroine out of OR before he passes
out.<br />
<span style="mso-bidi-font-weight: bold;">W</span>ould the hospital staff remove
his weapon when then tend to him?</strong> </span><span style="font-size: 14pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></span></span><br />
<span style="background-color: #cccccc;">
</span><br />
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<span style="font-size: 12pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Calibri;"><span style="background-color: #cccccc;">Yes,
they’d remove it. Assuming he was taken to the ER, they’d remove the gun and
lock it in the ER safe—unless another officer was there to take it into
custody.<o:p></o:p></span></span></span></div>
<span style="background-color: #cccccc;">
<span style="font-size: 12pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Calibri;"></span></span></span><br />
<span style="font-size: 12pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><span style="font-family: Calibri;"><span style="background-color: #cccccc;">Questions?
Comments?<o:p></o:p></span></span></span><br />
<span style="font-size: 12pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><span style="background-color: #cccccc; font-family: Calibri;">~*~</span></span><span style="color: black; mso-bidi-font-family: "Courier New";"><br /><span style="background-color: #cccccc; font-family: Calibri;">
Kelly has worked in the medical field for over twenty years, mainly at large
medical centers. With experience in a variety of settings, chances are Kelly
may have seen it. <br />
<br />
Sometimes truth seems stranger than fiction in medicine, but accurate medicine
in fiction is fabulous.<br />
Find her fiction at </span><a href="http://www.kellywhitley.com/"><span style="background-color: #cccccc; color: #0068c6; font-family: Calibri;">www.kellywhitley.com</span></a><span style="font-family: Calibri;"><span style="background-color: #cccccc;">.</span>
<br />
<span style="background-color: #cccccc;">Like crime scenes? I recommend Crime Scene Writer. To join: </span></span><a href="http://medicalscenewriter.blogspot.com/crimescenewriter@yahoogroups.com"><span style="background-color: #cccccc; color: #0068c6; font-family: Calibri;">crimescenewriter@yahoogroups.com<br />
</span></a></span><span style="font-size: 12pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span><br />
Unknownnoreply@blogger.com2tag:blogger.com,1999:blog-8255935895272962129.post-12070649037431434542013-02-15T13:47:00.002-08:002013-02-15T13:47:34.512-08:00Pregnancy Complications in a Postapocalyptic World<blockquote>My futuristic story is set in a post-apocalyptic primitive world, sort of like in the seventeen hundreds. No electricity. I have an eighteen year-old pregnant woman, and I need a complication of late pregnancy that is likely to kill her but not her child (who is the future hero).</blockquote>Here are a few:<br />
<b>1) Eclampsia</b>-- a condition of severe high blood pressure, kidney and liver issues. More common in first pregnancies, but can occur with any pregnancy. Very dangerous, and can be fatal.<br />
<b>2) Cardiomyopathy</b>-- the heart muscle becomes weak during the pregnancy, and the woman goes into heart failure. It can happen with any pregnancy. Once it does happen, further pregnancies are not recommended.<br />
<b>3) Heart valve issues</b>, especially narrowed heart valves (specifically the mitral and aortic valves). Rheumatic fever would be a cause of valve disease in a woman without access to antibiotics for a childhood strep throat.<br />
<b>4) High blood pressure in the lungs (pulmonary hypertension). </b>This is most common in women between ages 20 and 40. It may be autoimmune. It causes terrible shortness of breath, swelling of legs, and patients can have a bluish color due to low blood oxygen. Pregnancy is not recommended in women with this problem, as it is often fatal.<br />
<b>5) Blood clots in the legs</b>, breaking off and going to the lungs (pulmonary embolus). Can be fatal. A clot in the leg was known as “milk leg.”<br />
<b>6) Placenta forming over the cervix </b>(the exit to the uterus). Known as placenta previa, it causes bleeding, and can kill both the mother and child.<br />
<b>7) Placenta pulling loose</b>--bleeding, fetal distress. Known as abruptio placenta; the mother can bleed to death.<br />
<b>8) Failure during delivery</b>: baby gets stuck coming out. As C-section wouldn't be an option, mother and child would both likely die.<br />
<b>9) Uterus won't contract after delivery</b>-- severe bleeding. Can be fatal.<br />
<b>10) Twins, triplets</b>-- higher chance of injury to or loss of the babies and the mother.<br />
<b>11) Breech birth</b>-- baby tries to come out feet first. May get stuck, may have fetal distress.<br />
<b>12) Gallbladder disease</b>-- more common during pregnancy. In extreme cases, a stone can get stuck and lead to pain, infection, inflammation of the pancreas. Death can ensue.<br />
<b>13) Appendicitis</b>--an old fashioned killer, but not uncommon when medical care (especially surgical care) is not available.<br />
<b>14) Pneumonia</b>--another old fashioned infectious disease that can turn fatal.<br />
<br />
<b>If you want something showy, plague is a possibility.</b> Spread by lice in unclean conditions, this infectious disease scourged Europe in the Middle Ages. Infants sometimes survived when their mothers didn't.<br />
<br />
Hope this helps clarify the situation. If you need more help, please leave a question in the comments!<br />
Cheers, Kelly<br />
<br />
Questions? Comments?<br />
~*~<br />
Kelly has worked in the medical field for over twenty years, mainly at large medical centers. With experience in a variety of settings, chances are Kelly may have seen it. <br />
<br />
Sometimes truth seems stranger than fiction in medicine, but accurate medicine in fiction is fabulous.<br />
Find her fiction at <a href="http://www.kellywhitley.com">www.kellywhitley.com</a>.<br />
<br />
Like crime scenes? I recommend Crime Scene Writer. To join: <a href="crimescenewriter@yahoogroups.com
">crimescenewriter@yahoogroups.com<br />
</a>Unknownnoreply@blogger.com9tag:blogger.com,1999:blog-8255935895272962129.post-66540202708163738402013-02-10T18:21:00.001-08:002013-02-10T18:21:56.203-08:00Strangulation Part Two: More on Mechanisms<i><blockquote>A couple of questions: when you set a scene where someone is being choked by an object around the neck or pushing against the neck - that death isn't immediately from that particular action, but rather it is the breaking of the hyoid and the swelling that results from it? So unless the garotte cuts through to the carotid arteries, this could be a much slower way to die?<br />
<br />
What about people who go unconscious from lack of air? Is it possible they could also suffer from the hyoid breaking and not wake up after passing out? I'm just curious as to how alive a person might be in order to overhear his would-be killer's plan :)<br />
<br />
Thanks ~ Killion<br />
</blockquote></i>Hello, Killion!<br />
The brain needs blood. A few seconds without blood flow causes unconsciousness. This is the so-called simple faint. You lay the victim down, more blood flows to the brain, and the victim wakes up.<br />
<br />
After a couple of minutes--like in a cardiac arrest situation--the brain is starving for oxygen, and the cells can be damaged. Waking up is harder, takes longer, and the victim may have deficits.<br />
<br />
Four to five minutes--and brain damage (enough to cause a vegetative state, as in organ donor) starts.<br />
<br />
All of this just from lack of blood flow through the carotid arteries.<br />
<br />
The initial stage of "strangling" is the result of the victim passing out from lack of blood flow. They're defenseless.<br />
<br />
The perpetrator continues squeezing the neck.<br />
Breaking the hyoid usually collapses the airway. There is immediate soft tissue damage and swelling. Now you have impaired blood flow to the brain and impaired oxygen in the bloodstream.<br />
<br />
Lack of air alone won't break the hyoid. Strong hands--usually a man's hands--with thumbs over the hyoid is necessary to break it.<br />
<br />
Passing out from lack of air--like at altitude (a small plane for example, or suffocating inside a plastic bag) is because of low oxygen. Defenseless victim.<br />
<br />
If the bad guy strangled the victim just enough to cause a faint (there would still be a pulse and breathing) the victim could potentially wake up and overhear the plans.<br />
<br />
Since the brain prefers glucose (sugar) as its food source, low blood sugar will cause passing out (example--a diabetic who takes their insulin then doesn't eat).<br />
<br />
Hope this helps clarify the situation.<br />
Cheers, Kelly<br />
<br />
Questions? Comments?<br />
~*~<br />
Kelly has worked in the medical field for over twenty years, mainly at large medical centers. With experience in a variety of settings, chances are Kelly may have seen it. <br />
<br />
Sometimes truth seems stranger than fiction in medicine, but accurate medicine in fiction is fabulous.<br />
Find her fiction at <a href="http://www.kellywhitley.com">www.kellywhitley.com</a>.<br />
<br />
Like crime scenes? I recommend Crime Scene Writer. To join: <a href="crimescenewriter@yahoogroups.com">crimescenewriter@yahoogroups.com</a><br />
<br />
<br />
Unknownnoreply@blogger.com2tag:blogger.com,1999:blog-8255935895272962129.post-80770209416476270162013-02-06T14:15:00.002-08:002013-02-06T14:15:53.771-08:00Strangulation—How it Works<b><blockquote>In my scene, I want to have the villain strangle the victim, using a picture wire. The death needs to be very fast. Will this work?<br />
</blockquote><i></i></b>A wire tends to cut into the tissue of the neck, and isn't very broad--it'd be hard to place it directly over the hyoid, especially if the victim struggled. <br />
Most victims will grab at the wire, twist their body, trying to dislodge it—this is survival instinct. The arms won't be flailing. If the victim is off the ground, they may kick.<br />
I can't think of any protrusion or modification of the wire that would be so effective so fast that the victim won't struggle at least a bit. A protrusion that angles upward toward the base of the tongue, which would jam into the bone, might work. Still, death won't be instantaneous.<br />
Let me give you an example.<br />
I’ve seen a drunk driver—not wearing his seatbelt—who rear-ended a parked pick-up. The guy wasn’t going that fast, but his vehicle was old and didn’t have air bags. He hit his throat on the steering wheel. He had some pain in his neck, but drove home. By the time he got there, he was more and more short of breath. He woke his wife, and she drove him to the ER. On the way, he began clawing at his neck, wheezing with each breath.<br />
By the time we got him, he’d had a cardiac arrest; we had to cut a hole in his throat for him to breathe.<br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj5lizFGtZeZxww9gM70LaKM3nZQbhurfsdqJDHk7XOqk1sSiMteVnOd5dBNLbA5a08ES9iyOCjW2klA_75fbssDtv6dOySwCjqeegzLuIALYMJfpyhBMghyphenhyphenZIVPgqDdN5uY8x8t10yBjQ/s1600/hyoid-bone.jpg" imageanchor="1" style="clear:left; float:left;margin-right:1em; margin-bottom:1em"><img border="0" height="285" width="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj5lizFGtZeZxww9gM70LaKM3nZQbhurfsdqJDHk7XOqk1sSiMteVnOd5dBNLbA5a08ES9iyOCjW2klA_75fbssDtv6dOySwCjqeegzLuIALYMJfpyhBMghyphenhyphenZIVPgqDdN5uY8x8t10yBjQ/s320/hyoid-bone.jpg" /></a></div>X-rays showed his hyoid was broken. BUT, what killed him was swelling in the soft tissue of the neck that progressed after he hit his throat. This is part of the mechanism of strangulation. Here's an illustration of the neck and location of the hyoid bone—that should help with visualizing the process.<br />
Cheers, Kelly<br />
<br />
Thanks to Connie for this question!<br />
Questions? Comments?<br />
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~*~<br />
Kelly has worked in the medical field for over twenty years, mainly at large medical centers. With experience in a variety of settings, chances are Kelly may have seen it. <br />
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Sometimes truth seems stranger than fiction in medicine, but accurate medicine in fiction is fabulous.<br />
Find her fiction at <a href="http://www.kellywhitley.com">www.kellywhitley.com</a>.<br />
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