Hello, Pencil Neck here.
What would the ER personnel do if a patient showed up presenting:
1) Cold sweats
2) Shaking
3) Stomach cramps and complaining of hunger
4) Nausea
5) Erratic behavior
6) Dark rings under the eyes and a pallid cast to the skin
7) Possibly sensitivity to light
What would they test for? What questions would they ask? What would they do to try to stabilize him?
This isn’t a simple question without more information, so this is a general overview:
First thing, take his vitals: temperature, heart rate (pulse), breathing rate (respirations), and blood pressure. This will give an idea if there’s a possible infection, whether dehydration might be a factor, if there’s evidence of increased adrenaline (fast heart rate and breathing) suggesting his body is under perceived threat.
We’ll stabilize the blood pressure, heart rate, and breathing.
Start an IV. Do a finger stick blood sugar level. Check blood oxygen level with a finger clip (pulse oximeter). Put on oxygen if necessary.
***If this is an overdose, right away we’ll want to know what was taken, when, and how much. Depending on the substance, we might give activated charcoal to bind the drug (via a tubs through the nose and into the stomach) or do “gastric lavage,” which is pump saline in through the tube and suck it back out—in the layman’s term, “pump the stomach.”
History of present illness:
Age—helps decide if this might be a heart attack (more common in an older person) or overdose (more common in kids).
When did this start, and what was he doing when it started? What were the first symptoms? What did he try for relief (if anything)? What makes it better (if anything) or worse (if anything)? Is anyone else at home or work sick with something similar?
Did he take anything or eat anything? Drugs and poisons can give this appearance.
***In this day of frequent introduction of new “designer” drugs, we’re constantly having to watch for odd presentations—witness the recent “bath salts” scenarios.
If it’s a kid, and he’s alert enough to give information, I usually kick the parents out for a few minutes and ask the kid in private about doing something he shouldn’t have, and about illicit drug use. Typically, the kid needs to know 1) we can’t help him if we don’t know what he took, 2)we’re not going to call the cops, and 3)we’re going to run a drug screen regardless. Most kids will own up if they know anything.
Medical history:
--What medications is he taking? Diabetics can look like this if their blood sugar is low. Quite a few medications in toxic doses can have a profile similar to above. Could the guy have overdosed? (intentionally or accidentally)
--What kinds of health problems has he had in the past?
--Does he smoke (anything) or drink (anything)?
--Where does he work? This goes to environmental exposure.
At this point, we’ll want to get lab cooking.
***Initial Labs: EKG (to check if the illness is affecting the heart rhythm or electrical system—overdoses in particular can have bad effects on the heart rhythm); electrolytes, blood count, urinalysis, drug screen (depending on the hospital, most panels will check for acetaminophen, marijuana, benzodiazepines (valium, etc.), narcotics, alcohol), blood levels for any known drugs that could be at toxic levels—like Digoxin, for example—and a couple of extra tubes for stuff we might want to add on.
Toxic exposure: If the history reveals exposure to something specific—like exposure to ant killer, for example, we consult the Poisindex, a tome that outlines poisons and how to treat them.
***Link: Poisindex
A lot of poisons can’t be assayed on blood tests. Treatment is supportive, meaning we keep the patient stable until the poison exits.
***If there is an antidote, we’ll give it.
Maybe a chest X-ray, or other imaging depending on what’s been learned up until now. Maybe a head CT because of the behavior.
Next, an examination:
General appearance: pale, sweating, shaky. All these make infection near the top of the list. Also add in toxic exposure, overdose.
Head/neck: Pupils dilated? Do they contract with a light shown in the eyes?
Chest: rattly, like pneumonia? Wheezing, like bronchitis? The temp will have given us a heads-up on this one.
Heart: heart rate? Murmurs that could suggest heart valve infection? Scratching that could suggest inflammation of the sac around the heart?
Abdomen: Are gut sounds present? Tenderness, and if so, where? Guarding or rigidity (which typically mean something bad—ruptured appendix, for example)
Extremities: Blue? (low blood oxygen) Pink? Pale palms or nail beds? (anemia)
Neuro: Assess “erratic behavior.” Does he know where he is? The date? The president? (always a challenge when this is changing) Does he know his own name? Is he combative?
Lymph: Any glands swollen?
Pencil Neck, based on what you’ve said alone, I’d favor a diabetic reaction or toxic exposure (drug or poison). After the above assessment, I’d have a much better idea what’s going on.
Hope this helps!
Cheers, Kelly
~*~
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. Sometimes truth seems stranger than fiction in medicine, but accurate medicine in fiction is fabulous.
Find her fiction at www.kellywhitley.com.
Saturday, September 29, 2012
Friday, September 28, 2012
Treatment of Trauma After a Fall from a Vehicle in a Remote Area
Hi Kelly,
I’d really appreciate your help with this scene.
My scenario. Hero and heroine’s first meeting. Remote location, time is early 2003. Heroine is driving a horse and cart and finds hero unconscious in a ditch. Hero has catapulted off a moving truck and is suffering a broken leg, shoulder separation, multiple cuts and contusions. (He is not quite human so the injuries aren’t going to kill him.) Heroine must stabilize and transport him in the bed of the cart by herself with what supplies she has at hand. She has experience with farm animals and she washed out of EMT training years ago so she does have some knowledge. For the heroine to physically get the man into the cart the hero must be somewhat conscious.
Which scenario would be more likely:
A)Heroine decides to set the broken leg and the pain awakens the hero, or B) hero regains consciousness and convinces the heroine to set the leg, thereby being awake enough to aid his move?
Hello, DM.
In this day and age (including in 2003), no one would try to set the leg without X-rays. She could try to stabilize it with a splint—a board on either side of the leg banded together with cloth (ripped clothes/blanket/rags).
The hero is likely to wake up if she moves his leg—fractures are very painful. It won’t make it easier to move if his leg is splinted. He won’t be able to stand on it.
He can wake spontaneously—doesn’t have to be from pain.
And how much detail should I put in the scene? Would a reader be interested in how she checks for lung puncture or why she makes a cervical collar out of the SAM split she has in the cart’s first aid kit?
Consider putting in whatever detail anchors the reader in the scene. What is she going to do to check for a punctured lung? I’d suggest he could cough up pink foam (blood mixed with air) as an indication of that.
Come to think of it, would she bother with a cervical collar when she can’t immobilize him in a back board anyway? What do you think?
IMHO, it’s better to focus on a couple of big medical details. I’d skip the collar—if she’s going to move him anyway, it becomes a moot point.
Good luck with your scene, DM!
Cheers, Kelly
~*~
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. Sometimes truth seems stranger than fiction in medicine, but accurate medicine in fiction is fabulous.
Find her fiction at www.kellywhitley.com.
Monday, September 24, 2012
MONDAYS ARE QUESTION DAYS
Have a question?
Anything you'd like to see discussed? A scenario you'd like to see laid out in black and white?
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.
Sometimes truth seems stranger than fiction in medicine, but accurate medicine in fiction is fabulous.
Find her fiction at www.kellywhitley.com.
Anything you'd like to see discussed? A scenario you'd like to see laid out in black and white?
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.
Sometimes truth seems stranger than fiction in medicine, but accurate medicine in fiction is fabulous.
Find her fiction at www.kellywhitley.com.
Sunday, September 23, 2012
Arrow Wounds
With all the recent popularity of bow and arrows (The Hunger Games, Revolution), can you tell your readers the proper way to deal with injuries like this?
Thanks, Kimber
Hello.
Arrows are an old weapon and a unique weapon. Let’s start by looking at the arrow itself—that lends a lot to the understanding of the injury and treatment.
A Bit About Handmade/Homemade Arrows Ala Hunger Games
The earliest recorded information about arrow injuries and their treatments comes from the 1800s, when the Bow and arrow was still a common weapon—not yet supplanted by guns.
First, let’s look at the traditional hand-made arrow, like in Hunger Games or Revolution.
The arrow was comprised of a head, a shaft, and feathers.
The arrowhead—usually rock or bone—was shaped into a roughly triangular shape. The tip needed to be sharp and able to “cut” the skin, and had to be sturdy enough to penetrate clothing. Arrows were often shot with enough velocity that they could lodge in bone, although perforation of the skull was uncommon unless the victim was hit in the eye socket.
The shaft was typically made of dogwood stripped of bark, then soaked and twisted to ensure a straight shaft that would rotate. The shaft had to be long enough to stabilize the flight of the arrow, but be of a length easily portable in a quiver. A horseback-seated archer needed to be able to reach over his shoulder and pull an arrow out of the quiver.
The end of the shaft was stabilized by feathers. The choice of feather was based on the weight of the arrowhead. The bigger and heavier the head, the bigger the feather needed to balance it. The other function of the feathers was to influence the spin of the arrow. Like a quarterback, an archer wants spin in the flight. A rotating projectile goes farther.
The head was bound to the shaft with tendon and sinew. The reason for this (other than convenience) is this: when the arrow penetrates body tissue, the blood and moisture loosens the binding. When the well-meaning friend went to remove the arrow, the arrowhead remained inside the victim, where it generally did more damage by moving—those sharp edges—and caused infection. Compared to bullets, which are hot (and more likely to be sterile) and blunt (less likely to cause damage once they’ve stopped), arrowheads could not be left in place. The easiest way to get one out was to cut down to the head and extract the whole thing. This was the best chance for survival.
Chest wound were more dangerous, especially if it wasn’t a through-and-through injury.
Poisoning an Arrowhead
An old method was to take a chunk of raw animal liver and entice a rattlesnake to bite the liver. I have no idea how they got the snake to do this. Then the liver was buried and allowed to rot for a few days. The meat was disinterred, and arrowheads (already mounted on shafts) were dipped in the rotten poisoned liver and allowed to dry. The consequence of this—even if the arrow was successfully removed, the victim often died of poisoning, either from nasty bacteria or the rattlesnake poison.
The Modern Arrow
Most arrows today have machine-made carbon shafts and sharp cone-like points. Their shape is conducive to going deep with a low velocity, and tends to cut through body structures in its path. The good news is the arrow tends to act like a plug—if it lodges in the heart, the last thing you want to do is pull it out. Same for penetration of major blood vessels. The upshot is you can’t tell exactly where it is or what it punctured.
DO NOT PULL OUT THE ARROW!
The arrow should be stabilized in place, usually with gauze or cotton around the arrow at the entry site, and the patient should be transported like this. Many patients have a stable blood pressure and heart rate. In the ER, X-rays may be obtained. A CT scan can help map the tract of the arrow and give medical personnel a better idea of what structures may be affected. The arrow is generally removed in surgery.
Barbed arrows are similar to the handmade ones, causing more damage and tend to be fraught with more surgical peril during extraction. Again, don’t pull the arrow out.
In fiction, the choice of the arrow—homemade or machine-made, poisoned or plain—depends on the scene you’re looking for. Just…don’t pull out the arrow.
Cheers, Kelly
~*~
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. Sometimes truth seems stranger than fiction in medicine, but accurate medicine in fiction is fabulous.
Find her fiction at www.kellywhitley.com.
Thanks, Kimber
Hello.
Arrows are an old weapon and a unique weapon. Let’s start by looking at the arrow itself—that lends a lot to the understanding of the injury and treatment.
A Bit About Handmade/Homemade Arrows Ala Hunger Games
The earliest recorded information about arrow injuries and their treatments comes from the 1800s, when the Bow and arrow was still a common weapon—not yet supplanted by guns.
First, let’s look at the traditional hand-made arrow, like in Hunger Games or Revolution.
The arrow was comprised of a head, a shaft, and feathers.
The arrowhead—usually rock or bone—was shaped into a roughly triangular shape. The tip needed to be sharp and able to “cut” the skin, and had to be sturdy enough to penetrate clothing. Arrows were often shot with enough velocity that they could lodge in bone, although perforation of the skull was uncommon unless the victim was hit in the eye socket.
The shaft was typically made of dogwood stripped of bark, then soaked and twisted to ensure a straight shaft that would rotate. The shaft had to be long enough to stabilize the flight of the arrow, but be of a length easily portable in a quiver. A horseback-seated archer needed to be able to reach over his shoulder and pull an arrow out of the quiver.
The end of the shaft was stabilized by feathers. The choice of feather was based on the weight of the arrowhead. The bigger and heavier the head, the bigger the feather needed to balance it. The other function of the feathers was to influence the spin of the arrow. Like a quarterback, an archer wants spin in the flight. A rotating projectile goes farther.
The head was bound to the shaft with tendon and sinew. The reason for this (other than convenience) is this: when the arrow penetrates body tissue, the blood and moisture loosens the binding. When the well-meaning friend went to remove the arrow, the arrowhead remained inside the victim, where it generally did more damage by moving—those sharp edges—and caused infection. Compared to bullets, which are hot (and more likely to be sterile) and blunt (less likely to cause damage once they’ve stopped), arrowheads could not be left in place. The easiest way to get one out was to cut down to the head and extract the whole thing. This was the best chance for survival.
Chest wound were more dangerous, especially if it wasn’t a through-and-through injury.
Poisoning an Arrowhead
An old method was to take a chunk of raw animal liver and entice a rattlesnake to bite the liver. I have no idea how they got the snake to do this. Then the liver was buried and allowed to rot for a few days. The meat was disinterred, and arrowheads (already mounted on shafts) were dipped in the rotten poisoned liver and allowed to dry. The consequence of this—even if the arrow was successfully removed, the victim often died of poisoning, either from nasty bacteria or the rattlesnake poison.
The Modern Arrow
Most arrows today have machine-made carbon shafts and sharp cone-like points. Their shape is conducive to going deep with a low velocity, and tends to cut through body structures in its path. The good news is the arrow tends to act like a plug—if it lodges in the heart, the last thing you want to do is pull it out. Same for penetration of major blood vessels. The upshot is you can’t tell exactly where it is or what it punctured.
DO NOT PULL OUT THE ARROW!
The arrow should be stabilized in place, usually with gauze or cotton around the arrow at the entry site, and the patient should be transported like this. Many patients have a stable blood pressure and heart rate. In the ER, X-rays may be obtained. A CT scan can help map the tract of the arrow and give medical personnel a better idea of what structures may be affected. The arrow is generally removed in surgery.
Barbed arrows are similar to the handmade ones, causing more damage and tend to be fraught with more surgical peril during extraction. Again, don’t pull the arrow out.
In fiction, the choice of the arrow—homemade or machine-made, poisoned or plain—depends on the scene you’re looking for. Just…don’t pull out the arrow.
Cheers, Kelly
~*~
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. Sometimes truth seems stranger than fiction in medicine, but accurate medicine in fiction is fabulous.
Find her fiction at www.kellywhitley.com.
Saturday, September 22, 2012
A Man Stabbed in the Back of the Shoulder
My hero was stabbed in his shoulder from the back. I don't want him to be kept overnight. I want him to be able to refuse to stay in the hospital. What would the ER docs do for him? The idea is he ducked and the man got him from behind.
thanks--CK.
Hello, CK.
There’s a lot of bone and muscle in the shoulder. The vessels to the arm are in the front beneath the collar bone, and therefore protected when the victim is stabbed from behind.
The shoulder blade protects the back of the shoulder and part of the rib cage. The muscles attached to the shoulder girdle (the “corner” of the shoulder where the outer ends of the shoulder blade and collar bone meet) can be damaged with a knife.
The ER docs will want an X-ray series of the wounded area and a chest X-ray. A blood count (to gauge blood loss) would be reasonable.
If the cut is deep enough and long enough, it'll require stitches. I'd suggest having the knife hit the meaty part of the shoulder (read: muscle) but not sever tendons. Tendon damage equals surgery and admission to the hospital.
A stab wound over the shoulder blade will protect your victim from the knife entering the chest cavity (and protect him from admission).
The wound is likely to require a shot of antibiotic. It’ll also require a tetanus shot if your hero hasn’t had one in the last five years. The wound will need to be kept clean and dry, and no showering (getting water on it) for a couple of days.
He’d be advised to come back for a wound check, and to have the stitches out in about ten days. Of course, he may decide to take them out himself. A common mistake people make when they do this is cut the knot off and leave the loop of the suture beneath the skin. Cut only one side of the suture below the knot—then the whole thing can be pulled out intact.
thanks--CK.
Hello, CK.
There’s a lot of bone and muscle in the shoulder. The vessels to the arm are in the front beneath the collar bone, and therefore protected when the victim is stabbed from behind.
The shoulder blade protects the back of the shoulder and part of the rib cage. The muscles attached to the shoulder girdle (the “corner” of the shoulder where the outer ends of the shoulder blade and collar bone meet) can be damaged with a knife.
The ER docs will want an X-ray series of the wounded area and a chest X-ray. A blood count (to gauge blood loss) would be reasonable.
If the cut is deep enough and long enough, it'll require stitches. I'd suggest having the knife hit the meaty part of the shoulder (read: muscle) but not sever tendons. Tendon damage equals surgery and admission to the hospital.
A stab wound over the shoulder blade will protect your victim from the knife entering the chest cavity (and protect him from admission).
The wound is likely to require a shot of antibiotic. It’ll also require a tetanus shot if your hero hasn’t had one in the last five years. The wound will need to be kept clean and dry, and no showering (getting water on it) for a couple of days.
He’d be advised to come back for a wound check, and to have the stitches out in about ten days. Of course, he may decide to take them out himself. A common mistake people make when they do this is cut the knot off and leave the loop of the suture beneath the skin. Cut only one side of the suture below the knot—then the whole thing can be pulled out intact.
Thursday, September 20, 2012
Undetectible poisoning
Hi.
I’m writing for help on poisoning. I want something that’ll work fast, but can be put in a drink. It can’t be detectible on a blood test. I also want something unique—not cyanide or something like that.
Hello.
Okay. How about something not available in the United States? (Assuming the setting is in the USA)
Years ago, coyotes were poisoned with a substance known as 10 80 (ten eighty), a poison that affects metabolism in mammals. It’s illegal in the USA.
The poison is stable in alcohol, if that helps.
After ingestion, symptoms appear in 30 minutes to two hours. The first indication that something is wrong is nausea, followed by a sense of apprehension. Stomach ache and sweating are next. Twitching starts as the muscles are affected, and progress to seizures. Left untreated, it affects the heart, causing malignant rhythms that kill.
If help reaches your victim in time, a hospital can try to support the patient symptomatically with IV fluids, treatment of heart rhythm disturbances, and meds for seizures. If they know what your character was poisoned with, the doctors can try administering glyceryl monoacetate, which may compete for the poison at the level of the body’s cellular metabolism. There is no laboratory assay for 10 80. Citric acid levels may be elevated in the blood.
Alcohol (the drinking kind) was used as an antidote for many years with little success.
Few (very few) people or animals survive the poisoning.
Questions? Comments?
~*~
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. Sometimes truth seems stranger than fiction in medicine, but accurate medicine in fiction is fabulous.
Find her fiction at www.kellywhitley.com.
I’m writing for help on poisoning. I want something that’ll work fast, but can be put in a drink. It can’t be detectible on a blood test. I also want something unique—not cyanide or something like that.
Hello.
Okay. How about something not available in the United States? (Assuming the setting is in the USA)
Years ago, coyotes were poisoned with a substance known as 10 80 (ten eighty), a poison that affects metabolism in mammals. It’s illegal in the USA.
The poison is stable in alcohol, if that helps.
After ingestion, symptoms appear in 30 minutes to two hours. The first indication that something is wrong is nausea, followed by a sense of apprehension. Stomach ache and sweating are next. Twitching starts as the muscles are affected, and progress to seizures. Left untreated, it affects the heart, causing malignant rhythms that kill.
If help reaches your victim in time, a hospital can try to support the patient symptomatically with IV fluids, treatment of heart rhythm disturbances, and meds for seizures. If they know what your character was poisoned with, the doctors can try administering glyceryl monoacetate, which may compete for the poison at the level of the body’s cellular metabolism. There is no laboratory assay for 10 80. Citric acid levels may be elevated in the blood.
Alcohol (the drinking kind) was used as an antidote for many years with little success.
Few (very few) people or animals survive the poisoning.
Questions? Comments?
~*~
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. Sometimes truth seems stranger than fiction in medicine, but accurate medicine in fiction is fabulous.
Find her fiction at www.kellywhitley.com.
Monday, September 17, 2012
What would you like to see?
Well, folks, it's Monday, so it's question day.
What would you like to know about?
What would you like to know about?
Sunday, September 16, 2012
After a fall down the stairs, what would keep an elderly witness awake long enough to call for help?
In my WIP, the killer pushes the 80-year-old witness to his previous murder down the stairs in her home. It’s a long, straight flight of 10 carpeted stairs. The elderly woman is otherwise strong and in good health. He thinks she’s dead and leaves before the neighbors can respond to her barking dog.
I want her to be conscious long enough to push a button on her cell phone. And I want her to survive but be in a coma and incommunicado for much of the rest of the story. What injuries would she be likely to have that are severe but allow her to make it?
Your help is much appreciated.
Hello, Susan.
Two choices that would work well—subdural hematoma or epidural hematoma.
What might work is this:
A fall down the stairs with a blow to the head. Doesn’t have to be severe, doesn’t have to cause a skull fracture or even a cut/laceration.
Subdural hematoma—a blood collection between the membrane covering the brain—the dura—and the brain itself. Older people can get these fairly easily, even without severe head trauma. The pupil can be enlarged on the side of the bleeding. This is the one I’d favor for your witness.
Epidural hematoma—a blood collection between the skull and the membrane covering the brain, known as the dura. This type of injury comes tearing the veins between the skull and the dura—the “bridging veins.” The tear results in bleeding, which compresses the brain. These are more dangerous, and less likely to occur in the elderly.
Both the subdural and epidural varieties have the following signs: the patient usually has a “lucid interval” (a period of time where your witness would be awake) of a few minutes up to a couple of hours can occur. This would give her enough time to push the button on her phone. Without prompt treatment, the patient thereafter lapses into a coma.
Depending on whether you want her to have surgery and recover, or be out of it for the rest of the book, either one will work. Again, I’d favor the subdural hematoma given the fall and her age.
Hope this helps!
Cheers, Kelly
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. Sometimes truth seems stranger than fiction in medicine, but accurate medicine in fiction is fabulous.
Find her fiction at www.kellywhitley.com.
I want her to be conscious long enough to push a button on her cell phone. And I want her to survive but be in a coma and incommunicado for much of the rest of the story. What injuries would she be likely to have that are severe but allow her to make it?
Your help is much appreciated.
Hello, Susan.
Two choices that would work well—subdural hematoma or epidural hematoma.
What might work is this:
A fall down the stairs with a blow to the head. Doesn’t have to be severe, doesn’t have to cause a skull fracture or even a cut/laceration.
Subdural hematoma—a blood collection between the membrane covering the brain—the dura—and the brain itself. Older people can get these fairly easily, even without severe head trauma. The pupil can be enlarged on the side of the bleeding. This is the one I’d favor for your witness.
Epidural hematoma—a blood collection between the skull and the membrane covering the brain, known as the dura. This type of injury comes tearing the veins between the skull and the dura—the “bridging veins.” The tear results in bleeding, which compresses the brain. These are more dangerous, and less likely to occur in the elderly.
Both the subdural and epidural varieties have the following signs: the patient usually has a “lucid interval” (a period of time where your witness would be awake) of a few minutes up to a couple of hours can occur. This would give her enough time to push the button on her phone. Without prompt treatment, the patient thereafter lapses into a coma.
Depending on whether you want her to have surgery and recover, or be out of it for the rest of the book, either one will work. Again, I’d favor the subdural hematoma given the fall and her age.
Hope this helps!
Cheers, Kelly
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. Sometimes truth seems stranger than fiction in medicine, but accurate medicine in fiction is fabulous.
Find her fiction at www.kellywhitley.com.
Monday, September 10, 2012
MONDAYS ARE QUESTION DAYS
Have a question?
Anything you'd like to see discussed? A scenario you'd like to see laid out in black and white?
Do you want to read real-life anecdotes that might be of interest--humorous to scary to gory to...yo get the idea.
MONDAY IS FOR YOU.
Questions? Comments?
Kelly has worked in the medical field for over twenty-five years, mainly at large medical centers. With experience in a variety of settings, chances are Kelly may have seen it. Sometimes truth seems stranger than fiction in medicine, but accurate medicine in fiction is fabulous.
Find her fiction at www.kellywhitley.com.
Anything you'd like to see discussed? A scenario you'd like to see laid out in black and white?
Do you want to read real-life anecdotes that might be of interest--humorous to scary to gory to...yo get the idea.
MONDAY IS FOR YOU.
Questions? Comments?
Kelly has worked in the medical field for over twenty-five years, mainly at large medical centers. With experience in a variety of settings, chances are Kelly may have seen it. Sometimes truth seems stranger than fiction in medicine, but accurate medicine in fiction is fabulous.
Find her fiction at www.kellywhitley.com.
Friday, September 7, 2012
The Ambulance and ER Management of Stab Wound to the Chest
What happens to a stabbing victim in an ambulance and the ER? This is a general overview—take what detail you want for your scene. The EMTs or paramedics will stabilize his breathing—if necessary, they’ll put a breathing tube down his throat and into his airway. Then they can “bag” him—use a pliable plastic bag to push air into his lungs—breathe for him. The chest wound will be inspected and covered. An IV line will be started (at least one) of a large size to add volume to the blood supply and keep the blood pressure up. This also allows medications to be given. A heart monitor will be attached. Blankets to maintain warmth and help stave off shock. During all this, heart rate, blood pressure, and breathing will be monitored. The ambulance will be in contact with the ER. In hospitals that have the capability of functioning as a trauma center, a surgeon may be waiting for the patient. Otherwise the ER staff will be ready for a “hot unload,” a seriously ill patient in need of immediate attention. The goal in the ER is to stabilize the patient. Depending on how the hero is doing, he’ll get a chest X-ray, maybe a CAT scan of the chest and abdomen (low stab wounds can involve the belly), and a tube may be inserted into the chest to reinflate the lung if it’s collapsed. This tube drains both blood and air. Blood will be drawn for labwork, including a type and cross for blood. The hero might need surgery. This will depend on the extent of his injuries. The surgeon, the ER doc, and the imaging tests (X-ray and CAT scan [if done]) can make this decision. I’ve seen stab wounds minor enough to require very little, up to life-threatening wounds requiring emergency surgery. You can tailor your scenario to give the result you want. The more severe the injury, the longer the hero will be in the hospital. One last minor detail—he’ll need a tetanus shot unless he’s had one in the last five years! Questions? Comments? Kelly has worked in the medical field for over twenty-five years, mainly at large medical centers. With experience in a variety of settings, chances are Kelly may have seen it. Sometimes truth seems stranger than fiction in medicine, but accurate medicine in fiction is fabulous. Find her fiction at www.kellywhitley.com.
Wednesday, September 5, 2012
Stab wound to the chest
Hello. My hero is in an altercation, and is stabbed in the chest. I know he’ll be bleeding. I want him to need hospitalization, but don’t want him to die. What can my heroine do besides call 911? 911 is a good start. After you get expert help on the way, the heroine needs to do the ABCs: Airway, breathing, circulation. Airway—make sure the hero doesn’t have anything blocking his throat that would prevent breathing. Breathing: is he? If not, she’ll need to give him breaths. Circulation: does he have a pulse? If not, CPR is next. The current method is to do CPR to “Stayin’ Alive,” the old Bee Gees’ song. (oh, oh, oh, oh, stayin, alive… one compression for each word). Giving breaths is appropriate, but the current focus is on circulation. Since he’s been stabbed in the chest, it’s good to move the clothing away from the wound to get a look. Is air coming from the wound? Pink froth? Seal the wound with something occlusive—a palm, a waterproof jacket, latex glove. Go with what you have available. If the hero seems to be getting worse, and his neck veins are standing out, he may have a tension pneumothorax—a big term meaning air from the damaged lung is leaking into the chest cavity and compressing the lung. Letting the air out helps. This is the maneuver you see on TV/in the movies where someone jams a needle/pen case/straw between the ribs, and air whistles out. If you choose to have this scenario, please have the good Samaritan punch through at the top of a rib—blood vessels and nerves run through a groove at the bottom of each rib, and you don’t want your patient to get worse! Shock may set in—he’ll feel cold, shiver, have a thready (weak) pulse, and become pale and sweaty. This would be a great time to have paramedics show up, as the hero is going downhill fast. The next entry will cover what happens to our stabbing victim in the ambulance and the ER. Questions? Comments? Kelly has worked in the medical field for over twenty-five years, mainly at large medical centers. With experience in a variety of settings, chances are Kelly may have seen it. Sometimes truth seems stranger than fiction in medicine, but accurate medicine in fiction is fabulous. Find her fiction at www.kellywhitley.com.
Monday, September 3, 2012
Hey.
I hear a lot of medical questions from writers, everything from poisoning to stab wounds.
What happens in an ER? (It's not pandemonium, and it takes longer than three minutes from door to surgery.)
What does the heart look like in surgery? (A picture is worth a thousand words.)
How can my character take out his own appendix? (Don't try it.)
Seems like a bunch of writers want access to reliable information.
This blog will feature entries about items of medical interest to writers, and I'll review comments for requests for upcoming blogs. If you have a question you want answered privately, leave me your email in the comment. I'll do my best to get back to you.
So...get out there and write that medical scene with the flavor of being there.
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