I'm working on a story where one of my characters wakes up in a hospital, and I need her to be able to find a weapon that she can use in a future scene to kill something Rottweiler-sized.
What is she killing? Human or animal? Can she get close enough to touch it, or does it have to be from a distance? Ultimately, it depends where in the hospital your character wakes up, what shape they're in (ie, good enough to lift something heavy), and what you make readily available.
Access to a defibrillator would be very effective. One unsynchronized shock would do it.
Oxygen explodes with flame, for instance. The waterless shampoo the hospitals give patients is also extremely flammable. You can spray it and light the spray on fire, and voila! Flame thrower!
Most bed tables have glass mirrors in the table that pop up when you lift the tabletop. Mirror shard as knife.
Plastic sheets/Chux can be used for suffocation. Any tubing also would work.
If you wanted to go MacGyver, a saline IV spill and electricity might work.
An IV pole can be used as a weapon, and the top part (with the hooks) pulls out. That piece is usually about three feet long and could make a blunt stab (belly, maybe).
Good luck!
Questions? Comments?
Thanks to Crime Scene Writer for this question!
~*~
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, October 29, 2012
Monday, October 22, 2012
Writing a Comatose Character On a Ventilator After a Stroke
Hi Kelly, My character is 70ish, and is hospitalized after a car accident, broken bones and head injury. While in the hospital, he has a stroke.
1. What would cause the stroke?
A couple of options. Strokes can be ischemic (lack of blood flow) or hemorrhagic (bleeding into the brain). Either would work for an older individual.
2. I'd like him fairly soon go into a comatose state. Could that happen?
Yes—and it can occur with whatever timing you wish, if you want it to coincide with the stroke.
2-A. If he has a stroke and is comatose and ventilated, could he have normal brain activity?
If he has a stroke and becomes comatose, the EEG (Brain wave activity measured by the pattern of electrical impulses coming from the brain) won't be normal. Diffuse slowing is usually noted with a diffuse brain injury, such as lack of oxygen after cardiac arrest.
More abnormal patterns are seen after severe trauma.
Two EEGs seventy-two hours apart are often used to get an idea of prognosis.
If the patient doesn't react to external noxious stimuli, like pain or cold water in the ears, chances are you're looking at a very poor prognosis.
Coma of any source has abnormal brain activity--after cardiac arrest, for example, where the brain can be damaged by lack of oxygen until circulation is restored.
The ventilator can be for many reasons: the patient who doesn't breathe on his/her own; sedation given for seizures or agitation; severe brain injury.
Sometimes in electing to withdraw life support the ventilator is removed. Some patients will breathe on their own as breathing is a brainstem function, not a cerebral "Gray Matter" function.
3. What would lead to a tracheotomy?
A tracheotomy (or tracheostomy) is a surgically created hole in the windpipe, generally used for longterm ventilator patients or in cases of head/neck cancer.)
Need for a ventilator beyond a few days. The breathing tube (endotracheal tube) is held in place by a balloon cuff, which puts pressure on the trachea. After a few days, that can injure the trachea, so a tracheostomy is done.
4. Could he have the ventilator and a tracheotomy?
Both. The trach would be done because of the continued need for mechanical ventilation.
5. What I'm really wanting to do is set him up so that he gets increasingly worse and the children have to debate whether to take him off life support. I'd like the doctor to say a few words that would convince one hesitant grown up child that his prognosis if futile and he should be taken off all life support and be allowed to die, but yet I'd like the patient be open for a miraculous recovery. What words would a doctor use to convince the person to stop treatments?
“No hope of meaningful recovery.” Or, “Severe brain damage.” Or, “His organs have shut down.” Kidneys and liver being biggies in this area and worsening the prognosis.
6. Is it possible to take off the feeding tube and if the patient breathes on his own, to continue giving nourishment, if a decision is made to let him die?
If the patient has enough brainstem function, he can breathe on his own. Nourishment is considered to be supportive care. There’s a lot of controversy about whether it equals life support. Starving a patient will make most medical personnel uncomfortable, and they will likely refuse to starve the patient. This can lead to an ethics inquiry within the hospital.
In these situations (no vent, nourishment given), it’s not uncommon for a secondary complication to lead to death, such as pneumonia or another infection.
7. Say the family all agrees that the vent should be removed, but if he breathes on his own, he should be given treatment. Is that doable?
Anything is doable. There are no absolutes when it comes to these situations.
You can decide not to resume the vent if the patient can’t breathe, decide not to use CPR for resuscitation and use only drugs, use no drugs or CPR.
Another thing you may want to keep in mind: if there is no wife and no medical care proxy, the oldest child is the legal next of kin and legal decision maker. That doesn't mean they won't take the wishes of the others into account, but legally that individual can call the shots.
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.
1. What would cause the stroke?
A couple of options. Strokes can be ischemic (lack of blood flow) or hemorrhagic (bleeding into the brain). Either would work for an older individual.
2. I'd like him fairly soon go into a comatose state. Could that happen?
Yes—and it can occur with whatever timing you wish, if you want it to coincide with the stroke.
2-A. If he has a stroke and is comatose and ventilated, could he have normal brain activity?
If he has a stroke and becomes comatose, the EEG (Brain wave activity measured by the pattern of electrical impulses coming from the brain) won't be normal. Diffuse slowing is usually noted with a diffuse brain injury, such as lack of oxygen after cardiac arrest.
More abnormal patterns are seen after severe trauma.
Two EEGs seventy-two hours apart are often used to get an idea of prognosis.
If the patient doesn't react to external noxious stimuli, like pain or cold water in the ears, chances are you're looking at a very poor prognosis.
Coma of any source has abnormal brain activity--after cardiac arrest, for example, where the brain can be damaged by lack of oxygen until circulation is restored.
The ventilator can be for many reasons: the patient who doesn't breathe on his/her own; sedation given for seizures or agitation; severe brain injury.
Sometimes in electing to withdraw life support the ventilator is removed. Some patients will breathe on their own as breathing is a brainstem function, not a cerebral "Gray Matter" function.
3. What would lead to a tracheotomy?
A tracheotomy (or tracheostomy) is a surgically created hole in the windpipe, generally used for longterm ventilator patients or in cases of head/neck cancer.)
Need for a ventilator beyond a few days. The breathing tube (endotracheal tube) is held in place by a balloon cuff, which puts pressure on the trachea. After a few days, that can injure the trachea, so a tracheostomy is done.
4. Could he have the ventilator and a tracheotomy?
Both. The trach would be done because of the continued need for mechanical ventilation.
5. What I'm really wanting to do is set him up so that he gets increasingly worse and the children have to debate whether to take him off life support. I'd like the doctor to say a few words that would convince one hesitant grown up child that his prognosis if futile and he should be taken off all life support and be allowed to die, but yet I'd like the patient be open for a miraculous recovery. What words would a doctor use to convince the person to stop treatments?
“No hope of meaningful recovery.” Or, “Severe brain damage.” Or, “His organs have shut down.” Kidneys and liver being biggies in this area and worsening the prognosis.
6. Is it possible to take off the feeding tube and if the patient breathes on his own, to continue giving nourishment, if a decision is made to let him die?
If the patient has enough brainstem function, he can breathe on his own. Nourishment is considered to be supportive care. There’s a lot of controversy about whether it equals life support. Starving a patient will make most medical personnel uncomfortable, and they will likely refuse to starve the patient. This can lead to an ethics inquiry within the hospital.
In these situations (no vent, nourishment given), it’s not uncommon for a secondary complication to lead to death, such as pneumonia or another infection.
7. Say the family all agrees that the vent should be removed, but if he breathes on his own, he should be given treatment. Is that doable?
Anything is doable. There are no absolutes when it comes to these situations.
You can decide not to resume the vent if the patient can’t breathe, decide not to use CPR for resuscitation and use only drugs, use no drugs or CPR.
Another thing you may want to keep in mind: if there is no wife and no medical care proxy, the oldest child is the legal next of kin and legal decision maker. That doesn't mean they won't take the wishes of the others into account, but legally that individual can call the shots.
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.
Wednesday, October 17, 2012
Bulletproof Vests and Injuries When Shot With a Hand Gun
Hi.
My cop hero is shot with a hand gun while wearing a bulletproof vest. I want him to be injured, enough that he has to see a doctor, but not enough that he requires hospitalization. What kind of injuries could he have?
Hello.
I’m assuming you want him to be hit in the vest. Let’s consider the factors involved.
The force of the bullet is going to depend on the type of vest, how close your hero is when the shot is fired, and the type of round/bullet.
First, the vest. Most police issue vests are made of Kevlar, a synthetic fiber woven into a dense fabric. Multiple layers strengthen the vest. The weight is proportional to the thickness, therefore these vests are generally not too heavy and very reliable in preventing perforation of small caliber hand gun bullets.
Distance: consider a small caliber hand gun at relatively close range. With a trajectory perpendicular to the chest, the bullet can hit with enough force to knock the cop backward. He could sustain injuries related to falling on a hard surface. The bullet can also hit hard enough to injure the chest wall beneath the vest, including bruising, abrasions, and cracked ribs.
The bigger the round, the more damage. The average law enforcement vest isn’t designed to handle a rifle round. This kind of round can pierce the vest and do as much damage as it would without the vest.
With a cop shot by a hand gun at a short distance, I’d expect him to be knocked backward and possibly fall. He’ll be seen in the ER, and get a chest X-ray to check for broken ribs. If he’s just banged up, he’ll be discharged. If he has cracked ribs, he’ll be sent home with cautions relative to treating this (pain control, deep breathing to prevent pneumonia, follow-up doctor’s visit). In the rare case of a severe rib fracture puncturing a lung, he’ll be admitted.
Good luck with your scene!
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.
My cop hero is shot with a hand gun while wearing a bulletproof vest. I want him to be injured, enough that he has to see a doctor, but not enough that he requires hospitalization. What kind of injuries could he have?
Hello.
I’m assuming you want him to be hit in the vest. Let’s consider the factors involved.
The force of the bullet is going to depend on the type of vest, how close your hero is when the shot is fired, and the type of round/bullet.
First, the vest. Most police issue vests are made of Kevlar, a synthetic fiber woven into a dense fabric. Multiple layers strengthen the vest. The weight is proportional to the thickness, therefore these vests are generally not too heavy and very reliable in preventing perforation of small caliber hand gun bullets.
Distance: consider a small caliber hand gun at relatively close range. With a trajectory perpendicular to the chest, the bullet can hit with enough force to knock the cop backward. He could sustain injuries related to falling on a hard surface. The bullet can also hit hard enough to injure the chest wall beneath the vest, including bruising, abrasions, and cracked ribs.
The bigger the round, the more damage. The average law enforcement vest isn’t designed to handle a rifle round. This kind of round can pierce the vest and do as much damage as it would without the vest.
With a cop shot by a hand gun at a short distance, I’d expect him to be knocked backward and possibly fall. He’ll be seen in the ER, and get a chest X-ray to check for broken ribs. If he’s just banged up, he’ll be discharged. If he has cracked ribs, he’ll be sent home with cautions relative to treating this (pain control, deep breathing to prevent pneumonia, follow-up doctor’s visit). In the rare case of a severe rib fracture puncturing a lung, he’ll be admitted.
Good luck with your scene!
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.
Tuesday, October 9, 2012
Death by Hanging:Suicide or Homicide?
I have a murder by hanging, but I want it to look like a suicide. The murderer ties a rope to the second floor stair railing, puts a noose around the victim’s neck, and tosses her over. Is there a way to confuse the medical examiner?
Hello.
Most suicidal hangings are from lower heights, and the victim dies from suffocation and lack of blood flow to the brain. The victim typically has a Vee-shaped bruise on the front of the neck. Tiny broken blood vessels can be seen in the eyes and mouth.
If the killer uses a ligature to strangle the victim and then attempts to make it look like a hanging: the medical examiner would find a transverse bruise from the ligature.
If the victim dies from the strangulation, less bruising will occur from the rope. The ME would call this a homicide.
Other trauma that suggests a struggle will cause suspicion about homicide. It would be difficult to subdue a conscious adult, place a noose, and throw the victim over a railing without trauma. Injury from incapacitating the victim—head wound, for example—increases the likelihood of homicide.
The way the knot is tied and secured can give clues as well.
A hanging by the neck with a fall of more than six feet is capable of fracturing the neck. There’s a fair body of evidence on this since hanging is utilized as capital punishment in many countries. Throwing a victim off a second floor balcony is very likely to cause a fracture. Few suicides would choose this method.
Hanging from an intermediate height--such as forcing the victim to stand on a chair and then removing the chair would look like suicide. If the victim is drunk or has taken sedatives, she could be unconscious from this, making it easier to control her. It's not unusual for suicides to takes pills or alcohol.
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.
Hello.
Most suicidal hangings are from lower heights, and the victim dies from suffocation and lack of blood flow to the brain. The victim typically has a Vee-shaped bruise on the front of the neck. Tiny broken blood vessels can be seen in the eyes and mouth.
If the killer uses a ligature to strangle the victim and then attempts to make it look like a hanging: the medical examiner would find a transverse bruise from the ligature.
If the victim dies from the strangulation, less bruising will occur from the rope. The ME would call this a homicide.
Other trauma that suggests a struggle will cause suspicion about homicide. It would be difficult to subdue a conscious adult, place a noose, and throw the victim over a railing without trauma. Injury from incapacitating the victim—head wound, for example—increases the likelihood of homicide.
The way the knot is tied and secured can give clues as well.
A hanging by the neck with a fall of more than six feet is capable of fracturing the neck. There’s a fair body of evidence on this since hanging is utilized as capital punishment in many countries. Throwing a victim off a second floor balcony is very likely to cause a fracture. Few suicides would choose this method.
Hanging from an intermediate height--such as forcing the victim to stand on a chair and then removing the chair would look like suicide. If the victim is drunk or has taken sedatives, she could be unconscious from this, making it easier to control her. It's not unusual for suicides to takes pills or alcohol.
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.
Wednesday, October 3, 2012
Shock and sucking chest wound at the site of an accident
***A portion of this post appeared previously on Crime Scene Writer.(Link at end of post)
A passerby comes upon an accident. The victim is in shock and has a sucking chest wound.What can be done by a layman armed only with a first aid kit and good intentions?
The Good Samaritan is alive and well and willing to risk a lawsuit to provide aid.
The first weapon in your arsenal is a cell phone. Call 911, then administer first aid.
Shock in this case would most likely be due to blood loss. The damage causing the majority of the bleeding is going to be internal. If the victim is breathing, compressing the wound to stop external bleeding is about all you can do.
Elevating the victim’s feet will keep the blood central, where it will do the most good. Keeping him/her warm by covering the torso will help conserve body heat.
Now for the sucking chest wound.
I’m going to make a leap here and assume you mean a tension pneumothorax. With our accident victim, air enters the chest—it's “sucked” in, but doesn’t exit. This generally happens when air leaks from the damaged lung into the chest, but can’t exit. This so-called “free air” takes up space, and leads to collapse of the lung on that side. The more air that leaks into the chest space and is trapped there, the worse things become.
The treatment is to get the air out. Depending on what you have in your first aid kit (and glove compartment) there are a few options.
First, seal the wounds on the outside of the chest. With penetrating trauma, this means entry and exit wounds. Doing this prevents air from entering from the outside.
Next, look at the patient’s neck—are the neck veins standing out? Normally they wouldn't be, especially in shock. Is the trachea (the breathing passage in the front of the throat). Normally, it should be straight up and down. If it's shifted to the side opposite the wounded side of the chest, this is a sign of pressure in the chest.
The air must be evacuated. In an emergency, a needle between the ribs will let the air out. Inserting the needle will give the trapped air an exit. This is a favorite TV scenario, but it's right on the money as far as a first step.
If no needle is available, any small tube will do. In a MacGyver moment, you can make a hole between the ribs with a pocket knife, and use a pen (take out the innards) and use this as a tube. A drinking straw will work, but is harder to keep from collapsing.
By this time, hopefully the sweet music of an approaching ambulance will fill your ears, as you did the right thing and called 911 first.
~*~
Crime Scene Writer is a forum for asking and answering crime scene investigation, applied forensics, and police procedure questions for fiction or non-fiction writers.
***Click here to join Crime Scene Writer.
~*~
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.
A passerby comes upon an accident. The victim is in shock and has a sucking chest wound.What can be done by a layman armed only with a first aid kit and good intentions?
The Good Samaritan is alive and well and willing to risk a lawsuit to provide aid.
The first weapon in your arsenal is a cell phone. Call 911, then administer first aid.
Shock in this case would most likely be due to blood loss. The damage causing the majority of the bleeding is going to be internal. If the victim is breathing, compressing the wound to stop external bleeding is about all you can do.
Elevating the victim’s feet will keep the blood central, where it will do the most good. Keeping him/her warm by covering the torso will help conserve body heat.
Now for the sucking chest wound.
I’m going to make a leap here and assume you mean a tension pneumothorax. With our accident victim, air enters the chest—it's “sucked” in, but doesn’t exit. This generally happens when air leaks from the damaged lung into the chest, but can’t exit. This so-called “free air” takes up space, and leads to collapse of the lung on that side. The more air that leaks into the chest space and is trapped there, the worse things become.
The treatment is to get the air out. Depending on what you have in your first aid kit (and glove compartment) there are a few options.
First, seal the wounds on the outside of the chest. With penetrating trauma, this means entry and exit wounds. Doing this prevents air from entering from the outside.
Next, look at the patient’s neck—are the neck veins standing out? Normally they wouldn't be, especially in shock. Is the trachea (the breathing passage in the front of the throat). Normally, it should be straight up and down. If it's shifted to the side opposite the wounded side of the chest, this is a sign of pressure in the chest.
The air must be evacuated. In an emergency, a needle between the ribs will let the air out. Inserting the needle will give the trapped air an exit. This is a favorite TV scenario, but it's right on the money as far as a first step.
If no needle is available, any small tube will do. In a MacGyver moment, you can make a hole between the ribs with a pocket knife, and use a pen (take out the innards) and use this as a tube. A drinking straw will work, but is harder to keep from collapsing.
By this time, hopefully the sweet music of an approaching ambulance will fill your ears, as you did the right thing and called 911 first.
~*~
Crime Scene Writer is a forum for asking and answering crime scene investigation, applied forensics, and police procedure questions for fiction or non-fiction writers.
***Click here to join Crime Scene Writer.
~*~
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, October 1, 2012
Monday is for Questions
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
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