Recovery After Gunshot Wound to the Head

My character attempted suicide with a small-caliber revolver as a teenager. He survived and became a police officer. I need to know about recovery time, stages of recovery, rehab, and possible lingering effects of the trauma.

It’s going to depend on your scenario.

It’s not unusual for someone to survive a GSW to the head. Suicides tend to put the gun against their temple, and take out the optic nerve. They end up blind and with some facial deformity, depending on the gun.

Since your character is a police officer in the future, you can choose anything from the bullet “ricocheting” off the skull and traveling under the skin (without penetrating the bony calvarium—the bone of the skull) to going through part of the motor strip (which controls muscle action), which would give rise to the need for rehab. One caveat—he might never overcome those mechanical deficits enough to work as a police officer; witness Congresswoman Gabby Giffords. She’s better, but she’d never qualify for police work.

**Consider having the bullet penetrate the skull, but do minimal damage to the brain itself by traveling beneath the bony calvarium. The brain is a tricky, and you can pick and choose to a certain extent about what deficits you’d like to induce.

Rehab in this case would be directed at relearning motor functions in the damaged area; physical therapy for strengthening, occupational therapy for fine motor skills. Maybe speech therapy.

Begin with sitting up in bed for fifteen minutes, and go from there. Again, the duration of rehab is going to be proportional with the amount of damage. If a small amount of damage, I’d say a week to ten days in the hospital, four to six weeks at a rehab hospital/facility, and maybe outpatient therapy for a couple of months beyond that. The patient would be expected to do exercises at home on his own.

Lingering effects of the injury include easy fatigability, more muscle weakness when tired, sleep-deprived or hungry, and possible abnormal emotional reactions from inappropriate laughter to crying. It’s also not uncommon for these patients to end up with a seizure disorder. Posttraumatic stress disorder also isn’t uncommon, as is depression and a lower frustration threshold.

One of the most interesting GSWs I’ve seen was a man who’d been shot in the forehead. He had decreased ability to process pain, an increase in irritability, and poor decision-making—none of these would be good in a cop.

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.

Like crime scenes? I recommend Crime Scene Writer. To join: crimescenewriter@yahoogroups.com

A Killer Performs Premortem Organ Harvest

In my story, the villain keeps the victim alive, while removing their organs (before eating them). I need a drug that will keep the victim alive but sedated. I don’t want to use curare. What would be a workable drug?

I’d suggest IV Propofol (the drug that killed Michael Jackson). It’s a powerful but short-acting sedative, a white liquid sometimes called “mother’s milk” by anesthesiologists. I've seen patients sedated enough to quit breathing, and wake up within 15-20 minutes. The drug is rapidly metabolized-- i.e. before "dinner" for your killer.

To do the proposed organ harvest (and have the victim not flailing around) the killer would need to administer enough to affect respiration, so your “surgeon” would require a way to breathe for the patient—a tube in the airway to get oxygen to the lungs. If your killer can put a tube down the victim's throat, or cut a hole in front in the trachea and put in a tube, breathing for the victim can be done two ways:

1) Someone could "bag" the victim (and a bellows-type bag squeezed 10-16 times a minute) until the killer gets the organs out. This would require a second person. In third world countries, medical organizations have used a McGyver version of this with a garbage bag as an oxygen reservoir and a bellows.

2) A mechanical ventilator. Consider having him steal a mechanical ventilator. An ambulance, Life Flight helicopter, or a doctor's office that has a surgical suite would be places to look.

These portable vents can be ordered online if you have a medical credential (maybe for your book, a fake credential). If I were your killer, I'd steal a portable ventilator and the propofol (which is a hospital item).

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.

Like crime scenes? I recommend Crime Scene Writer. To join: crimescenewriter@yahoogroups.com

Death by Ant Sting

I want to set a scene where the victim is staked in the desert and stung by ants. Can ants kill people?

Sure.
Fire ants, which can be found in the desert Southwest (Oklahoma and Texas), can kill.
Small animals like kittens can be killed. So can humans. Here’s how:

These are the most aggressive ants on the planet. They’re distinguished by a penny-colored head and thorax, and a darker body. They have mandibles or “jaws” In contrast to other kinds of ants, fire ants use their mandibles to grip the skin; a stinger in the abdomen delivers a venom (solenopsin). The ant can rotate around the site of its attachment and keep stinging. A swarm of ants can deliver a large number of stings in a short period of time.

The sting is said to be “like fire,” hence the name of the ants. It results in raised red bumps. Treatment of the skin with bleach or ammonia in water, meat tenderizer, or even urine will denature the venom and relieve some of the pain.

Most people can handle multiple stings; individuals allergic to insect stings (bees, scorpions, etc) are susceptible to severe allergic reactions called anaphylaxis. Flushing, profuse sweating, and swelling—particularly of the face and airway—and difficulty breathing occur in short order, ranging from seconds up to an hour. It’s a medical emergency, and death occurs if treatment isn’t undertaken with epinephrine (as in an epi-pen) and antihistamines.

As far as setting, in areas without ground cover, the ants form mounds, which can be up to fifteen inches high. A desert wound be a likely location for a mound, or even an area with little ground cover like a lawn or rough grazing land.

These ants are aggressive—disturbing the mound will bring them swarming out. Staking a victim allergic to bees/wasps/ants in the vicinity of a mound would work. A victim not allergic could potentially die if he/she had an underlying medical condition—bad heart, severe asthma, elderly are possibilities. The killer needs to be wary of stings; boots and heavy clothing are recommended.

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.

Like crime scenes? I recommend Crime Scene Writer. To join: crimescenewriter@yahoogroups.com

Traumatic Amputation in a Car Accident

In a car accident, my character’s arm is trapped and severely injured. Emergency personnel are working to get him out, and it looks like his arm is severed. What determines whether his arm can be saved?

This is a case of traumatic amputation—usually as the result of an accident.

The first factor will be what shape he’s in otherwise. If he’s had a lot of bleeding, shock may set in. Other trauma (head, abdomen, etc) may take precedence in treatment. In this case, there would be consideration of amputating the arm to get him out of the wreckage and save his life.

Your scenario would suggest that these other injuries are not present—which can be the case in a car wreck. Bleeding and shock must be controlled.
Once he’s freed, he may have:
1) A severe crush injury—this would likely require amputation. Very difficult to salvage a limb in this case.
2) A relatively clean complete severing of the arm—better chance of limb salvage and replantation (ie, reattachment).
3) A partial amputation—incomplete severing of the arm. The sharper the edges of the cut, the better. Best chance of replantation.

Upper limbs have a better chance of a good outcome in replantation.

The proper way to care for the completely severed arm is to wrap it in DRY clean towels or a sheet, and then wrap it in plastic. This may sound like the opposite of what to do, but getting the wound wet can worsen the situation.

The stump should be carefully cleaned and protected; loose tissue should be preserved as-is—no trimming or forcing into the anatomic position.

In the ER, the doctor will use the Mangled Extremity Severity Score (MESS) to determine the likelihood of successful reattachment. The score takes into account the type of amputation (partial, complete, clean, dirty), circulation, health of the limb and general health of the patient (younger people have better outcomes) temperature, paralysis (in the case of partial amputation) and numbness. The best chance of replantation is within six hours of the injury.

After replantation, bleeding, shock, and infection are all considerations.
For hand amputations, sometimes medical leeches are used to improve circulation. Yes, this is a real treatment. It’s odd to see a medical leech at work on a patient in the ICU.

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.
Blog: www.kellywhitleybooks.blogspot.com

Killing a Character with Fireworks Falling From the Sky

My character is at a commercial fireworks display. Can a firework fall from the sky and kill him?

Burns, bruises, blast injuries—all well-known problems associated with fireworks. But what about the big displays, the massive showers of multicolored sparks in the night sky at New Year’s Eve and the Fourth of July? Do they ever fall from the sky?

Yes. Yes, they can, and they do. These accidents occur with commercial fireworks—large and loaded, and restricted to trained and licensed pyrotechnics experts.

An aerial shell—basically a mortar—is loaded with multiple clay balls, each containing chemicals that ignite in color. The shell is launched, and the contents ignite in a desired order. The burning chemicals give the color, while the packaging controls the timing of the explosion. This gives rise to the fancy displays typical for Fourth of July.

A launched shell that does not explode—a “dud”—can drop from the sky. They can be heavy enough to cause serious injury from the weight, in addition to burns and blast injuries if the shell ignites close to people. An unlaunched shell that explodes on the ground is dangerous--there are reports of decapitation resulting from bending over a shell as it goes off.

Although rare compared to more typical home fireworks injuries, there are multiple reports of accidents caused by commercial fireworks displays.

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.
Blog: www.kellywhitleybooks.blogspot.com