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.

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.