Thursday, July 24, 2014

Author Question: Hockey and Head Injuries


Elaine asks
:

A hockey player gets knocked down in a fight and hits his head (with his helmet in place) on the ice. Could he be unconscious? I know the trainer would come out on the ice and possibly a doctor, but if he is unconscious, I’m assuming they’d call for the stretcher and put him in the ambulance as a precaution.

I was going to have him regain consciousness in the ambulance on the way to the hospital, but wonder what would the paramedics/EMT (which/who would it be) be doing in the ambulance? What would they do if he “came to”? And what would happen when they reached the hospital?

Jordyn Says:

Yes, it would be possible for a hockey player to be knocked unconscious with a fall on the ice even with his helmet on. If he stays unconscious, then he's going to need to be transported to a hospital. Baseline treatment would be C-spine precautions (C-collar, back board), supplemental oxygen even if he is breathing adequately on his own, and likely an IV.

If he wakes up in the ambulance, they'll first orient him to what happened. "Hey Mike, my name's Roy and I'm a paramedic taking care of you. You took quite a hit on the ice and you were knocked out. To be safe, we put a c-collar on you and put you on a backboard to protect your back. We're on the way to Swedish Medical Center to get you checked out."

Then they'll assess him. Can he move everything? Can he feel everything? Does he know his middle name? Does he know the month? Does he remember any part of the accident? Does he know what city he's in?

At the hosptial in the adult world-- you're more likely to get a CT of the head for this type of injury. So upon arrival to the ER-- the nurse would check his vital signs, do a neuro exam (as described above), and make sure the IV is patent.

The doctor will likely order plain x-rays of his neck and spine and a CT of his head. If all that checks out-- he would probably be discharged home.

Tuesday, July 22, 2014

Author Question: Doctor's Training


T.E. Asks:

Hello, I realize this may sound quite bizarre, but another author recommended you to me because I have a question about medical school.

One of my characters is currently doing an internship to become a doctor. I imagine he's about 8-10 years in with his studies, and he's at a small hospital in a fictional town right now. I know he's not a certified doctor just yet . . . but I have no idea what people refer to him as? I've heard he should be called "Fellow Xiong", but I want to make sure I've got this right. Can you help me?

Thank you so much for your time.

Jordyn Says:

Thanks for sending me your question! First, my answer is based on this being a US medical school. Not sure where you're from.

Medical school is four years. After a person completes medical school-- they take an exam and if they pass-- they are then referred to as "Doctor" and then last name. After medical school they pick what type of residency program they want to do such as adult surgical, adult medical, pediatrics, etc. A doctor's first year of residency is called their intern year but they are still referred to as Dr. such and such. After residency, they can further specialize into a discipline like cardiology, transplant surgery, etc and this would be referred to as their fellowship program.

But-- after they pass the exam after medical school they are always "doctor" and then last name regardless of where they are at in their residency or fellowship program. We might further clarify among ourselves as medical people (he's a first year resident or first year fellow) because this will give us an idea of how much training they have had.
If writing a book, though, as staff we usually call each other by first names. In front of families we'll usually say "doctor".

One thing I want to caution you on is that "small" hospitals typically don't have these types of residency programs. Just larger hospitals and those associated with universities are the most likely so you may need to rethink your setting or rethink where the doctor is at in his training-- maybe make him an attending. A small community hospital is not going to have this type of program.
**********************************************************************
 
T.E. Ridener lives in a small community in Southeastern Kentucky.  She is an author paranormal romance and urban fantasy, including but not limited to; vampires, werewolves, werebears, elementals, and ghosts. When she isn't stuck in her writing cave, she loves being an awesome aunt to her niece and nephew and catching up on all of her favorite TV shows.   She is the co-founder and co-creator of an online Christmas charity that gives presents to children in need.  In 2013, over $69,000 worth of toys was given to children who otherwise would not have had a present to open.

Sunday, July 20, 2014

Up and Coming

Hello Redwood's Fans!

How has your week been? Mine-- lovely. As you know, I'm not a fan of summer but we've been having quite a few summer thunderstorms and it has been positively marvelous. I love hearing the rain and seeing the lightning flash in dark bedrooms at night. Definitely gets my suspense author's mind working.

For you this week!

This week is my favorite activity for this blog-- answering author questions.

Tuesday: Just when do you call a doctor a doctor?

Thursday: Hockey and head injuries. Just what would the ER treatment be?

Have a safe and cool week.

Jordyn

Thursday, July 17, 2014

Author Question: Drug Testing

My super good friend and author Mark Young is stopping by to challenge me with a medical question. Mark writes great novels and recently won the 2014 National Indie Excellence Awards panel in the Mystery category for his novel Broken Allegiance. Congratulations!

Welcome back to The Edge, Mark.

Mark asks:

I was hoping you could help with a little medical drug testing problem I have in my latest novel.

Here is the situation: My main character, Tom Kagan, is knocked out using the drug Ketamine. Later, when an internal affairs investigator orders blood and  urine samples taken, Kagan also has the hospital take a second sample for himself. 

When the drug test comes back for the cops, it shows nothing in his system. But when Kagan gets his sample back, it show Ketamine in his system.

Here is my question: Can someone provide a sample of a clean blood type that is the same as Kagan’s but is someone else's, destroy the test sample containing Ketamine, and make it appear that Kagan’s blood is clean? And urine tests, how specific are they tied to an individual? Can anyone provide a sample and make it appear as if it is Tom’s?

Jordyn Says:

It is not routine to "type" someone's blood unless they need blood. In general, when blood is sent to the lab, we have no idea what type it is. These days, there is a push at many hospitals to label specimens at the bedside to avoid patient ID errors. Many hospitals are also having the patient or family member initial the lab label (that has the patient's name, DOB, and medical record number) as a double check. The nurse (or collecting provider) then notes a collection time, the date and initials the specimen as well.

Most specimens are sent to the lab via a tube system. Specimens that are collected for legal reasons, I imagine, would also have to maintain the chain of custody.

So, it is possible for a blood specimen to be switched out for someone's who doesn't have the ketamine in their system but these are the problems you'll have to overcome. Switching out the tube but still having the label appear as it normally would. 

You could do a handwritten label. This would be rare but not unusual as long as it had all the identifying characteristics the lab would require. At a minimum, this would be the patient's name and DOB. Something like the computer system going down could cause something like this to happen. The lab may call to investigate why it was labeled in such a manner which could increase tension/conflict in your scene.

Also, in some situations, specimens are hand-carried to the lab on occasion to ensure delivery. This might well be the case here because there is legal concern and this is when a switch could take place as well.
  
Generally, what is tested for drugs is urine. Here is a post I did on the common, illicit (depending on the state) drugs we look for. You can test for Ketamine but it is going to be a "special order" test. Here is some great info on Ketamine drug testing.

You will have the same issue with a urine sample. Urine isn't "typed"-- it's not tied to a particular individual except by the label on the cup. Also, if it's a legal manner, the individual might have to be monitored as they pee to ensure the specimen wasn't altered or substituted out.

An intriguing scenario you have here. Good luck with your novel!

*******************************************************************


Mark Young is an award-winning author of three previous bestsellers, Revenge (A Travis Mays Novel) and two Gerrit O’Rourke novels, Off the Grid and Fatal eMpulse. Prior to his full-time writing career, Young served as a police officer with the Santa Rosa Police Department in California for twenty-six years. Additionally, he was an award-winning journalist and a Vietnam combat veteran. He served with several law enforcement task force operations, including the presidential Organized Crime and Drug Enforcement Task Force targeting major drug traffickers, and the federal Organized Crime Task Force charged with identifying and prosecuting prison gang leaders. He lives in the Pacific Northwest with his family. Visit www.MarkYoungBooks.com to find out more about Young and his writing.