Tuesday, July 29, 2014

Author Question: Treatment of Burns circa 1807


Michelle G asks
:


I'm working on a historical (surprise, surprise) 1807, to be exact, in England, and wondered if you could give me a little medical advice? I've burnt the leg of one of my characters, a little boy, like 9, and I want him up and about in 3 weeks or so, but he can use a crutch. What would that leg look like? How much pain? How would he react that first week? I don't want to overdo it, nor do I want to gloss over it either. What's your .02?

Here's what happened to him...

“Thomas leaned over the hearth to scoop a ladle of stew from the pot. He moved too fast, with too much force. The hook broke. The pot fell into the flames. Coals shot out, catching the fabric of his trousers. He tried to whack it out, brave boy, but ended up fanning it larger. He ran. I stopped him. I thought he was…” She gulped back the lump in her throat. “I thought he was dead.”

Jordyn Says:

This sounds like a pretty significant burn-- his pants catching on fire. Easily partial thickness and could even be full thickness in some places. Have you considered just having the pot of stew fall on him-- maybe with bare legs? This would be more partial thickness and could more likely heal in your time frame.

Full thickness burns are problematic because they usually require grafting so back then treatment was likely very limited. We also do fluid resuscitation for significant burns and if both of his legs were this severely burned-- he'd need quite a bit of fluid, and again, I'm not sure this would be available during your time period.

So, I might try to back down the injury to second degree burns. Those should heal up pretty nicely in your three week time frame. Second degree or partial thickness would include skin blistering and peeling, big concern for infection (intact skin is your largest protector against infection) and dehydration initially because burns also leak a lot of fluid. He could probably walk with crutches. It's not really a muscle injury (it would be if you go with full thickness burns-- like his pants catching of fire) so he should be able to walk.
Pain is going to be a big issue. Burns are very painful. So, he's going to need something.

Here is a very interesting link that has tons of information on the evolution of burn surgery. It will give you some treatment options for your time period. 

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Keep up with the exploits of Michelle Griep at Writer Off the LeashFacebookTwitter, and Pinterest. You can check out her latest novel,  A Heart Deceived, at David C. Cook as well as AmazonBarnes & Noble, and ChristianBook.  


Sunday, July 27, 2014

Up and Coming

Hello Redwood's Fans!

How has your week been? Mine? STRESSFUL! I've been planning a surprise birthday party for my husband. It's a BIG one but I won't divulge the number here. As of this writing, the party is tomorrow but when this posts the party will be DONE and I'll likely be drinking some of the leftover liquor to celebrate.

Do you like surprises? I do. Maybe that's why I'm a suspense author. It's been interesting, weaving these lies to keep him in the dark until the big reveal. It's actually been kind of hard because, even though I am a suspense author, I don't find it easy lying to people in real life-- particularly a loved one. I don't know how people lead multiple lives and lie to SO many. I've had trouble with one birthday party and not letting something slip.

What's been your most favorite surprise ever?

For you this week.

Tuesday: Michelle Griep stops by (who is awesome!) with an author question about historical treatment of burns.

Thursday: Author Martha Ramirez stops by to share her personal experience of discovering she had a congenital heart defect as an adult and how this inspired her to write a children's book.

Have a great week!

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.
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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.