Author Question: The ER Doc and the EarthQuake

Patrick Asks:

In my novel, I have an ER doc on vacation with his family. An earthquake strikes. His 14 y/o son suffers grievous injuries (I'm thinking a concrete pillar falls across his midsection.) The doc knows that in the best of situations, in an equipped trauma center, he'd only have a slim chance of saving his son's life. As it is all he can do is try to comfort his son and be with him as he dies.

So my questions are threefold:

1.  What would be the signs that would convince him that his son is doomed and there's nothing he can do?

2.  How long would it take for the poor kid to die?

3.  How would the doctor identify himself, or think of himself, in a casual situation?

Jordyn Says:

Hi Patrick! I am happy to help with your question.

#1: What would be the signs that the son is going to die?

Essentially the scenario you've set up would be death from hypovolemic shock (the son is bleeding out). Or, organ dysfunction from crush injury. But, let’s stick with hypovolemic shock as it will work well in this scenario.

What would be more concerning to the father and trained ER doctor would be his signs of shock--- this would lead to his death. I'm going to use the medical words because this is how your ER doctor would think and then I'll put what they mean in parenthesis.

I think one thing that helps is to understand the symptoms in light of the injury. When you're bleeding out, you're losing blood. Blood carries oxygen. So the body compensates by trying to circulate those remaining red blood cells faster.

Shock is your body's inability to meet its oxygen demands (hypovolemic shock is one type of shock.) So, initial signs of hypovolemic shock are: tachycardia (increased heart rate to circulate the blood faster), tachypnea (increased breathing rate to load more oxygen on the cells that remain), complaints of thirst, pallor (pale skin-- circulating red blood cells gives you your color) and diaphoresis (sweating). Also, diminished, weak, rapid peripheral pulses. Peripheral pulses are those at your wrist (radial) and feet (pedal). This would progress to central pulses--those in your neck (carotid) and groin (femoral)--- being weak and thready.

In kids (this is my area of specialty)-- the blood pressure will be normal initially because kids can do really well at compensating for shock up to a point.

So-- hypotension (or low blood pressure) is then an ominous sign. One way a trained ER doctor can estimate what his son’s blood pressure is is by palpating his pulses.

eMedicine

For instance:

If you have carotid, femoral and radial pulses: Your BP is at least 70mmHG systolic.

If you have carotid and femoral Pulses: Your BP is at least >50mmHG systolic.

If you have only a carotid pulse: Your BP is about 40mmHG systolic.

You cannot discern diastolic pressure using this method.

As his shock progresses, his level of consciousness will begin to wan. He'd have periods of being coherent-- then unresponsive (depending on how fast you'd want this death to occur). The brain is oxygen hungry so when it doesn't have enough-- you become unconscious.

His ultimate sign of impending death will actually be bradycardia (low heart rate-- less than 60 beats/minute) progressing to asystole (no heart beat). This is how kids generally die. The child would become unconscious. His breathing would slow/stop. His heart rate would slow then stop. Pupils will dilate and become unresponsive to light.

#2. How fast would this happen?

This is really your choice. If your character has a major aortic rupture (this is a major blood vessel--your descending aorta-- that is in your abdomen) death could take place in 1-2 minutes. Also the spleen and liver are highly vascular (meaning they have a lot of blood vessels) and crush injuries to these organs would lead to rapid exsanguination (bleeding out) as well. Or, you could have slow leaking type bleeding that could take longer to die from. All bleeding-- if not stemmed-- can lead to death.

#3. How would he refer to himself? "Hey, I'm Dan, I'm an ER doctor."

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Patrick J. Worden is the author of several books, including the just released novel, Voracious. He blogs on culture and current events at http://pworden.com/.