Authors Question: Treatment of Burns in Children

I got this question in my blog comments and thought I would also provide the answer here.

Latedra asks:

How would they treat burns in children? I imagine as they grow the burn scar would shrink right? My heroin received a burn as a child and I write it like she still has this big burn that is a part of her life. Is that possible? Maybe I'm over thinking it. I'm just now taking her burn seriously.

Jordyn Says: 

Hi Latedra!

Thanks for leaving a question. It depends on what kind of burn you're talking about. Burns that need a higher level of care would be those that would inhibit function. We get concerned about burns that cover a large portion of the feet, hands, face or genitalia (including breasts). The larger the burn area or the deeper the burn-- the more it may require skin grafting to heal.

Let's take a simple burn. Red with some blisters but covers maybe a palm size of the thigh. We would wash it with mild soap and water. Apply a copious layer of triple antibiotic ointment. Then we put something over top that won't stick to it-- we use a Vaseline impregnated gauze called Adaptic-- then it won't stick as the dressing comes off. More extensive burns would be referred to a burn center.

Scars generally stay the same size. They don't grow as the child grows so it may appear that they are shrinking because the child is bigger but really they are the same size.

Hope this helps!

Author Question: Cardiac Catheritization

Sandy Asks:

Hi, Jordyn. Wondering if you could help me with a couple details for my WIP. I have an 82 year old character, he had a heart attack in the presence of a couple trained in CPR. They save him, he's had an angioplasty, and doctors are shocked because all the prayer got him through this.
 
1. How long does he need to lie still?
2. When would the nurses move him to a chair?
3. How would he feel?
4. How long would he remain hospitalized if he's got folks to care for him at home?
 
Any help you can give would be appreciated.

Jordyn Says:

I actually pulled in a couple of my medical colleagues for your question since adult cardiac care isn't my main focus and I wanted to get you the best answer possible.

Here are the answers I got through a nursing friend, Crystal, from a Cardiac Unit Educator at the hospital in North Carolina where she works. Thanks, Andrea W., RN, CCRN!

1.  Well, bedrest varies per the doctor and the closure method after pulling the sheath. I guess I have seen anywhere from 2-6 hours for bedrest after pulling the sheath. Nowadays, they use closure devices most of the time and this lessens the amount of bedrest. A good average would be 4 hours.

2.  They can get him up to a chair as soon as the bedrest ordered timeframe is up and if the patient has not had any further bleeding from the site or if they have not developed a hematoma at the site.

3.  He should feel pretty good, some patients complain of soreness in their chest from the procedure.

4.  He should stay in the hospital 2-3 days max if no complications.

Sandy, best of luck to you and this book. Keep me posted on how your road to publication is going!

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Sandy Nadeau loves to go on adventures, photograph them and equally loves to write about them. She and her husband do a lot of four-wheeling in the back country of Colorado and share those experiences with others by taking them up in the mountains. With a background in writing a column about her community for a local newspaper, she also has had several magazine articles published. She loves to write novels about adventure, mystery, romance, but most importantly sharing God’s love. She is currently a member of the American Christian Fiction Writers and Vice President of the ACFW South Denver Chapter. Married for 37 years, she and her husband are loving life as grandparents to their two grandchildren. 

Forensic Question: Solving Cold Cases

My question is about cold cases. Are you able to test for DNA from blood on a knife or clothes from 30-40 years old? Also, if the remains of a body were found in a mine shaft, could you tell the manner of death from that same time or even older, say, 150 years old? How would you do this and how long would it take? Thanks so much for your help!

Amryn Says:

Cold case investigations have come a long way with the use of DNA technology. Answers that would have been impossible 20 years ago are now commonplace. The problem with cold cases is often in the handling of the evidence. On the knife or clothes that you mentioned, when they were first collected from a crime scene 30-40 years ago, the investigator may not have worn gloves. That seems shocking given what we know now, but it wasn’t all that routine a few decades ago.

What that might mean for your DNA results is that you get a mixture—say, the victim’s blood and another unknown profile. Now, does that profile belong to the killer or just the detective or crime scene tech that handled the evidence without gloves? Without something to compare back to, you won’t be able to say.

Let’s assume best case scenario, though. If the bloody evidence was stored and handled properly, it is definitely possible to get a DNA profile from the blood present on a knife or on clothes. This can usually be done with routine DNA testing, which generally takes 2-3 weeks. Of course, for the purposes of fiction, the DNA could be “rushed” and then results would possibly be available as soon as 48 hours. This testing will probably be done at the police department’s or state’s crime lab.

As far as a body in a mine shaft, unless the body is frozen, it’s likely to be not much more than a skeleton by the time it’s found 30-40 years later, and certainly 150 years. However, if the manner of death was some sort of trauma (i.e. broken neck from a fall or stab wound where the knife grazes the bone), a lot can still be determined from bones.

In most cases, a forensic anthropologist would be the person to make that determination. Some states have one on staff while others call in an expert like Dr. Bass (founder of the Body Farm) when they are needed.  I would say the time frame for that sort of determination is at least a couple weeks, though I’m sure there are cases where it could be done faster. And I should also mention, many forensic anthropologists like to be present when the team is recovering the bones to make sure none are missed and to make observations based on the position of the bones.

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Amryn Cross is a full-time forensic scientist and author of romantic suspense and mystery novels. Her first novel, Learning to Die, is available on Amazon. The first book in her latest series, loosely based on an updated Sherlock Holmes, is available for pre-order on Amazon. Look for Warzone in January 2015. You can connect with Amryn via her website, Twitter and Facebook.

Book Review: In The Name of God

In The Name of God delves into the ramifications of religious shield laws which (thank heavens this is changing) grant protection under the law if a child dies of a treatable medical illness and due to the parent's religious beliefs-- they refused medical care.

This touches close to me as a pediatric ER nurse seeing parents refuse some aspects of medical care-- immunizations would be the largest. As a parent, I believe in my right to make decisions for my children, but as a pediatric nurse, I also believe that children deserve a certain level of medical care to grow up strong and healthy. The line between these two are not always clear.

Refusing immunizations pales in comparison to what these religious groups do-- who believe that God is the ultimate healer and that if God decides-- their child will be healed from illness. Sadly, these kids die from highly treatable conditions like pneumonia, cysts, prematurity, diabetes, and urinary obstructions. The strange thing is, The Followers don't seem to have trouble going to the dentist or eye doctor.

The book alternates perspective between the legal side (those trying to change these laws) and inside views of The Followers as a religious group.

The book is interesting but really needed to be pared down. I don't need to read a play by play of a child's vomiting and throwing up each meal over two days to get the point that they couldn't hold anything down. Also, I don't think it's necessary to give gory details about a pediatric autopsy-- using words like, "This doctor was going to eviscerate . . . " I think it's disrespectful of a pediatric victim to do that. The intimate look into The Followers, in my opinion, became overindulgent and tedious to read.

That being said, I do think this is an important, challenging book and in this era of religious extremes, I think those of us that have faith need to speak out against the extremes of our faith and I applaud this book for doing so in a balanced way.

Up and Coming!

Hello Redwood's Fans!

How is all with your world? I am now fully recovered from the holiday frenzy and it's time to get back to the real world of saving children's lives, blogging about all things medical mayhem and writing suspense novels.

The Christmas tree is down and all the ornaments are put away. I've got a writing plan in place that I simply need to execute which is always the difficult part. I feel like this time of year I enjoy the remaining days of snowy weather and begin the countdown to fall-- my favorite season. Why does it have to be the shortest?

Overall, I had a good Christmas. A lot of joyful time spent with family. I didn't have to work in the ER which is always good for increasing my holiday spirit. This weekend I'm celebrating my 17th wedding anniversary! It's hard to believe how fast the years go by.

How were your holidays? Any special celebrations?

For you this week:

Tuesday: Book review of In The Name of God. Just what are religious shield laws and why should we care about them?

Thursday: Author question surrounding nursing care of the patient after a cardiac cath procedure.

Hope you have a GREAT week.

Jordyn

Book Review: Lip Reading

When I first started thinking about writing for the inspirational market, I read every one of Harry's books to see what a medical person would write. 

In Lip Reading, I feel like Kraus got back to what I love about his writing. An intriguing medical concept (developing artificial blood) and the ethical ramifications around it. For instance, should two pharmaceutical companies share research in order to get a life-saving compound to market faster? 

What creates the suspense in this novel is one of the lead researchers, and brilliant mind behind the concept, has just been diagnosed with a terminal illness. 

If you love medical suspense with an inspirational thread then pick up Lip Reading STAT. 

AND-- imagine my surprise when I didn't a little research into artificial blood and discovered we could be closer than ever to an actual product. You can read about that here.

I love it when medical thriller authors are writing cutting edge books. Great job, Harry!

Author Question: Facial Disfigurement

Dianna Asks:

I have some ideas of my own plus other medical professionals’ input but would also like yours – what would you suggest for this:

My character has some sort of facial….disfigurement is too strong a word, but what facial features could’ve been damaged via trauma two years ago enough to change a 16-year-old’s appearance (so now she’s 18-years-old)? What ideas come to mind for you?   

Jordyn Says:

I heard a talk once on facial disfigurement and the surgeon stated that we basically identify people via a small triangle of their eyes, nose and cheeks. Even though it may not be overtly obvious, even the slightest offset to the eyes will put people off. So, maybe she was in a car accident that caused this kind of disfigurement and she mostly looks all right but just slightly off and people sense that but don't say anything. And yet, she knows they are distant for this reason.

From a pediatric perspective, there is always cleft/lip palate repair as well that generally leaves scarring as well.

Hope this helps and good luck with your novel!

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Dianna Torscher Benson is a 2014 Selah Award Winner, a 2011 Genesis Winner, a 2011 Genesis double Semi-Finalist, a 2010 Daphne de Maurier Finalist, and a 2007 Golden Palm Finalist. In 2012, she signed a nine-book contract with Ellechor Publishing House. She’s the author of The Hidden Son, her debut novel. Final Trimester is her second release. After majoring in communications and a ten-year career as a travel agent, Dianna left the travel industry to earn her EMS degree. An EMT and a Haz-Mat and FEMA Operative since 2005, she loves the adrenaline rush of responding to medical emergencies and helping people in need. Dianna lives in North Carolina with her husband and their three children. You can connect with Dianna via her website.

   

          

Author Question: Juvenile Diabetes

Carol Asks:

I have a 5y/o girl who was recently diagnosed with diabetes.

Is it possible to need insulin sometimes but not others if she’s eaten “correctly”? Does stress play a role? What is she has lunch at noon and doesn't get another real meal for at least 24 hours? Maybe some crackers, granola/protein bar, peppermints,etc but she’s trapped in a post-Katrina-esque situation from about 1700 until the next afternoon/early evening.

She has a pediatrician with her. How often would he need to check her blood sugar during that time? How often would she need insulin?

Jordyn Says:

A diabetic always needs insulin. They cannot live without it (Type I or juvenile diabetes). Basically, their body is not producing insulin anymore. Insulin carries sugar from your blood to the inside of the cell where it is used for cellular energy. In the absence of glucose, the body will begin to burn fat and muscle for energy. This leads to a build up of acid in the blood and evidence of this is ketones spilling over into her urine.

Diabetics typically check their blood sugar before each meal and before bed time. Some diabetics check their blood sugar up to eight times a day. Usually, they look at what they're going to eat and decide how much insulin they need to "cover" themselves. Even if they don't have insulin and are not eating-- their blood sugars will still go up. Typically, diabetics are using insulin pumps that will give them a small but continous dose of insulin all the time but it really depends on the age of the patient and parental involvement to decide if an insulin pump would be a good idea. Also, when diabetics are newly diagnosed, it is hard to get them regulated.

Your pediatrician is going to have to stay on top of things-- particularly if they are stuck in a situation where the child doesn't have insulin-- she's going to get sick and it could happen pretty fast.  

Check out some previous posts I did concerning diabetes.

Diabetes Primer Part I and Part II.

Diabetic Emergency by Dianna Benson

Movie Review: The Purge

You may be wondering why, on a medical blog for authors, I would do a movie review. I like to think of this blog as not only exploring medical issues, but also ethical, moral and social situations. These often bleed into the medical realm-- euthanasia being one such collision.

The Purge, starring Ethan Hawke and Lena Headey, is a thriller/speculative movie that brings out some interesting social commentary that I thought would be worthy of discussion.

James Sandin, Ethan's character, is head of a specialized security firm that installs high-tech (very high-tech) security systems into private residential areas. His largest clients are his neighbors who live in a pricey, gated community.

Quickly, the viewer discovers that the need for these swanky security lock down systems is to protect people from The Purge-- which is a government sponsored 12 hour period of criminal mayhem where any crime you commit (including murder) is given a free pass. The point of this freedom to act violently is to keep the crime rate at zero for the rest of the year.

That's the trade off. Survive The Purge and live fear free the rest of the year.

Soon, the movie becomes a social commentary on our society. Is this really a government sponsored way to thin out the impoverished because they cannot afford to protect themselves like the upper class can by purchasing these types of security systems?

Things go awry when one of James's children lets in a man who is being hunted by a mob of blood-thirsty young adults. If James and his family don't release the man-- then the mob will come in and kill his family.

Of course, jealous neighbors play into a good twist at the end but The Purge is a worth it thriller. I do think it's nice to see a suspense movie with a thought provoking plot and not just violence without cause.

What about you? Have you seen The Purge? What did you think of the movie?

As an end note-- I have not seen the second film in this series, The Purge: Anarchy, which seems more like violence for violence sake.