Miracle or Experience?

I can't tell you how many times a day I run into parents at the hospital who don't believe what I tell them in triage. Now, as a nurse I can't diagnose an illness but when I try to relay their fears-- I often get the quizzical one eyebrow raise.

This happens a lot with abdominal pain. Abdominal pain in kids is most often constipation and it fits a pretty consistent pattern. Most parents who present with their children to the ER for abdominal pain think their child has appendicitis. That also fits a fairly consistent pain pattern. This is not to say you can put ALL kids into one of these two camps (because sometimes kids actually have both or one presenting like the other) but you can reassure parents who feel like the next step for their child is the OR by saying something like:

"This could be appendicitis but based on my experience, your child's symptoms fit more into a constipation issue. You'll get a doctor's exam and they'll diagnose you but you will not be going to the OR in say . . . the next ten minutes."

And then I get that knowing eye roll that says . . . "Well, why believe her. She's just the nurse."

And nine times out of ten do you know what the discharge diagnosis is? Constipation.

It's not rocket science. I don't have a crystal ball. But what I have is nearly twenty-two years in nursing . . . almost twenty years in pediatric ER and critical care. What that says is I've seen, literally, thousands of kids present with abdominal pain. I know the classic signs of constipation. I also know the classic signs of appendicitis. They do present differently. I can educate (this is a nurse's job) on the signs and symptoms of these two illnesses and what the doctor will likely choose to do-- to prepare the family for what they face.

After an ER shift, I got home and the first thing my husband says is, "Harley let out the weirdest yelp when he was just lying down. We have no idea what it was about."

Harley is our dog. Harley has pretty bad hip dysplasia so it's not unusual for him to tweak a hip if he's been moving but in this instance he hadn't which raised my husband's suspicion.

I call Harley over and immediately notice blood in his fur near his neck. Now, it wasn't a lot of blood and my husband hadn't noticed it. Why did I? Because I see blood every day and am in tune to noticing even the smallest amounts of it.

I comb through his coat with my fingers and there isn't a cut underneath. How else would a dog get blood on his coat in that area? We're used to asking ourselves this with kids-- because kids may not always be developmentally able or willing to tell us.

Which led me to think that he'd scratched himself and the blood came from a paw. Then I see droplets of blood on the floor-- like when we accidentally cut his toenail too close. Yes, I had done this myself.

I see one of his toes looks bloody.

"Where was he laying?"

My husband points to the spot and I see a full-length toe nail on the carpet. He'd been scratching himself and caught the nail in his chain collar which ripped it fully off.

Mystery solved in under five minutes. My husband was somewhat baffled.

Not me. It's not a miracle. It's my experience in injury mechanism that I practice every day.

This is how it can be for your medical characters. Have them use their experience in other situations to make them come to life in your novels. They don't just have to stay in the hospital.

Winner!!

A quick note to announce the winner of Bethany Macnanus's e-book Nerve . . .

Congratulations Mattie P!

Hope you enjoy the novel and thanks so much to Bethany for your insight into genetic analysis and how it inspired your story. Can't wait to read it myself.

Up and Coming

Hello Redwood's Fans!

How has your week been? Mine? Feeling a little overwhelmed lately. My writing life is gearing up in a good way but trying to fit all that in with working part-time is anxiety producing. Any other author in that boat with me?

Colorado is in what a good friend of mine calls "the teasin' season" when she can't really decide if it's still winter or spring. One day this week, we had a few inches of snow and then by evening it was sunny and all melted. Anyone else live in a state like this?

For you this week I thought I'd give you a glimpse into what really happens behind the scenes in the ER.

Tuesday: Are ER nurses smart about medical things?

Thursday: Just why can ER wait times be sooo long?

Tune in and find out.

Have a GREAT week.

Jordyn

Can Peanut Allergies Be Cured?

There are few things that make me nervous in the ER anymore. After spending twenty plus years in nursing, I've seen and handled most everything.

One exception is peanut allergies. When a patient signs in with that complaint it is emergent because of the concern of anaphylaxis which I posted about here. There is a point of no return when it comes to an allergic reaction where the patient will die despite all efforts. 

The other question becomes just how do we protect these children? An Epi-pen should be kept with these children at all times. For one, some parents won't do this. Also, parents are uncomfortable giving these injections. 

Another reaction is to create a peanut-free environment. In reality, I don't know how feasible this is. Peanuts and peanut products are prolific and I feel like this gives parents a false sense of security. 

Recently, researchers developed a study to see if they could inhibit the body's response in a peanut allergy. They gave small but increasing amounts of peanut protein along with a probiotic every day for eighteen months. The test group was split in half with half of the participants receiving a placebo that looked and smelled like the treatment. On the last day of the study, the participants were given a double dose of peanut protein with the probiotic. Twenty-six of the twenty-nine children didn't have an allergic reaction whereas only two of twenty-eight in the placebo group demonstrated the same.

Of this group on non-reactors, after a two-five week period of being peanut free, they were retested and twenty-three of twenty-five still had no reaction.

Over time, it is possible for the body to build up tolerance but this method has been found to be twenty-times more effective.

The next step is to see how long this effect will last. Will it be a cure?

It might be too early to tell but it might well be a very good step in the right direction. 

Would you try this for your child if they had a peanut allergy?

Allergic Reaction: Dianna Benson

I always love it when friend and author Dianna Benson stops by! Dianna is a talented writer and has two treats for you today-- a new novel, Persephone's Fugitive, is releasing. I was blessed to have the opportunity to read and endorse this novel. Two, she is giving a factually based fictional account of an EMS call dealing with a severe allergic reaction called anaphylaxis.

Welcome back, Dianna!

“EMS 6, allergic reaction, at 123 Main Street.”

At 7:40 Christmas night, my partner and I flip on the lights and sirens and race our ambulance toward 123 Main Street. En route, my partner reads off details of our dispatched call on our dashboard laptop.

“Twenty-year-old female. Respiratory arrest.”

I grab the radio. “This is EMS 6, requesting assistance on our anaphylaxis call. Copy?”

“Copy EMS 6. FD 14 is en route.”
    

Once we roll up on scene, several people wave us into the two-story home, their faces contorted in panic. As we hear sirens from an approaching fire truck, we rush our loaded stretcher inside the front door and toward the young lifeless body lying on the tiled kitchen floor, cyanosis around her lips.

I notice our patient’s chest is motionless, and I don’t feel or hear any air moving out of her mouth or nose.

“What is her name?” I ask no one in particular in the crowd of about a dozen surrounding us.

“Ally,” several voices answer.

“Ally?” I rub my knuckles over her sternum.

“Unresponsive,” I inform my partner, who’s yanking out a BVM (bag-valve mask), other airway equipment, and the med box.

I feel for a carotid pulse on her flushed neck. “Rapid and weak,” I say to my partner. We share a look of understanding—our patient is headed for cardiac arrest. Our interventions must be quick and efficient.

“What happened here?” I again ask the room full of people as I press the mask over my patient’s mouth and nose with my left hand in the E/C formation. With my right, I squeeze the football-sized bag every five seconds to oxygenate the young woman’s system. Her chest rises and falls with every squeeze, indicating her airway isn’t blocked by swelling or any foreign object.

“She was eating and started coughing, and said her chest is all tight,” a hysterical woman answered, suddenly kneeling next to me. “She was itchy all over, had trouble breathing, hives on her back.” 

I face the middle-aged woman, tears flowing out of her eyes and down her cheeks. “Are you her mother?”    

“Yes. She was severely allergic to peanuts when she was little but out grew it or whatever.”

As I continue bagging, my partner pushes epinephrine IM (intermuscular) then inserts an IV into our patient’s left arm for med access and fluid replacement. A fire crew of four men darts into the house.

Without an exchange of words, I hand one of the firefighters the BVM, and two of them take over bagging. One presses a tight seal over the mouth and nose, the other squeezes the bag.
   

“Hand me our monitor,” I ask the firefighter closest to our cardiac monitor. He and the fourth guy assist me in hooking up a twelve led ECG to our patient’s four limbs and chest.

I study the monitor for our patient’s vital signs, looking for indications of imminent anaphylactic shock and cardiac arrest. “BP 80/52. Pulse 134. SPO2 86%. Normal sinus heart rhythm.”

“Uh-huh,” my partner says, letting me know he heard my report of the grave vital signs.

I hand him diphenhydramine and methylprednisolone to administer into the IV line.

“Does Ally have any medical conditions or take any medications for anything?” I ask the mother.

“No. Nothing.” 

We add Benadryl to the line then attach a little bag of Pepcid to the IV set up. Following up with those meds, we add Solu-medrol.

In scanning the kitchen, I spot several whole pies ready to be served, remnants of T-Bone steaks and empty lobster tails on multiple dirty plates. “Did she eat any nuts tonight?” I ask the mother to keep her occupied.  

“Nothing any of us ate tonight contains nuts.” The mother points over her shoulder. “We haven’t eaten any pie yet, but none of them has nuts.”
     

“Has she ever eaten lobster before tonight?” I ask while digging into our airway bag.
 

“Once. Couple of months ago and loved it.”

“It was probably the lobster. The second encounter with an allergen is when an allergic reaction occurs.” I turn to my partner. “Let’s intubate.”

“Uh-huh.”

I’m readying the intubation equipment when Ally jerks to a conscious state, coughing and rolling on to her side, shoving the mask away from her face.

“Guess she didn’t want to be intubated,” one firefighter whispers near my ear, not out of humor but relief, a feeling I share. 

“Ally? Hi.” I grab a non-rebreather mask. “You suffered a severe allergic reaction. You need oxygen.”

She nods, rolling to lie on her back again. Her mother squeezes her hand, pats her forearm.

“Bummer, I know, but we gotta take you to the hospital to be monitored overnight.” After turning the portable O2 tank on to 15 liters per minute, I strap the non-rebreather to Ally’s face. “Just breathe normally and relax. You’re doing fine. We’ve got you, Ally.” I smile at her.

The firefighters lift her weak body onto our stretcher; I study the monitor. “BP 96/60. Pulse 118. SPO2 92%,” I say to my partner.

“That’s what I want to hear,” he responds in a relief matching my wide smile.

You can read more posts done on allergic reactions/anaphylaxis here, here, and here.

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

Dianna T. Benson is the award-winning and international bestselling author of The Hidden Son and Final Trimester. Persephone’s Fugitive is her third release. An EMT and a HazMat and FEMA Operative since 2005, Dianna authentically implements her medical and rescue experience and knowledge into all her suspense novels. She lives in North Carolina with her husband and their three children. www.diannatbenson.com

Up and Coming

Hello Redwood's Fans!

Are you enjoying the warmer weather? I must say, it is nice to be out of the bitter cold but I'm one in the minority that is a little sad to see winter leave. I'm not a big fan of bright sun and hot days so you can find me holed up inside in a dark, air conditioned room.

But I'm happy for the rest of you!

For you this week we're focusing on allergic reactions.

Tuesday: Friend and author Dianna Benson stops by with a factually based fictional account on how to treat the most severe form of allergic reaction called anaphylaxis. Dianna's new book, Persephone's Fugitive, is releasing so I hope you'll check it out!

Thursday: Can peanut allergies be cured? Some interesting research in this area that could prove to eliminate this dreaded allergy.

Have a great week!

Jordyn

Author Forensic Question: Evidence of Pregnancy on Autopsy

Aray Asks:

Can an autopsy show evidence of a three week old fetus? I’m researching for a novel I’m writing and I need your help, considering that the information has to be accurate.

My MC’s mother’s body is severely mutilated ( carved into).  She was three weeks pregnant at the time this gruesome murder took place. Police officials accuse her husband of doing the deed.  Having no leads, they arrest him. The husband’s on trial for capital murder.  The medical examiner takes the witness stand. The lawyer asks him a series of questions, one being the autopsy report.

Amryn Says:

A 3 week old fetus would not be visible during an autopsy. At that point in development, the fetus is a ball of cells but without any physical characteristics that one would recognize as human. If the medical examiner needs to detect that the victim was pregnant, the best way would be to perform an HCG test on the victim's blood.

HCG is the hormone that is responsible for making a pregnancy test appear positive. It usually takes 3-4 weeks for this hormone to be at a high enough level to trigger a positive test, however a quantitative test might be enough to suggest that the victim's hormone levels were slightly above normal. I wouldn't think it would be enough for a medical examiner to definitively say the victim was pregnant, but it might be enough for he/she to say it's possible. Any time after 4 weeks, the HCG levels will begin to rise almost exponentially and therefore would be more easily detected.  

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

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.

Genetic Analysis: Guest Blogger Bethany Macmanus

Today, I'm pleased to host author and friend, Bethany Macmanus. She's guest blogging on what diseases can be discovered through genetic analysis.

Bethany has graciously agreed to award one e-book copy of Nerve to a commenter of this posts. Comments close on Wednesday, March 25th. 

Welcome, Bethany!

I've always found the ancient “nature vs. nurture” debate interesting, to the point of writing a paper on it for my Child Growth and Development class in college. What determines a person's physical traits, IQ, personality, or even their ability to process things like gluten and phenylalanine? Is it mostly their environment, or is it mostly their genes?

I've heard of individuals who live the most healthy life they think possible, by exercising regularly, eating what they've been told is most nutritious and balanced, and seeing their physician for recommended appointments. When they wake up one day and find out they have advanced cancer, they wonder what in the world happened. Their environment, though it couldn't be controlled completely, had been “nurtured” as much as possible. What, then, did their genes contribute to the equation?

The answer is, probably a lot.

Geneticists are discovering more and more factors which are predetermined by what is written on our DNA. Here is only a partial list, which I've taken from www.geneplanet.com:

·         Episodic memory (KIBRA gene)

·         Pain sensitivity (SCN9A gene)

·         Norovirus resistance (FUT2 gene)

·         Bitter taste perception (TAS2R32 gene)

You may have heard of the double mastectomy actress Angelina Jolie underwent in 2013 to prevent breast cancer. Genetic analysis showed she had a specific BRCA1 gene mutation, which is reported to make her 87% likely to test positive for the disease. The BRCA1 and 2 genes are responsible for tumor suppression.

I wondered what other disease processes can be tested through genetic analysis. Gene Planet has a long list: Alzheimer's disease, asthma, atrial fibrillation, breast cancer, celiac disease, colorectal cancer, gallstones, glaucoma, heart attack, hypertension, lung cancer, MS, prostate cancer, psoriasis, rheumatoid arthritis, diabetes (type 1 and type 2), restless leg syndrome, and venous thromboembolism (a blood clot in an extremity).

The list included a lot of the diseases with high mortality rates, which made me have another thought. If I had one or all of these (very expensive) analyses done, I sure wouldn't want this genetic information falling into the wrong hands!

And so I asked one of the story questions in my novel, Nerve: What if a sample of my DNA was stolen from me and analyzed without my knowledge or consent? What might the thief do with their new power over me? Find out when you read!

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

Bethany Macmanus lives in Houston with her husband, daughter, and son. After practicing as an RN for five years, Bethany left the nursing field to pursue a writing passion the Lord planted in her heart when she was a child. Nancy Drew mysteries were her guilty pleasure during those early years, so she naturally gravitates her pen toward the things that go bump in the night, and most of her plots have a psychological spin. She’s allergic to cheese, Sulfa drugs, and people who stop in the middle of intersections while driving.

Up and Coming

Hello Redwood's Fans!

How has your week been? Mine? Let's just say I'm glad I got that novel done last week because this week has been busy-- saving lives and teaching other people how to save lives.

Spring is coming. Do you love springtime? For me, spring is my third favorite season (behind autumn and winter). I'm ready for the snow to melt and for some warmer weather but I'm a cave girl so the bright sun is not always high on my list. Oregon, I think I'd do well living in your rainy state.

For you this week! Two fantastic ladies and guest bloggers.

Tuesday: Friend and author Bethany Macmanus stops by to guest blog on some of the diseases that can show up on genetic testing and how it inspired her latest novel, Nerve. Bethany has been kind enough to offer one free e-book to a commentor on her March 17th post-- so be sure to stop by.

Thursday: Forensic expert Amryn Cross answers an author's question. How early can a pregnancy be detected on autopsy?

Have a GREAT week.

Jordyn

Acetaminophen Poisoning

Acetaminophen, commonly known as Tylenol, is one of the number one ingestion (accidental and intentional) calls to the Rocky Mountain Poison Control Center. One of the reasons behind this is that Colorado has one of the highest rates of prescription drug abuse and acetaminophen is a common co-ingredient of narcotics (Vicodin, Percocet and others.)

Using a possible overdose in a novel is a good way to increase conflict/tension. Acetaminophen ingestion, if caught early enough, is highly treatable with a mortality rate of <0.5% which is in large part to N-Acetylcystein (NAC).

Acetaminophen was first used in 1955. It's primary function is as a pain reliever and fever reducer. It peaks in 45 minutes and the half-life is 2-3 hours. I discussed the importance of half-life and ingestions here.

Acetaminophen is metabolized by the liver which also becomes the primary victim in overdose. If untreated, acetaminophen kills off liver cells over the period of a couple of days. This type of overdose is the #1 cause of liver failure in the US, UK and Europe-- again, largely as a result of prescription drug use/addiction.

What's considered a toxic dose? Greater than 150mg/kg for a child and 7.5 grams and over for an adult. Keep in mind, extra strength tablets are 500mg each so taking just fifteen of these places a person in the toxic category. For an acute overdose, the entire amount needs to be ingested in eight hours. A person can still become toxic from chronic ingestions but it does complicate their medical management a little.

We do use decontamination at times in poisonings but the treatment for acetaminophen ingestion is so good that it generally outweighs the benefit of decontamination which is discussed here.

What's most important in acetaminophen overdose is the four hour drug level (four hours after the time of ingestion.) Whether or not to give the antidote is based on this level. Now, in a massive overdose (let's say twice the toxic level) the medical team may be directed to decontaminate the patient because the patient can die from a massive overdose even though their liver may be fine. At the four hour mark if the drug level is less than 150-- the patient does not require NAC. If over 150-- they get the treatment.

NAC can be given two ways-- either IV or by mouth and should be started within eight hours of ingestion. The oral route is preferred because it goes to the liver in higher amounts. NAC works by enhancing a protein that breaks down acetaminophen in the liver when it's own mechanisms are overwhelmed by the amount of drug the patient has taken.

Even if a patient denies taking acetaminophen, we'll generally test for it under suspicious circumstances-- such as admitting to taking another drug or suicide attempt through other means. In 8.4% of cases, the patient will test positive and 2.2% of those require extensive treatment.

A negative acetaminophen level doesn't mean they didn't take an overdose so in a patient where there is concern for acetaminophen toxicity-- we would also draw liver enzymes. If those are elevated, the patient will get the antidote even if the acetaminophen level is negative.

Patients generally die from cerebral edema or overwhelming sepsis. Researchers are unsure why the cerebral edema develops. Sepsis occurs because the liver protects the body against bacteria and if the liver has died-- their protective mechanism fails.

What's interesting in acetaminophen overdose is there is little intermediate ground. Either the patient gets better or they don't. Past a certain point, the only way to save them is to transplant their liver.

General Treatment of Ingested Drugs

One thing that has evolved a lot in medicine is the general treatment of drug overdoses. 

Early in my nursing career, I worked in a community ER. In this setting we saw both adult and pediatric patients. One day, three young boys were brought in after they'd gotten into grandma's medicine cabinet and sampled a multitude of pills. 

In those days, if the ingestion was within one hour, we did use Syrup of Ipecac to induce vomiting and each of these boys got a dose and a big bucket. Syrup of Ipecac is more effective the more water you drink. All three children were lined up next to one another, each on their own gurney, and I walked down the line encouraging each of them of drink. 

Soon enough, one of them began to vomit. One of the other boys proclaimed that wasn't going to happen to him and I simply gave him another glass of water to drink. After he saw his second sibling throw up, he said to me, "I don't want any more water." 

That didn't keep him from the invetible. 

What we learned is that causing patient's to throw up increased their risk of more serious complications-- like aspiration pneumonia. It is a risk that while vomiting, you'll inhale some of that material. 

Then there was "stomach pumping." There's a lot of confusion about what this actually is and the last time I did it was over twenty years ago. A large (literally garden size hose) is inserted down the patient's mouth into their stomach and then, through a pumping action, the stomach contents are washed out with large amounts of saline.

The problem with this therapy became the electrolyte shifts that can happen when replacing stomach contents with saline and this practice has been largely abandoned as well. Also, having a large tube put down into your stomach also increases your risk for vomiting and the same risk discussed above still applies.

What has remained is the use of activated charcoal. Activated charcoal literally looks like ground up charcoal. It is a thick, sludge like material that is sweetened to make is more palatable. In kids-- we usually put it in a covered up Styrofoam cup so they can't see it. If they won't initially drink it we may flavor it with chocolate milk. The problem becomes that whatever it is diluted in they have to drink all of in order to get the full dose.

Activated charcoal works by binding the drug to make it inactive. If the effects of the drug would be more detrimental to the patient (versus just observing and offering symptomatic support) then we'll generally try to give it if the patient comes in within one hour of the overdose.

With any ingestions, we usually follow the direction of our Poison Control Center.

If your child has ingested anything of concern, I highly recommend you call them first at 1-800-222-1222.  

Up and Coming

Hello Redwood's Fans!

How was your weekend? Mine? Amazing.

I finished the first draft on my indie novel releasing this Fall! Doesn't it, fellow authors, feel so good to type those words "THE END"!

Yes, yes it does.

More news on that later.

It's a pretty exciting week here at Redwood's because I'm covering some very common questions that I get asked repeatedly. Most authors are keen to find the perfect poison to kill off their characters.

Sometimes, though, we want our characters to survive a poisoning incident. That's what we're talking about this week.

Tuesday: Decontaminating a patient who has been poisoned. Do we still use Syrup of Ipecac? What exactly does it mean to "pump" someone's stomach?

Thursday: Treatment of acetaminophen (aka Tylenol) poisoning. This is one of the most common overdoses that medical personnel deal will. I'll cover why that is and how to save patients.

Hope to see you here!

Jordyn

Author Question: Motor Vehicle Collision 2/2

Today, we’re focusing on Susan’s questions surround two victims of a car accident. You can find the first post here.

Let’s turn our attention to the second patient.

Patient #2: The passenger (the above's twenty-six- year-old sister) flies from the convertible.
 

1. If she was found unconscious about 20 feet from the vehicle without any injuries, how would EMT's treat her?

2. Would she still be in her own clothing while unconscious at the hospital?

3.What sort of treatments would they give her, if any, at the ER? IV's, examinations, etc?

We find out later that the passenger actually was near death and healed by a supernatural character. She actually hit her head (skull fracture?) and is close to death when he finds her

4. Is this scenario even possible or would she have immediately died from the injury?
5. If her survival was impossible, what can I make her injuries so she can be healed by the other character?
6. How would she appear? Eyes open, eyes closed, or would it matter? Vomit? Skin coloring?

Jordyn Says:
1.  One, they’ll assume she could be gravely injured considering her mechanism of injury. They’ll first check to see if she’s breathing and has a heartbeat. At the same time, they’ll be stabilizing her spine by putting on a C-collar and placing her on a backboard. If she’s breathing on her own at an adequate rate, they’ll give her some oxygen via a mask. If she’s not breathing or doesn’t have a pulse then they’ll begin resuscitation by giving her breaths and doing CPR. After those major things are taken care of, they’ll start an IV to give her some fluid. Then begin to look for secondary injuries. An unconscious patient thrown from a vehicle will have presumed traumatic brain injury or TBI.
2. If the EMS team can provide her adequate care without cutting off her clothes, then they’ll leave her that way until she gets to the hospital.

3. In the ER, we start where the EMS team left off. We’ll start our assessment much in the same way the EMS team does. We continue any care they’ve provided. If they were unable to get IV access—we’ll start to work on “getting a line”. We’ll do a detailed secondary survey looking for other injuries which means entirely undressing the patient, log-rolling them to their side and checking for injuries to their back as well. A catheter would be inserted into her bladder and the urine tested for blood and she’d also likely get a pregnancy test.

Additional tests in the ER for this unconscious patient would be: x-rays of her spine, CT of her brain and likely chest and abdomen. Some baseline labs: blood counts, electrolytes, labs that look to see if organs have been injured and bleeding time studies. They’d likely “type and cross” her for blood products. Any other injuries would be x-rayed as well—for instance if her arm were misshapen or significantly bruised.

The unconscious patient is challenging because they can’t tell you what hurts.

 4. Skull fractures can run the gamut and there are several different types of skull fractures. A patient could have a traumatic brain injury that eventually causes death but just have a simple linear skull fracture. Or, a patient can have a depressed skull fracture and be awake and talking to you. As an author, you have a lot of leeway here.

5. I guess it depends on what you mean my “healing”. Do you want her to have evidence of injury but be fine?

6. I’ll go with the assumption that she presents to the ER unconscious. An unconscious patient can look relatively well to nearly dead—again, you have a lot of leeway here. They can “appear to be sleeping” except they’re completely dead weight. There are specific vital signs a patient will demonstrate when their brain is swelling but I’m not sure you want to go that route.

Hope this helps and good luck with your novel!

Author Question: Motor Vehicle Collision 1/2

Susan Asks:

I found your site while I was researching some things for a story I'm writing. I'm not sure I will ever try to get this story published or anything, but I wanted to get all my details as accurate as possible.  

In the story two people are involved in a car accident.

Patient #1: The driver, twenty-three- year-old male. Hits the steering wheel and ruptures his aorta. This character dies.

My questions are: 

1.  Could he be conscious immediately following this?
2. Would he make it to a hospital about 4 miles away in an ambulance or likely die at the scene?
3. How would he look in the hospital after death (coloring, would they leave his clothing on if he just died)?
4. Would they let his sister see his body?

Jordyn Says:
1. Would he be conscious? Yes, it’s possible but for a very short amount of time following his injury. Your aorta is a very large vessel that comes right off the heart. If it is entirely ruptured—you’ll bleed out in one to two minutes. The quicker the blood loss the sooner unconscious sets it because blood supplies oxygen to the brain and the brain is a very oxygen sensitive organ.
2. This character would likely die at the scene.
3. What you might want to look into is reasons an EMS provider is allowed to call death at the scene. Patients who are obviously dead may not even go to the hospital. Let’s say they do “work” him and bring him to the hospital where he is declared dead shortly after. Likely, his clothes are on with the exception of the care EMS provided. It’s atypical for them to cut off all their clothes like a trauma center will. He’ll be extremely pale with areas of blueness. Livor Mortis begins fairly quickly where the blood will be begin to settle in dependent areas of the body. This looks like bruising. If he lying on this back—it would settle all along his backside.
4. Yes, the sister would be allowed to see his body. Nurses are pretty sensitive to this so they’ll try to make the body as presentable as they can and explain what the sister will see before she views the body.

We’ll tackle Susan’s second patient in the next post.

Living on the Edge

Hello Redwood's Fans!

You may have been wondering just what has happened to me since I haven't done these preview posts for a few weeks. Well, it's been a little bit of a roller coaster ride lately. There has only been one member of our family that hasn't been to the UC/ER in the last three weeks.

That is no joke.

I came down with a horrible case of bronchitis. Dang that flu shot for not working so great this year! My youngest broke her arm. My husband was in the ER for a heart arrhythmia. 

I know, fun times. I can see the jealousy on your faces.

It's also respiratory season which means everyone who works in pediatrics is getting their rear-ends kicked at work every shift with increased patient loads of sicker kids. Let me just say my US magazine reading has sharply declined.   

None of us can predict with these life events will happen. It reminds me a little bit of white water rafting. What?-- you say. She has certainly lost her mind.

White water rafting is fun but a little anxiety producing. You fear getting tossed into the water. There are all these dire warning about what to do when that happens.

1. Don't put your feet down hence they get trapped and you drown.

2. Don't loose your paddle because we don't want to have to find a new one.

3. Swim to the side because we might not be able to get you.

Why would anyone try this sport? One, the scenery is awesome. Two, it's a God made roller coaster. It's fun getting splashed with water-- most of the time. Not so fun, getting hailed on but I digress.

In the back of your mind while you're having all this fun is the thought you might get tossed out and what will you do if that happens. It's a little slice of living on the edge. 

I've been tossed out into white water several times. You know what-- you cannot anticipate it. One minute you're in the boat. The next, you're wet and cold and wondering what the heck just happened. 

Isn't this so much like death in our lives? We really do not know when that moment will be. Are you prepared? Can you ever be prepared?

Thoughts?

This week's posts will be spent answering an author's questions about medical treatment of patients who have been in a motor vehicle accident. 

Another one of those unexpected things.

Have a great week of unexpectedness.