C-A-B: The new CPR guidelines.

At some point in your novel, perhaps you'll have a character that has a life-threatning event and will require CPR. If so, it's important to know that there has been a big change in how CPR is delivered to victims from lay people all the way to the healthcare professional.

Why change? Every five years, the American Heart Association (AHA) examines available scientific study to determine if the current guidelines are the best way to resuscitate a patient who is not breathing and does not have a pulse. Over the last ten years, what's been found, is that compressions are paramount to delivering residual oxygen loaded up on hemoglobin to the cells. The only way to do that is to keep the blood moving.

Another couple of components was the general discomfort among the lay public to initiate CPR, particularly mouth-to-mouth resuscitation. Also, several studies showed that people (including healthcare professionals) were not that great at determining whether or not the patient was breathing and/or had a pulse. Some people mistook agonal respirations (which are gasps of air when a patient is near-death) as breathing and thus would delay support of the patient.

In the new guidelines, there is a quick check for responsiveness. If not responsive and you're alone, you should get an AED if one is available and call 911. Then return to the patient and attempt resuscitation by starting chest compressions. If you're with someone then one stays with the patient to perform CPR and the other will get the AED if available and call 911.

The sequence goes as follow:
1. Check the patient for responsiveness and no breathing.
2. Call for help.
3. Check the pulse for no more than 10 seconds.
4. If no pulse, give 30 compressions.
5. Open the airway and give 2 breaths.
5. Resume compressions.

Consider these new AHA guidelines when writing scenes that involve resuscitating a patient. Another thing to keep in mind is that some fire departments are instituting protocols whereby the arriving EMT and/or paramedic will provide 200 compressions before delivering a shock as a way to "prime the pump". This has been shown to increase the effectiveness of electrical defribillation. If you're writing a location specific novel, check the local fire department to see what their protocol dictates.

Marketing and Social Media

Today, I'm taking a short break from all things medical mayhemish and participating in a blitz blog on marketing. My agency, WordServe Literary, through Rachelle Gardner's blog is doing an all out attack on the good and bad of this side of the book business. Several authors are participating so you can find more links on her August 2nd post.

If this is the first time you've ever stopped in at Redwood's Medical Edge... welcome! This blog is devoted to helping authors of historical and contemporary fiction write medically accurate details. So, keep this place in mind for those medical questions and nuances you may need help with.




billypitter/PhotoBucket

 Marketing is the bane of most authors I think. We'd much rather stay in our writing caves than have to worry about this "other side" of the book business. My debut suspense novel has just been contracted and is set to release sometime in the Spring of 2012. I'm just dipping the tips of my toes into the large ocean of marketing possibilities and it is foreign territory. It feels a lot like learning a new language. After all, nursing school didn't have a lot of emphasis on marketing... all right... none.

Here's what I've started doing to "get my feet wet".



1. Begin to build relationships through social media. I've found people to guest blog for me through these avenues. For me, FaceBook has been the most useful social media tool. I like it because you can carry on a decent conversation with people and are not limited in the amount of words you can say. I feel like I'm getting to "know" others who have the same interests as mine through FaceBook. I do participate in Twitter but this is a little bit of an enigma for me. I'm not sure I understand the full potential that exists. I don't often read other people's tweets whereas I do find myself surfing FaceBook to see what my friends are up to. The aspect of Twitter that I do like is that my blog posts go to Twitter and are then posted to Facebook. That's a lot of advertising work that doesn't need my input. I'm on LinkedIn but I don't use it and don't actively network there. LinkedIn has not been beneficial for me.

2. Learn from other authors and marketing professionals. There are lots of resources out there where you can begin to learn about marketing for little money. One place to check out is WildFire Marketing. This site has a lot of free resources that will definitely give you ideas to get started. I read Austin S. Comacho's self published book Successfully Marketing your Novel in the 21st Century. Although it is more geared toward self publishing and e-publishing, I did pick up several helpful hints on how to market with a traditionally published book. I think he covers how to set-up and handle book signings well which many publishers are now leaving up to the author to arrange. Also, he has good tips on press kits. A what? Exactly. He explains it nicely. Also, check out the Murder Must Advertise Yahoo Group.

3. Think about your brand early on. This is one area I'm working really hard on. A brand clearly links you with a product-- be it a novel, record or coffee. You know what Starbucks sells even if you haven't stepped foot into a store. They have a strong brand. I think many authors feel a pressure to get out there in the Internet realm and don't spend a lot of time thinking about their brand. What is it that will make you stand out from the other hundreds of authors who have a blog? I spent a good couple months mulling over what my blog would be because once an impression is out there, it may be hard to change mid-stream. Have a clear identity at the beginning. If you're not gifted as a web/blog designer, this is one area I would consider investing some money to have it professionally done.

If you're in my stage of marketing, what are some things you've done that have worked or not worked?

Guest Blogger: Lillian Duncan

I'm pleased to have Lillian Duncan guest blogging here at Redwood's Medical Edge today. She's discussing her research into diabetes and how she managed this character's disease in her novel Pursued.

Welcome, Lillian!

According to statistics, diabetes affects 25.8 million Americans of all ages which is 8.3% of the U.S. population. It only makes sense that sooner or later one of my character's was going to end up with the disease.

The character’s name is Reggie Meyers and you can find her in my new book, Pursued.  In spite of Reggie being chased by an unknown killer, she manages to keep her sugar level on an even keel while her blood pressure spikes through murder attempt after murder attempt. The woman is seriously committed to eating right and taking care of herself!

In real life, diabetes is not a laughing matter, and I certainly don’t treat it lightly in my book or in my life. I don’t have diabetes; however, my father died from complications of it along with my paternal grandparents, aunts, uncles, and cousins on both sides of my family.

I chose to give my heroine diabetes to bring more awareness of the disease to my readers. I also wanted to show that with a combination of diet, exercise, and other lifestyle choices, a person can live a full and healthy life in spite of having it.

It was easy in my book to keep Reggie making the right food choices and following good medical advice. Unfortunately, it’s a lot harder in real life. People struggle every day with making the right lifestyle choices or suffering from the consequences of not making the right choices.

As I wrote Pursed, I had to walk a fine line between keeping it in the readers’ minds that Reggie was diabetic without belaboring the point. If I wrote about it too much, it would bore the reader. If I didn’t include enough details—especially physical details— it wouldn’t feel real.

An example of this is during a scene where all the characters are drinking a soda. Without mentioning her diabetes, Reggie’s friend simply hands her a sugar-free soft drink. No big deal. Another time, Reggie is given two choices for breakfast—sweet rolls or multi-grain cereal. She is sorely tempted but in the end she made the right choice.

Research was an important component when I decided Reggie had Type 1 Diabetes. In spite of family members having the disease, I wanted to make sure I had the right information, which isn’t always easy in spite of the glut of information on the Internet. I only included a small amount of what I learned, but it was there in the back of my mind as I wrote each scene.

Reggie’s diabetes definitely added to the challenge of writing Pursued, but I’m glad I included it. I wanted to show a character who had a serious health issue, but didn’t use it as an excuse to not accomplish her goals and dreams. In Pursued, Reggie makes the choice to be as healthy as she can be in spite of being a diabetic.

Everyone has challenges in this life. The question becomes are we going to let the challenges stop us from being the best we can be? And the answer comes in the form of the choices we make every day.

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

Lillian lives in a small town in the middle of Ohio Amish country with her husband, four parrots, one Jack Russell, and a Cavalier King Charles Spaniel. Whether as a speech-language pathologist, an educator, or as a writer, she believes in the power of words to change lives, especially God’s Word. She also enjoys a variety of activities, including traveling, camping, and bowling. She is active in her church where she serves as a sign language interpreter and teaches sign language classes. Lillian believes books can be entertaining without being trashy. She writes the types of books she loves to read, suspense with a touch of romance. Along with writing novels, she writes devotions for ChristianDevotions.us. Previous novels include Shattered and In a Corner of Her Heart. To learn more about Lillian and her books visit: www.lillianduncan.net

Diabetes: Part 2/2

Diabetic emergencies are not uncommon in the emergency room. In simple terms, there are two types of diabetic emergencies: the blood sugar is too low or the blood sugar is too high.

Hypoglycemia: This is a term used when the blood sugar is too low. Often times, in a person with diabetes, it is the result of taking too much of their medication causing sugar levels to drop. This is not the only thing that can cause a blood sugar to be too low.

Unrelated to diabetes, in the pediatric population, particularly among infants, there can be several causes of low blood sugar. Some of the top reasons are sepsis (blood or urinary tract infection), stress, and hypothermia (low body temperature).

Hypoglycemia is relatively easy to treat. If the patient is alert enough to swallow something, we can give them sugar by mouth (orally). It can be as simple as having them drink a small container of juice or giving them a fancy commercial preparation of sugar. If they are unable to take anything by mouth, then an IV is placed and the sugar (glucose) is given intravenously in the form of Dextrose.

Diabetic Ketoacidosis: Otherwise known as DKA. This results from a high level of sugar in the blood. As part of this, there is also a build-up of acids (ketones) in the blood as well. See last post for full explanation of this process. In order to correct this emergency, we have to bring both the blood sugar down and clear the ketones (the acidosis).

1.   Start an IV and get labs. There are several labs that need to be closely monitored in the diabetic patient. We’ll get a BMP (basic metabolic panel). This can also be known as a Chem 7 (or other number depending on how many items are measured). We’re looking specifically at the blood salts: potassium and sodium. These shift as sugar shifts. A BMP is generally monitored every 4-6 hours. Every hour, the patient will get a bedside glucose. We can only bring the sugar down so fast, typically no more than 50-100 points an hour. If the sugar falls too quickly, this can be problematic for the patient.

2.   Give IV fluids in the form of normal saline. Typically, the patient has a relative dehydration. Fluids are given very carefully as rapid fluid resuscitation can cause build up of fluid in bad places… like the brain (called cerebral edema). This is a phenomenon more common in pediatrics than the adult population. Giving fluids will also help the body clear ketones.

3.   Give insulin. Insulin is given to move the sugar from outside the cell (extracellularly) to inside the cell (intracellularly). This will bring the blood sugar level back down.

At some point, when the sugar level comes down to around 250 (remember normal level is 60-120) we will add IV fluids that contain sugar and continue to give the insulin until the ketones are cleared or the patient is no longer acidotic. We can check this by checking the urine for ketones or by testing the blood (a blood gas) to see what the pH level is.

Once both the sugar levels are normalized and the acidosis has cleared, the patient can begin to transition back to their normal diet.

Have you known someone that’s had a diabetic emergency?

Resources for you:

1.   http://www.emergencycareforyou.org/EmergencyManual/WhatToDoInMedicalEmergency/Default.aspx?id=230

2.   http://type1diabetes.about.com/od/schooldaycareandlaws/a/hypergly_emerg.htm

3.   http://diabetes.webmd.com/tc/hypoglycemia-low-blood-sugar-topic-overview