Author Question: Car Accident

Amy D. Asks:

I am putting one of my characters in a pretty major car accident -- a rollover in which she lands on a broken window and ends up with a lacerated back full of broken glass, in addition to a broken leg, fractured ribs, etc. I need a scene to take place in the hospital where she is recovering. With those kinds of injuries, what treatments would she be under? More importantly, how exactly would she be laying in the bed? Obviously not on her back. But would she be on her side or stomach? Perhaps that depends on the other injuries she sustains... but the lacerated back is the biggest one I want her to have.

Jordyn Says:

The biggest issue here is that she will likely have to lie on her back for a while. Considering her mechanism of injury (MOI)—the big rollover accident. The EMS crew is going to be very concerned that she may have injured her neck or back and she will be put onto a spine board and C-collar. To alleviate the pressure on her back, they may then tilt the whole board to side but it's going to cause some pain to lay on that flat board until her x-rays are complete.

Care for lacerations: One, she'll need x-rays of her chest to look for the glass. She'd likely have this anyway for her MOI which could then reveal the rib fractures. If the lacerations are severe and extensive-- she may end up going to the OR so they can be cleaned and stitched up under general but they'd have to be REALLY bad. Otherwise, we irrigate them out with sterile saline. Stitch them up. Antibiotic ointment over top. Make sure she's up to date on tetanus. She would get a shot if she hadn't had any in five years. It's 10 years without injury.

Rib fractures are generally problematic because you don't want to take a deep breath because of the pain which can lead to pulmonary problems. Lung contusions can actually put you on a ventilator if they are extensive enough. If several ribs are broken in succession-- this is actually referred to as a flailed chest which can inhibit the patient's ability to breathe. So, I'd keep it simple with one or two rib fracture so the character mostly has to deal with the pain issue and not the lung issues.

Broken leg-- which bone is broken and how bad? This would determine treatment.

Author Question: Treatment of Minor Injuries

Maisie Asks:

I'm writing today with a medical question, I really appreciated the flow of your medical expertise in Proof, with it being a part of the story, and not a distraction from the story. I want to accomplish that same steady flow with my current work in progress.

My 16-year-old female main character is going to jump down from something (akin to jumping from a tree branch), the ground below is pitted and sloped though, and I need her to get injured. In my mind, it would be her ankle or her wrist (from catching herself) with some minor lacerations to her face. I've never broken anything to know how it feels.

I want the medical scene that follows to be realistic. Her Mom will meet her at the hospital, it's late at night. What would be the steps, the healing process, pain management, any specialists, and healing time. I want her to be injured, but I don't want her to be crippled for the entire summer (length of the novel). I want to know how the hospital scene and future doctor appointments will go, what they'll look for, and how this is going to encumber her in her regular life.

Jordyn Says:

Thanks so much for sending me your question.

The thing to know about ankles is that they rarely fracture-- 95% of the time they are sprained. For a sprained ankle, an air splint (crutches if the patient can't bear weight) for 7-10 days and then the patient should work themselves out of the splint at that point. If still painful-- they should follow-up with their regular doctor or orthopedic doctor at that time.
 

It's more likely, with your scenario of falling down a hill, for a simple break to the lower forearm. Treatment in the ER would be x-ray to evaluate for fracture, and pain medication (usually Ibuprofen suffices). These would be the same initial treatments for an ankle injury as well. If fractured, the patient is placed in a splint and NOT a cast. Patient will follow-up with ortho in 7-10 days for cast placement. Cast is on for 4-6 weeks. There shouldn't be any permanent damage.
 

Lacerations: generally a topical numbing agent is applied. This sets in place for 20-30 minutes. Or, the patient is directly injected with Lidocaine. Wound is irrigated with normal saline. Stitched up. Antibiotic ointment over the stitches. Wound should be cleansed twice daily with mild soap and water then Neosporin or equivalent over top. Stitches to the face are usually removed in 5-7 days. Tetanus shot if the patient hasn't had one in the last five years.