Up and Coming

Hey Redwood's Fans!!

How's your week been?

Fall and/or Autumn is here in the Rockies! Fall is my favorite season. There's so much to look forward to. Here's a short list of some of my favorite things.

Pumpkin EVERYTHING-- particularly pumpkin muffins and tea with pumpkin spice creamer. I know... what?!? Don't mock it until you try it-- in fact this just reminded me to restock my tea cache-- post haste!

The colors. Truly a favorite of mine seeing the leaves change. A sign that even in death, beautiful things do happen. Okay-- maybe that's a little too religious for some so moving on...

Scary movies! I am a suspense author by the way and I do enjoy scary movies. Recently saw Possession-- the one with Sarah Michelle Gellar. Interesting. And also saw the last installment of the Scream Series which I love because it does so well at poking fun at the genre. Looking forward to seeing Taken 2 with Liam Neeson. Can't get much better than that. The first film was fabulously scary. I have the last season of Dexter just waiting for me as a reward for when my latest novel is done. I know that's a little frightening... but... suspense author.


How about you? Do you like autumn? What are your favorite things?

For you this week!!

Monday: JoAnn Spears continues her case study on Queen Ann and her obstetrical history. Truly fascinating and JoAnn does such a great job bringing interesting facts. Well, she is a nurse so of course she's wicked smart!

Wednesday: Why the television show Once Upon A Time rakes my nerves. And yes, it does involve a medical situation.

Friday: My friend, Nelda Copas, returns to talk about combat medicine.

Have a great, autumnly week.

Jordyn

Author Question: Car Accident Injuries 2/2

We're continuing with Amy's question. Dianna gave her thoughts here. I'm going to give my thoughts from an ER perspective.

Amy asked:

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 one 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 fractures so the character mostly has to deal with the pain issue and not the lung issues.

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Amy Drown has a History degree from the Universityof Arizona, and has completed graduate studies in History and Archaeology at the University of Glasgow. An executive assistant by day, she also moonlights as an award-winning piper and photographer. But her true addiction is writing edgy, inspirational fiction that shares her vision of a world in desperate need of roots—the deep roots of family, friendship and faith. Her roots are in Scotland, England and California, but she currently makes her home in Colorado. Find her on Facebook at www.facebook.com/GlasgowPiper.

Author Question: Car Accident Injuries 1/2

Author questions are some of my most favorite posts to do. How do you really write an accurate medical scene? Which injuries are plausible and which are not?

Amy is visiting and Dianna Benson (EMS expert) and myself (ER nurse extraordinaire) are going to tackle her question. Dianna will be today and I'll be Friday.

 

Amy 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.

Dianna Says: The story and the characters are first priority, so I’ll make the medical aspects fit into what you’ve explained. Since it sounds like you don’t have an EMS scene at all (no scene where rescue crews—EMS and fire—are present), it keeps it simple from my end, but I’ll give you pertinent background on what I’d do if I were the EMS crew on your scene. Also, based on the MOI (mechanism of injury) you described, I’ll explain what type of injures are possible. Every patient is different, every MVC (motor vehicle collision) is different, and every rollover is different, so that definitely gives you leeway.

First of all: I like the scenario: Your character runs a red light causing another car to slam into hers, which causes it to spin then roll over while her back is dragged on the asphalt over the broken window. I also like the adding of a boyfriend; yes, he’d definitely worsen her injures by landing on her, so have him either land elsewhere inside the car or just have him belted in (unless you want her seriously injured to the point she’s in-hospital for a long while and possibly suffering with lasting effects). Just so you know: The reason for the seatbelt law is not just to protect the person wearing the seatbelt; it’s to protect others from being struck by that person propelling in the air (inside and outside of vehicles) like a weapon. Just a thought -- if she landed on the driver window and it's a rollover, then the car is on its side (driver side) upside down, right? Make sure you're clear about that.  

Any rollover is a high index of suspicion of injury; meaning, severe injuries and death likely. You have two separate impacts in this story: 1) Smash from the other car 2) Rollover. Therefore, you have two separate MOI’s and both cause different injuries.

Since fiction is about the story and the characters, make the speed of the car fit; meaning, if you want your character(s) to be seriously and extremely injured, keep the speed high. For a character who is injured and needing in-hospital care (not just on-scene EMS treatment and ED treatment) yet doesn’t sustain any life lasting effects or long term damage, then keep the speed down low.  

Possible injuries for both the side impact and the rollover: Again, every patient and incident is different, and I’ve seen it all—some accidents where based on the MOI patients surprisingly die and some where patients surprisingly live.   

1)      Whiplash: back and neck
2)      Air bag deployment: facial injures (soft tissue), labral tear (shoulder), etc.
3)    Seat belt injures (chest injuries, labral tear, etc.)
4)      Head injures
5)      Anything flying around inside the vehicle and hitting her and boyfriend
6)      Other possibles: knee ramming into door and shattering patella, elbow ramming into steering wheel, shoulder striking window., etc. etc. 
7)      Fractured femur or fractured tib/fib or just one of them (tibia or fibula) from twisting or hitting, etc. 
8)    Fractured hips
9)      Fractured ribs
10)      Etc. Etc. Etc.

A fracture is the medical term for broken bone.

Assuming the patent is unconscious when I arrive on scene, I’d verify she has a pulse and is breathing efficiently. If so, then I’d control all bleeding via wound care—sterilization and bandaging. I’d strap a C-collar (cervical collar) around her neck then extricate her from the vehicle onto a back board with padded blocks holding her head in place and strapped to the board. I’d splint any dislocations or suspected fractured (I don’t have x-ray vision) if not properly splinted via backboard. We do a ton of medical treatments and monitoring, but I won’t blah, blah, blah it all, especially since you don’t have an EMS crew on your scene.

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Dianna Torscher Benson is a 2011 Genesis Winner, a 2011 Genesis double Semi-Finalist, a 2010 Daphne Finalist, and a 2007 Golden Palm Finalist. In 2012, she signed a nine-book contract with Ellechor Publishing House. Her first book releases March 2013.

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. Her suspense novels about adventurous characters thrown into tremendous circumstances provide readers with a similar kind of rush. You can connect with Dianna via her website at www.diannatbenson.com.  

A Sad Story of Royal Obstetrics: Part 1/4

I'm so pleased to host JoAnn Spears again. Her nursing musings on the medical ailments of some famous and not so famous royals has been a real crowd pleaser. In this series, she focuses on Queen Anne the Good and her very interesting obstetrical history. 

Personally, I found this fascinating.

Welcome back, JoAnn!

Part One: Who was the woman this happened to?

By the time Queen Anne the Good ascended the throne of Britain in 1702, she had been pregnant a remarkable seventeen or eighteen times. She died, twelve years later, childless. What was this remarkable woman’s story?

Part One: Who was the woman this happened to?

Henry VIII is the British monarch most associated with serious fertility issues. The failure of his first marriage to produce a surviving son led to the English Reformation, the execution of Ann Boleyn, and ultimately, six marriages. Henry in his youth was tall, healthy, vigorous, athletic and intelligent. In old age, he became markedly corpulent.

Queen Victoria is the monarch most associated with royal fecundity. Her nine pregnancies produced nine children and made her, through carefully orchestrated intermarriages, ‘The Grandmother of Europe’. Unfortunately, Victoria also appears to have been the point at which the hemophilia gene entered Europe’s royal houses. Victoria, like Henry VIII, was obese in later life.

Pretty much midway between these two extremes of royal fecundity, Britain was ruled by a queen named Anne, known as ‘the Good’. She is little remembered today. As a study in fertility and infertility, Ann deserves to be better remembered.

Ann was a Stuart, a descendant of the Tudors and of the romantic Mary Queen of Scots. Her father and mother were controversial figures. James II seems to have been always out of step. Anne’s mother, Ann Hyde, was a non-royal that James married, typically, against absolutely all advice. When Ann Hyde died–corpulent– in 1671, she had experienced eight pregnancies and left behind two living children.

The ‘good’ moniker is probably the best description of Anne as a child and young woman. In looks and intellect, it’s most likely that she was pretty average. She was a good and serious English Protestant. Her father, out of step as usual, was not. This political liability led to his losing his throne and to the reigns of Anne’s brother-in-law and sister, William and Mary. When Mary and then William died, childless, Anne ascended the throne.

At an appropriate age, Anne had married an appropriate young man: Prince George of Denmark, a cousin once removed. They were married for about twenty-five years and were a devoted couple. George seems to have been a lot like Anne, both unexceptional and unexceptionable. The wittier members of the English court found him boring, joking that the loud breathing caused by his asthma was the only way they had of knowing that he was actually alive.

Anne’s reign lasted from 1702 to 1714. It was notable for being the time when the two-party system emerged in British politics. It was also notable as a time when female friendships had more of an impact on government behind-the-throne than romantic alliances did. Anne’s friend Sarah Churchill, a distant relative of the modern Princess Diana, was a key political player of the day.

Anne’s obstetrical history was over and done with by the time she became Queen. The year 1700 had seen her final pregnancy. That pregnancy had been preceded by another sixteen or seventeen. The number of living children she had when she ascended the throne–sadly, and almost unbelievably to modern minds–was zero.

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JoAnn Spears is a registered nurse with Master’s Degrees in Nursing and Public Administration. Her first novel, Six of One, JoAnn brings a nurse’s gallows sense of humor to an unlikely place: the story of the six wives of Henry VIII. Six of One was begun in JoAnn’s native New Jersey. It was wrapped up in the Smoky Mountains of Northeast Tennessee, where she is pursuing a second career as a writer. She has, however, obtained a Tennessee nursing license because a) you never stop being a nurse and b) her son Bill says “don’t quit your day job”.