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.
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.