Author: Jordyn Redwood

Author Question: Details for Chest Tube Placement

/ Jordyn Redwood / Leave a comment

Rachael Asks:

I’m sure you get questions on this all the time, but I was wondering what insight you can provide on traumatic wounds. My project is science fiction and the characters in question have enhanced healing and a sped up metabolism which I’ve just been using as my cure-all, smooth-over for any inaccuracies thus far. But then I found your blog- which has been incredibly fascinating and entertaining.

The first question I had which led me here was in general for a gunshot wound to the chest though not involving the heart. Namely, the various potential complications, the meds, supplies, or procedures that may be employed, and the sorts of phrases and terminology and reactions that may be overheard from the staff working on the patient. I’ve read on the risks of things like a sucking chest wound and consequential lung collapse, punctured lung, of course blood loss, but I still am at a loss for particularly the things the medical staff on hand would be saying or doing. (Bonus points if you have any tips for the internal monologue for the victim besides “ow.”)

Jordyn Says:

Hi Racheal! Thanks for sending me our question.

Your question is hard to answer. You don’t give specifics of the injury though it looks like you’re leaning toward a collapsed lung. There are a couple of ways you can research the feel of an emergency and that is by watching reality based (non scripted) shows that center on emergency medicine or look for teaching videos (or live videos where they capture the procedure on a real patient on You Tube).

For instance, a patient with a collapsed lung will likely need a chest tube placement. You can search You Tube for “placement of a chest tube” and see what comes up. The below video is pretty good as it gives lots of technical detail on what the physician is doing, seeing, feeling, and even what medicines might be prescribed for the patient. However, it does lack a lot of language of what would be said to the patient during the procedure.

The next video shows more patient interaction and what might be said. Between these two videos you could probably extrapolate together a scene. I will say that typically patients are connected to a larger suction device, but what the below physician is connecting to looks to be a more portable device so the patient can be up and walking. Also, a patient with a tension pneumothorax who is crashing may not receive local anesthesia and may even be unconscious.

Your best option, once the scene is written, is have a medical person who actively is practicing in the field review it. If your scene is written from the POV of the doctor placing the tube, it would need to be more technical versus if you’re writing it from the POV of the patient. You can also search Google for patient experiences of having a chest tube placed to get a feel for the inner dialogue you’re looking for.

Hope this helps and good luck with your story!

Author Question: Causes of Respiratory Distress in a Ventilated Patient

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Terry Asks:

My question is what would make a person in a drug induced coma go into respiratory distress? My character is having really strange dreams/nightmares in his comatose state and I want to introduce a dark force (ie death), that is trying to take him. At the same time, in the hospital that dark force is actually a respiratory distress, but I can’t find any information on what would cause him to go into distress or how that would be handled by the doctors and nurses.

Image by Simon Orlob from Pixabay

Jordyn Says:

A patient in a medically induced coma will also be intubated (a tube inserted into the trachea to help the person breathe) and will be ventilated by a machine.

There is a pneumonic that most medical people run through when a person on a ventilator develops trouble breathing and it is the D.O.P.E. pneumonic. I first learned it in Pediatric Advanced Life Support (PALS) that is a class taught by the American Heart Association.

I’ll give you what they stand for and the medical treatment the nurse/doctor would take.

D: Dislodgement: Dislodgement means the tube is somewhere it shouldn’t be. The endotracheal tube (ETT) could be out of the patient (termed accidental extubation) or it could have migrated into the right bronchi thereby only ventilating one lung. If the tube is completely out (or sitting in the mouth— no longer in the trachea) then the patient would need to be reintubated. If the tube is in the right bronchi, it simply needs to be pulled back a little bit until there are breath sounds in both lungs and equal chest rise when the machine gives a breath. Often times, after measures are taken to correct the situation, a chest x-ray would be taken to verify the tube is in the right place.

O: Obstruction: Obstruction can mean a lot of things. It more commonly means that there are secretions in the ETT tube that need to be cleared. If that happens, they would be suctioned out. However, obstruction can also mean something like a developing pneumonia that may require increased settings on the ventilator and initiation of antibiotics. Ventilated patients are at high risk for developing pneumonia (if they don’t have it already).

P: Pneumothorax: This indicates that one lung has collapsed. Because the lung is deflated it can no longer be ventilated properly and is causing difficulty breathing. Treatment for a pneumothorax is placement of a chest tube to reinflate the lung. The patient should improve after the chest tube is placed, but it does take time for the lung to fully reinflate. Ventilated patients are also at risk for a collapsed lung, particularly if they are on pretty high ventilator settings.

E: Equipment Failure: This can mean something is wrong with the ventilator itself. It can be as simple as the machine became unplugged. Not all ventilators have battery back-up. If this is causing the patient to have respiratory distress, we simply take the patient off the ventilator and begin to bag the patient manually via the ETT until the problem can be sorted out.

Any of these situations can cause respiratory distress in a ventilated patient. It is your choice as the author which one to use.

Hope this helps and good luck with your story!

Author Question: Blood Types and Blood Transfusions

/ Jordyn Redwood / 2 Comments

Ryana Asks:

I want to do a story set in WWII and one of my climaxes is when a Jewish soldier gives blood to save a German soldier’s life (or vice versa). My question is this: do different races have different blood types? Like, do Jews have a blood type no one else has? I don’t want to do something medically incorrect just because I think my story is good.

Jordyn Says:

There are eight different blood types and all ethnicities/races can have one of these blood types though some are more prevalent in a race than others. Here is an interesting link where the Oklahoma Blood Institute looked at what blood types certain races were and their break down.

I think the harder part of your question is would these two soldiers, by chance, have the same blood type where it wouldn’t cause a life threatening reaction in the soldier receiving blood. I was able to Google this question and found this link. As you can see, the best odds are if both soldiers are O-positive and yet that random chance that both are the same blood type is only 38%. The next highest is if both are A-positive at 34%. The other blood types fall precipitously after that. Of course, if the soldier giving the blood is O-negative (this is the universal donor) then there should be no reaction regardless of what blood type the receiving soldier is. On the reverse side, the universal recipient (someone who can get anyone’s blood) is AB-positive.

It would actually increase conflict in your story if the soldier receiving blood DID have a transfusion reaction. This type of reaction would be called a hemolytic transfusion reaction. This article reviews some of the varied responses a patient can have. Of course, you’d have to consider the time frame of your piece and what treatment would have been available then.

Hope this helps and good luck with the story!

Author Question: Emergency Care of the Suicidal Patient

/ Jordyn Redwood / 2 Comments

Riannon Asks:

I’d really appreciate your help in answering some questions. I’ve Googled as much as possible, and I just can’t seem to find answers for some things.

At one point in a play I’m writing, a character attempts suicide. His goal is not actually to die, but he does go through the process. What happens is that he’s very drunk and it’s a combination of probably alcohol poisoning and a lot of pills, something relatively accessible lying around the house, but potentially lethal in a high dose and then he calls 911 right afterwards.

So my questions are:
1. Would he be allowed to have visitors the next day? Essential for plot reasons.
2. Would visitors have to be family members or something or would friends/acquaintances be able to fudge their way in?
3. Before someone visits a patient, is the patient told that they’re coming and who they are? (I have very little knowledge of how hospitals work.)
4. How screwed up would he be physically?
5. Would he have to be committed to psych, and if so, when?
6. What could he have overdosed on?

Jordyn Says:

Hi Riannon!

Thanks so much for sending me your questions.

1. Would he be allowed visitors the next day? Depends on where he is at in the process. I’ll give you the process a patient goes through at our hospital, but you might need to adapt it if your play is located in a specific town, state, etc.

When a patient comes in with a suicide attempt, they are placed on 1:1 observation. The patient must be “medically cleared” before they can participate in a mental health evaluation. What that means is that they are no longer in danger medically from what they ingested AND that they are clear mentally to participate in the process. For instance, our patients would have to be below the legal limit for alcohol in order to participate. During the time of medical clearance and during the mental health evaluation (as for pediatrics parents are involved in the process) the patient is allowed to have visitors. A limited number. We try to keep it to two at a time and generally only immediate family.

If the patient is deemed to be a danger to themselves and does not voluntarily consent to treatment, then they are placed on an M1-Hold. This will have different names in different areas, but it is a legal document where the patient is involuntarily committed to a mental health institution for stabilization for about three days. Most mental health facilities will strictly limit visitors and may not let anyone visit during the initial 24-48 hours. Depends on the facility.

2. Could family/friends fudge their way in? I think I’ve mostly answered this above. If the patient is at a mental health hospital probably not without inside help. These are generally locked facilities that will keep a close eye on who is coming and going.

3. Is the patient notified of visitors? I can give you the ER answer and that is it depends. If the patient is unconscious then probably not. If the patient is conscious then we do want to inform the patient of who is there, but we would likely keep it to immediate family. We don’t want to inflame an already volatile situation so if the patient would become harmful to themselves or others then visitors are restricted. Pediatric patients will sometimes try and not have their parents visit, but parents are part of the process, so we encourage them to be at the bedside as long as the patient can be safe.

4. How screwed up would he be physically? Depends on a lot of factors. What he took. How much he took. And how long before he sought medical care.

5. Would he be committed to psych? If so, when? Yes, in this instance, he would be committed involuntarily if he did not agree to a voluntary admission. This would happen once he’s medically stable and after his mental health evaluation. Sometimes, patients may not be medically cleared for 12-24 hours (sometimes longer depending on the drug’s half life). Then we have to wait for an available mental health counselor which can take an additional 3-6 hours. Then waiting for placement could be another 3-24 hours. It can be a very lengthy process. Mental health beds are not that easy to find at times. Patients are held in the ER until they have a bed placement. It is also a requirement of our hospital that patients be transported by ambulance to their mental health facility and generally family members are not allowed to ride in the ambulance with them. This is a safety concern for the EMS crew.

6. What could he have overdosed on? This is really up to you as the author. Any drug can be toxic given in enough quantities and alcohol ingestion on top of that can make things much worse. Some of the more common medications most people have at home that can become easily toxic, in my opinion, would be acetaminophen (Tylenol), aspirin, and diphenhydramine (Benadryl).

Hope this helps and best of luck with your novel!

Author Question: Multiple Survivable Stab Wounds

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Joseph Asks:

I am writing a story inspired by the Saw franchise in which a man is forced to stab himself with three Swiss army knives. The knives will remain in. For the best chance of survival, should all the stabs be in the lower abdomen, or also bladder and/or hands/forearms?

I’ve heard the hands, forearms and lower abdomen are the three safest places to survive a stabbing, although of course technically there is no safe place, but those three areas avoid major organs/arteries/blood vessels. Though I’ve also heard stab wounds to the extremities i.e. hands can cause lasting disabilities. Where should he stab himself and how long until he is expected to die? He will be able to call an ambulance immediately, and maybe could use some cloths nearby to help put pressure on the wounds, assuming the pain is not debilitating.

Jordyn Says:

Hi Joseph!

Thanks for sending me your question.

I would agree with most of your assumptions as far as the extremities in general and the lower abdomen. You don’t include the legs. I think another relatively *safe* area would be the front of the thigh into the muscle or the back of the calf. Anywhere in the extremities where there is a large muscle mass. You could browse anatomy pictures of the extremities looking for diagrams of where the arteries are located to make sure you avoid them.

The lower abdomen is a good choice as well for suvivability. The problem can be puncturing the intestines and spilling gastric contents into the the abdominal cavity. If this happens, this can set up infection and sepsis though this would take a couple of days. You mention in your question that your character will be able to call for an ambulance immediately, not sure if that’s what you intended to say, as a delay in calling for an ambulance would definitely increase the conflict in your story.

Next to bleeding out, developing infection and sepsis would be the greatest risk of death for this character, but would likely take 2-3 days to develop.

Any stab wound to the hands or feet could be a set up for a life long debilitating injury. Many of these can be repaired, but I personally ruptured a tendon in my hand over twenty years ago and have limited range of motion to that thumb. The decision to make as the author is what, if any, long lasting effects you want the character to suffer.

Hope this helps and best of luck with you novel!

 

Author Beware: Doctors Cannot Do Everything

/ Jordyn Redwood / 3 Comments

I was recently reading a YA novel (that I did really enjoy BTW) when I came across this passage. For a quick background, this young girl has just woken up screaming after being involved in a car accident so it’s presumed she has a head injury.

The passage is as follows from the novel:

The room fills up with people. Two nurses and a doctor appear as quickly as if I’d pushed the little red call button on my bed. 

“Sophie, I’m Dr. Langstaff. You’re in a safe place and I’m here to help you.” The doctor holds a syringe and a container, measuring out a clear liquid. “I’m going to give you some medicine to calm you down and help you sleep.” He inserts the syringe so the medicine flows into my IV. It drains the screams right out of me, like he’s pulled the plug on my lungs.

Interestingly, there are quite a few problems with this small passage.

1. There is a process to giving medications in the hospital. The doctor orders the medication, the pharmacy double checks and approves the dosage, and the nurse draws it up and gives it to the patient. This patient is on a medical surgical floor— this is the process that would take place.

2. Doctors generally don’t have access to sedatives or narcotics. There are only a few areas in the hospital where a doctor would have direct access to these types of medications that they could pull themselves and that would be anesthesia. Narcotics are very tightly controlled. Doctors generally can’t even access narcotics or sedatives via the medication dispensing machines on the floor— even those medications that only they can give (such as perhaps Ketamine for a sedation). This is not the “old” days where a doctor carried around a stock of medications he could dispense. Nowadays, they likely can’t even access them.

3. Sedatives generally aren’t the first choice for a distressed patient.  I think for writers, this idea comes from watching too many bad television hospital dramas, but in real life is rarely done. The first step in handling a patient that first wakes up from a traumatic event is to orient them to where they are and what’s happened. Involve the family in helping them feel safe. If the distress continues, evaluate if there is a medical reason behind it. Is there some undiagnosed medical problem? Does she need a repeat scan of her head? It really is unusual that you can’t calm a person down— even one with a head injury. Patients are generally only given sedation if they become physically harmful to themselves or others. We do use sedation in some of these situations, but not as a first line and not as often as you might think and most likely not in the head injured patient.

What are some other things you’ve seen in books that aren’t accurate as far as a hospital setting goes?

Author Question: Stab Wound to the Lower Abdomen

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Katerina Asks:

My character, Faith, is stabbed with a switch blade (about  8.5 cm long)  in the lower abdomen. I have three questions about this.

1. Can she die from this and how long would it take?
2. Would she have to go to the hospital?
3. If she survives will there be any permanent or semi  permanent  damage?

Jordyn Says:

Hi Katerina! Thanks so much for sending me your question.

You don’t give specifics on exactly where in the lower abdomen your character gets stabbed (left, right, or mid line). If stabbed in the lower abdomen, there are fewer things that can be hit that will cause you to die immediately— generally from blood loss. Though there is that descending aorta to worry about.

The lower abdomen mostly contains intestines, the bladder, and reproductive organs for the female. A person can die from injury to these body parts– most likely from infection leading to septic shock. This would be unlikely should your character receive medical care shortly after the injury.

If you choose to go this route, I would say death from sepsis could be as early as 48-72 hours to as long as a few weeks. On the early side if the character did not receive any medical treatment and there are some nasty germs either on the knife or the intestines are punctured leading to contamination of the abdominal cavity and no surgical repair or antibiotics are given.

Longer if there is surgery and antibiotic therapy but the person is infected with a resistant strain of a bacteria or fungus, or is immunocompromised, etc.

A stab wound of this type should be evaluated in the hospital. Again, this would be up to you as the author and what kind of conflict you want to have for your story.

It’s hard to say if this character would have any lasting effects from the wound as you don’t give specifics as to the injury.

Best of luck with your story.

VIP Patient Rooms: Are They Real?

/ Jordyn Redwood / Leave a comment

When most think of hospitals, we envision sterile environments with mediocre food and beds that lack the comfort of home. However, while watching an episode of The Resident, the concept of VIP rooms emerged.

In the scene, the hospital admits a wealthy donor and hospital board member to their VIP room. The space is decorated with lavish furnishings and a duvet cover to compete with those in most hotels today. However, the scene pales in comparison to the real accommodations some multi-millionaires experience in the US.

How the rich endure their hospital stay never crossed my mind before, but apparently, they receive five-star rooms with services that the average American can’t afford.

Some hospitals cater to the those with vast amounts of money, the famous Hollywood crowd or politicians and diplomats who live in the US and abroad.

Luxury three-bedroom, two bath suites, beautiful living and dining areas with sweeping views of the city await them when admitted. Kate Hudson, Victoria Beckham and the Kardashian sisters have all experienced the posh treatment when delivering their babies.

Not only are the furnishings top-notch, but the affluent patients receive meal delivery from private hospital chefs, their own personal doula, hair and nail services along with free bath robes or anything else their heart desires.

As for the average Joe, our wallets can’t afford the four thousand dollar a night stay.  Our rooms are less ornate. We get one clean bedroom, one small bathroom, mediocre food from the cafeteria and bland furnishings. No personal doula for us although, breast feeding centers and coaches are available.

The maternity suites are not the only area where the wealthy thrive. Even when emergencies strike, affluent patients often skip past the ER department and straight to luxury accommodations. Where an average patient will spend hours waiting, the rich fast-track their medical care, bypassing the conflicts assigned to the rest of us.

My father always used to say, “Money doesn’t buy happiness,” and I agree. However, having some cash might make a difference when faced with a hospital stay.

******************************************************************************************
Shannon Moore Redmon writes romantic suspense stories, to entertain and share the gospel truth of Jesus Christ. Her stories dive into the healthcare environment where Shannon holds over twenty years of experience as a Registered Diagnostic Medical Sonographer. Her extensive work experience includes Radiology, Obstetrics/Gynecology and Vascular Surgery.

As the former Education Manager for GE Healthcare, she developed her medical professional network across the country. Today, Shannon teaches ultrasound at Asheville-Buncombe Technical Community College and utilizes many resources to provide accurate healthcare research for authors requesting her services.

She is a member of the ACFW and Blue Ridge Mountain Writer’s Group. Shannon is represented by Tamela Hancock Murray of the Steve Laube Agency. She lives and drinks too much coffee in North Carolina with her husband, two boys and her white foo-foo dog, Sophie.

Author Question: Pedestrian vs. Truck 2/2

/ Jordyn Redwood / Leave a comment

Today, we’re continuing with Luna’s question. You can view Part I here. In short, a 24 y/o woman has been hit by a truck throwing her into the air. When she lands, her head hits a concrete divider.

What will the doctor check or say when she first arrives at the emergency department?

If EMS care has been provided as I outlined in the previous post, we would do the following in the ER:

  1. Check vital signs and level of consciousness. If vital signs are abnormal, we would address those immediately. For instance, if her oxygen level is low, then we’ll provide more oxygen and evaluate whether or not the patient needs to be intubated (a breathing tube into the lungs). EMS may have already done this. If so, we’ll check the placement of the tube. If her blood pressure is low address that by giving either more fluids, blood, and/or a vasopressor (which is a medication given via a continuous drip to raise blood pressure). Of note, sometimes giving lots of IV fluid with head injuries is problematic.
  2. Draw lab work. In this case, we would check multiple labs. Blood counts, chemistries, and labs that look at how well the blood is clotting.
  3. Radiology studies. This patient automatically buys herself a full spine series (looking for fractures in the spinal cord) and a head CT (that would look for bleeding– and other things). Other labs and studies would be ordered depending on what other injuries were found. As previously stated, this patient would likely have more than just the head injury. A chest x-ray as well particularly if intubated to check placement of the tube.

Is surgery needed? 

This would be up to you as the writer. Would there be a case in this scenario where surgery might be indicated? Yes. Hitting your head into a concrete barrier could definitely cause some fractures in the skull where bone fragments could enter the brain. This patient would get a neurosurgery consult for sure.

Does she require blood transfusion for the surgery? 

Whether or not a patient gets blood is largely dependent on what their blood counts are. We look at this by evaluating a patient’s hemoglobin and hematocrit or H&H in medical lingo. If low, the patient gets blood. In trauma patients where there is a concern for bleeding, we draw blood every few hours to trend this lab. If it’s dropping, we know the patient might be bleeding from somewhere.

What machines would be used to keep her alive?  

In this case, likely a ventilator (or breathing machine).

How long will she be in the hospital? I am writing for two days.

Unfortunately, I think this patient would be hospitalized much longer than that. A brain injured patient that requires brain surgery would likely be hospitalized for a week or more. A week on the short end if they wake up and are neurologically intact meaning that they can speak, walk, and talk. That they know who they are, where they are, and what time they are in. Also, are their cognitive abilities intact (memory, ability to do simple calculation, etc). If this patient had a simple epidural bleed, then perhaps home in a few days if the above is normal.

The reason I say a week for this patient is the concern for brain swelling surrounding this type of injury. Brain swelling peaks around 48-72 hours and patients generally get sicker when that happens.

Thanks for reaching out to me, Luna! Best of luck with this story.

Author Question: Pedestrian vs. Truck 1/2

/ Jordyn Redwood / Leave a comment

Luna Asks:

I hope you can help me with my writing. I need some details for my character.

She is a 24 year old girl that was hit by a 4×4 pickup truck while crossing the road. She was thrown and her head hit the road divider. She was bleeding moderately (not too heavy) from her head injury. She was conscious when her friend sent her to the hospital where later the doctor said she had brain hemorrhage as a result from that accident.

Can I have the details for:

  1. Will she have shock and shortness of breath on her way to the hospital?
  2. What will the doctor check or say when she first arrives at the emergency department?
  3. Is surgery needed?
  4. Does she require blood transfusion for the surgery?
  5. What type of machines would be used to keep her alive?
  6. How long will she be in the hospital? I am writing for two days.

Jordyn Says:

Hi Luna! Thanks so much for sending me your question.

First off, this is a VERY significant trauma to this young woman. There are some specifics missing from your scenario that would be helpful in answering your questions such as how fast the truck was going when it hit your character. The fact that you mention that the victim was thrown indicates a higher rate of speed. Being thrown coupled with the fact that her head hits a very hard surface (the concrete divider) doesn’t bode well for your character.

From your questions, it sounds like you want this to be a more minor injury. If you want this to be a survivable injury (which could be doubtful) you would need to change the nature of this accident and make it less lethal. For instance, the character isn’t thrown a distance. The truck isn’t traveling at a high rate of speed. Or, your character is in a vehicle of her own.

I will answer these questions based on your scenario as is, but keep in mind, this is a very serious accident and if the character survived, she would likely have an extensive hospitalization.

Will she have shock and shortness of breath on her way to the hospital?

You don’t specify in your question whether or not 911 was called and the patient was transported via EMS to the hospital. I would recommend that you do this. You also outline in your scenario that her head wound isn’t bleeding a lot. This is another part of your question that will need some revision. Head wounds do bleed extensively and heavily. If you’ve ever seen a minor laceration to the head you’d be impressed. The scalp is very vascular (meaning lots of blood vessels supply the area and therefore a much higher rate of bleeding).

Yes, this character could be in shock likely related to the blood loss from her head wound, or her head injury, or psychologically from the fact that she’s just been hit by a truck. Keep in mind, the head injury may not be her only injury. Anyone hit by a vehicle and then thrown will likely have other injuries such as broken bones, possible internal injuries, other cuts, lacerations, and abrasions.

If the patient was transported by EMS, they would first provide for C-spine stabilization (placement of a C-collar and backboard) while simultaneously assessing her breathing. Whether or not she’s breathing would be up to you. I could see it either way in this scenario. If she’s not breathing, then they would assist with her breathing. In addition, they would control any visible bleeding by applying pressure and dressings. She would be placed on a monitor to track her vital signs. An IV would be placed and IV fluids would be started.

Since this is a lengthy question, we’ll conclude tomorrow.