Author Question: Bullet Graze Wound Near the Ribs

Ella Asks:

I’m writing a pseudo-novel, and in order to inflict the most possible pain on my character without leaving him entirely incapacitated or even dead, I have a couple questions.

1. Would one be required to go to the hospital for a bullet graze?
2. If one is grazed on the side in roughly the 6th-8th rib area, how much would they bleed?
3. If you were grazed in the 6th-8th rib space, would it be possible that the bullet would fracture a rib?
4. If so, how severely?
5. How would a fractured rib and graze impact basic motor functions?

Jordyn Says:

Hi Ella!

Thanks for sending me your questions.

I think first it’s important to understand what a graze wound is medically— which would be a skin injury without serious underlying injury. The bullet nicked the person and that’s about it. Is it required that the person goes to the hospital? No, I think going to the hospital would be determined by if they could get the bleeding to stop and how extensive the injury is. The smaller the graze the less likely the need for the hospital.

Treatment would be:

1. Apply direct pressure to stop the bleeding.
2. Clean the wound thoroughly– sometimes vigorous flushing with relatively clean water and a touch of something like dish washing soap can be enough if the character is choosing not to go to the hospital. This can reactivate bleeding because the clots are getting washed out as well. After cleaning, apply direct pressure with the cleanest item available (preferably sterile gauze) or a really clean cloth.
3. If the wound edges can come together consider using butterfly closures to close the wound. This might also indicate that the person requires stitches. Sometimes you can apply antibiotic ointment over the butterfly closures to help control infection (something like over-the-counter antibiotic ointment), but keep in mind the oily nature of these ointments will tend to loosen anything with adhesive (like the closures as well).
4. Cover with a bandage.
5. Consider a tetanus shot if it’s been over five years since the last one.

Reasons to consider visiting the ER would be a large wound, unable to control the bleeding, and/or the wound is nicely approximated (and might benefit from stitches to control bleeding and reduce scarring), and to update the character’s tetanus shot. If the character is exhibiting any difficulty breathing this would be another reason for an ER visit.

How much bleeding would occur if the graze was near the 6th to 8th rib? Again, considering a graze wound is mostly a skin injury then applying pressure should be enough to stop the bleeding. Think of this type of wound as a cut or abrasion.

Could a graze wound fracture a rib? Yes, this is possible. How severely? This could be up to you as the author. The fracture could range from a simple fracture (a line is seen through the bone but the bone is stable and the parts stay together) to a type of fracture where the bone breaks apart into small pieces. The more extensive the rib injury, the more extensive the skin injury will likely be (and also increase the chances for internal injury) and could border past a simple graze wound.

A fractured rib and graze wound will have some effect on motor functions— mostly to the upper body. The person should still be able to walk and run but the motions of the arms (while running) will be painful. Fractured ribs are very painful so a person will naturally inhibit motion of the upper body to keep the pain from flaring up so raising the arm on that side while holding a weapon will hurt, but won’t be impossible. Taking deep breaths will be painful so anything that increases a person’s respiratory rate (like running) will hurt. Pain can be treated with over-the-counter pain medication like acetaminophen or ibuprofen particularly if just a simple fracture. Every day the pain should improve and be pretty tolerable in seven to fourteen days. The actual fracture (depending on how complicated) will take four to six weeks to heal.

Hope this answers your questions and best of luck with this story!

Author Question: Does Blood Loss Effect Fever?

Fraidy Asks:

I was wondering how blood loss would effect a fever? The character is ill with strep throat (or a stomach bug) and a fever that makes her want to cover up under layers of warmth. This is before an accident involving shattered glass and deep cuts and moderately serious blood loss. Would her fever be brought down due to the blood loss or would it complicate things more?

Jordyn Says:

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

In your question, you don’t specify whether or not the patient/character has received treatment for the cause of her fever. In the case of strep throat, they should have been prescribed an antibiotic, and should be feeling markedly better in 24-72 hours. There can still be fever, but it should not be as high as the days go on if the antibiotic is working against the bacteria that is growing.

If this accident occurred say after three days, I would imagine she should be fever free by that time.

However, let’s say the character was just diagnosed and still has increased fever related to the illness.

I would theorize that a high fever, 102 degrees and higher, could cause your character to have some exacerbated symptoms related to additional blood loss. A high fever will naturally increase a patient’s heart rate— and so does blood loss. There could also be a concern that an untreated infection could cause the patient to go into septic shock, of which one complication of sepsis is lowered blood pressure. Low blood pressure is also a symptom of blood loss— if the patient bleeds out enough.

The combination of these two things, low blood pressure and increased heart rate, in light of a patient with a high fever and blood loss can paint a complicated picture for the medical team. They may not know which (blood loss or infection) is making their patient so sick so they would take a dual approach to their treatment which could entail the following.

1. Drawing labs that look at blood counts, blood chemistries, but also those that would address sepsis concerns like blood cultures. Also type and cross for blood. Initially, for symptoms of low blood pressure and tachycardia, the patient will usually receive fluid boluses of normal saline IV.

If the patient is really hypotensive (low blood pressure) and tachycardic (increased heart rate) and is not improved from the IV fluid, the medical team might choose to give O negative blood instead of waiting for a formal type and cross to come back. If the patient is actively bleeding and the bleeding is hard to control, they could opt to start giving blood right away.

2. Consider antibiotics early in the course of treatment once any body fluids are cultured the provider thinks necessary to determine the source of infection. It is helpful if a family member could offer insight into what infection the patient might have or the symptoms they were experiencing before the accident.

3. If the blood pressure remains low despite fluid boluses IV and perhaps blood, then patients are generally placed on a vasopressor which is a class of medications given as a continuous infusion IV to help raise blood pressure.

4. Treat the fever with a fever reducing medicine like acetaminophen or ibuprofen. If the patient is headed to surgery to treat wounds from the car accident, then acetaminophen (or Tylenol) might be preferred.

Hope this helps and best of luck with your story!

Five Things This Is Us Got Right About Medical Care

Usually, when I write these blog post, it’s a scathing review of something a television show or movie got wrong. However, in a recent episode of This Is Us entitled The Waiting Room, there were several things that the show got startlingly right for a change. Chrissy Metz’s character, Kate, was in preterm labor leaving the family to dwell in the waiting room. Here’s what the episode got right.

1.  People use Google all the time to question medical professionals. In the episode, one of the family members pulls up the drug Kate is on to quell her contractions and begins to question its side effects. Listen, I’m all for informed family members, but as many medical professionals know, the information on Google can be less than accurate.

It does become frustrating as a medical person to take Google’s word for a medical treatment over a trained medical professional. I’m also all for questioning a provider in a respectful way. A better way to approach this question with your provider is to ask, “What side effects are common with this medication?” and “Do you feel like those side effects are worth the benefits of the treatment?” Any provider worth their salt should easily be able to answer these questions. If not, then you may have a problem on your hands. This will tell you more than Google will be able to tell you.

2. Often times, people think that waiting equates to poor medical care. In one part of the episode, Kevin begins to question the delay in hearing any news, and openly questions if his sister should be moved to another facility, insinuating that she’s not getting proper care. The truth is, few things are fast in medicine. I think the culture and patient expectations haven’t benefited from these one hour television shows.

Nowadays, everyone wants to be seen within an hour and discharged home shortly after. In reality, especially in units where you don’t have an appointment, triage happens all the time based on how life threatening a patient’s condition is. Also, sometimes patients need to be watched for lengthy periods to see if their condition will resolve to a point where they could go home, or see if they’re appropriate for admission. If needing to be admitted, where to? Does that unit have capacity and staff to take care of the patient? Just because you’re waiting doesn’t mean anything necessarily bad is going on or that your loved one is getting bad medical care. A lot is probably happening behind the scenes that you’re not aware of.

3. Threats to staff happen a lot more than you might think. Maybe a better term for this would be microaggressions. Threatening to leave. Threatening to transfer. Threatening to call the patient care representative to file a complaint. Threatening to sue.  Using profanity directed at the medical staff and not just expressing frustration at the situation. Unfortunately, medical professionals hear variations of these every day and often without merit. They are designed, generally, to force medical care to happen more quickly. Using threats or aggression to speed up medical care is not necessarily wise for a variety of reasons. The largest reason is that stressed out healthcare workers tend to make more mistakes— the one thing you don’t want to have happen.

4. Waiting rooms are pressure cookers. It’s not unusual for arguments and fights to happen in waiting rooms. The waiting room becomes a voluntary prison and all people can do is watch the clock ticking. The more time that goes by— the more frustration builds. We are all more likely to take out frustration on our loved ones most— probably after the staff. That frustration will bleed over into other people and families.

5. Healthcare workers respond to kind and courteous over anger a lot better. In the episode, Kevin and Randall both approach the nurses’ station asking for information. Randall does it with more kindness and respect and gets more of what he’s asking. We are normal humans and it’s true what they say about honey.

This Is Us used truth and reality to make a very effective episode. Well done.

VIP Patient Rooms: Are They Real?

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.

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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.

Treatment for Partial Thickness Burns

Robin Asks:

I have a question regarding burn care. The main character in my novel is burned in a house fire and receives second degree burns to his back. How long would the wound be oozing? If it’s second degree burns, would he require skin grafts? What is the general treatment for second degree burns? What pain medications would be ordered?

Jordyn Says:

With burns to the back, it would really depend on what percentage of his back is burned. Burns are always calculated in percentages so it’s hard to know exactly what the treatment would be without knowing that number.

However, in general . . . second degree burns are now called partial thickness burns in medical terminology. Usually, to qualify as a partial thickness burn, the skin is reddened with blistered areas. These will probably ooze quite a bit for a few days.

Current treatment is to slather the burned area with triple antibiotic ointment, generally leaving blisters intact. After the ointment is in place, the burn is covered with something that won’t stick to the leaking fluid (called serous or serosanguinous fluid) like non-stick gauze pads and then roller gauze is applied around. This is why not knowing the burn size is problematic.

If the burn is large, covering most of the back, then the torso may need to wrapped to keep the non-adhesive barrier/dressing in place. The goal is to leave blisters intact. Blisters can be popped if they are problematic in size but the skin may be left over top because it provides a protective barrier. Exposed raw skin is the most painful. Blisters are also left intact because they provide a barrier against infection.

These dressings would likely be done until the skin heals which can take up to two weeks. As far as home pain medications, once the wound is covered it usually decreases the pain dramatically because the raw, exposed nerve endings aren’t coming in to contact with air anymore. These days, the patient might be sent home with a few doses of Lortab or Percocet (three days is becoming more common) with the patient instructed to take Ibuprofen on a schedule as well for pain control. I don’t think this is a situation where skin grafting would be required.

Hope this helped and best of luck with your novel!

Tension in the Ultrasound Room

There are many ways to add tension and conflict to medical scenes without making them over the top or unrealistic.

Today, we’ll focus on how to add tension and conflict from real-life scenarios in the ultrasound department.

1) Family members – most patients have a family member with them when they get an ultrasound performed. But when a patient shows up with eight people in tow, things can get tense quick. This often happens with obstetrical ultrasound patients. Everyone wants to see the new baby and mom drags the three-year-old toddler who would rather pull the cords on the expensive machine than watch the monitor quietly (will come back to the toddler angle in a moment).  Here are the reasons why it might be best to leave Grandma and Grandpa at home too.

Ultrasound rooms are usually small – Most departments think they can roll our machines into the tiniest closet possible and save larger spaces for radiologist’s offices. While this does not make for a fun workday, having a crowd of people shoved into this small space makes for great tension in a story.

Too much talking – When family members gather, excited about the new addition to their family, they want to discuss and ask questions. The Sonographer however has about a hundred pictures needed to image for a complete exam. The scanner investigates every nook and cranny of the baby and mother for  syndromes and defects in the brain, heart, abdomen, chest and extremities of the baby. All structures on the baby are tiny and our sweet unborn model does not hold still for our pictures. When a multitude of questions bombard our thought process, this distracts from the most important goal, imaging the baby. However, for a story, a family peppering the Sonographer with questions could add tension and humor to the scene.

Young children – Sonographers are not babysitters and most toddlers are not interested in their sibling inside momma after about the first two minutes. Kids, however, love the really expensive machines that cost about a hundred grand. They want to pull on the cords, press the buttons and possibly put themselves in grave danger. The ultrasound room is not a safe environment for a toddler. However, Sonographers are constantly dealing with patients who let their children run around the room like it’s their own personal playground. Great for adding tension to the moment.

2) Doctors – Most Sonographers try to provide great images for their doctors to read, but when scanners don’t see an abnormality on an exam, then it is likely the doctor won’t either. When a pathology is missed, doctors are not happy. When adding a scene like this to your story, the author must be careful not to make the Protagonist appear incompetent. Perhaps, the doctor and employee disagree about what the protagonist sees. Many firm discussions take place in the real world when a Sonographer is convinced of an abnormality, but the doctor does not agree.

Also, make sure to give a variety of personalities to the doctors in the story. While a few doctors have the stereotypical arrogant attitude and can be difficult, most are nice and want to be a part of the team.

3) Other Sonographers – Some coworkers work well together, while others are lazy, sloppy or control freaks causing conflicts within the department. I have yet to be in a department where there is not at least one person stirring up trouble on a daily basis. Add tension to the story with arguments between coworkers.

4) Patients – we get a variety of personalities in our departments, from drug-addicted mothers to shackled felons with guards in tow and everything in between. I’ve rarely had anyone try to hurt me, although when I was an x-ray tech, some of the alcoholics we had to image, did try to hit me. In ultrasound, not so much.

Our job becomes difficult when we find abnormalities on a patient. When we find severe pathology, we realize our patient’s lives are about to go downhill. From finding cancer to blocked main arteries or a heart defect on a baby, these diagnoses create tension within the sonographer.

These are just a few ways to add conflict into an ultrasound machine. If you find you have more specific questions about this modality, then feel free to reach out to me – www.shannonredmon.com.

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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: How Fast Does A Tranquilizer Dart Work?

Alyson Asks:

I’m writing a script where the villains shoot people with a gun but we discover later it was only a tranquilizer. Is there a tranquilizer drug combination that can be shot from a distance (can be close range) at a person that would take effect fairly immediately? Or would stop them from being able to communicate immediately.

Jordyn Says:

Thanks for sending me your question.

There is no drug combination given intramuscularly (IM or within the muscle as a dart injection would be) that would incapacitate a victim immediately or even within a few seconds. For instance, Ketamine takes 3-4 minutes to work IM. This will be the case with most drugs given via this route— the range of 2-4 minutes for onset of action.

Hope this answers your question.

Best of luck with your story.