Author Question

Author Question: Medically Induced Coma

/ Jordyn Redwood / Leave a comment

Terry asks:

The information you sent me last time has been great for my story! One thing I forgot to ask though, and it is very important to the ending is this: When my character finally comes out of his coma I need to know two things:

1. He was put into a drug induced coma because of a head injury suffered in an automobile crash. Is it possible he can come out of that coma on his own? Like just open his eyes after about two weeks?

2.  When they finally take the breathing tube out of him how long will it take before he will be able to speak? I want him to be able to tell about what he went through in the coma from his perspective as soon as he can.

I thank you in advance for any and all info you can give me. I really appreciate your help. Your site is THE BEST for writers!!

Jordyn Says:

Hi, Terry!

Thanks for sending me your question.

In your first question it’s hard for me to tell if you mean is it possible for this patient to just wake up from a drug induced coma— like the drugs are still infusing? If that’s the case, then no. The medications would have to be stopped before the patient would have a chance of waking up. In fact, the type of medication on board often plays into whether or not a patient can be declared brain dead.

If a patient still has narcotic and/or sedative medications in their system they cannot be declared brain dead. So first, the medication(s) given has to wear off. Most often, these medications are given as continuous infusions and are weaned down slowly and not abruptly discontinued. If after that has happened then yes— a patient may just open his eyes.

More often, patients are slow to come about. The first time they open their eyes, it might only be for a brief period of time. They may have muscle movements first. Generally, the medical team knows they’re improving when they can respond purposefully to pain by first pulling away from the stimulus, then by trying to push the stimulus away, and then by opening their eyes and understanding and following commands. It’s usually a slow process– from days to weeks (and even months to years) depending on the type of head injury the person suffered.

In regards to your second question, how long before he can speak? If he is awake and able to speak then he should be able to speak right away if the brain injury did not affect the speech sensitive areas. Some patients are extubated (or taken off breathing machines) and they’re not fully alert and responding to commands, but may be breathing adequately enough that they no longer need a ventilator. Many of these patients do have a trach in place, though.

That being said, if your character is awake and alert, his voice will sound soft, hoarse, and strained. His throat will hurt. He may have some trouble swallowing. His voice won’t have the same strength right after the breathing tube comes out as it did before. It will take some time to return to normal. The shorter the intubation the more quickly the patient’s voice should return to normal.  However, he should be able to share his story.

Good luck!

Author Question: Directed Organ Donation– In a Suicidal Way

/ Jordyn Redwood / Leave a comment

Susan Asks:

My character ends up killing himself in order to be a heart donor. Problem is how does he kill himself without damaging the heart? Also, there needs to be enough time for EMT’s to reach him before his heart stops. Therefore he needs to be brain dead only . . . Is it something he could plan or is it too far fetched? For instance, a shot to the head?

Jordyn Says:

Hi, Susan.

Very interesting if not morbid question you ask here. It sounds like what this character is trying to accomplish is some sort of directed organ donation upon his death. His demise would have to ensure brain death, but also ensure that paramedics arrive in time to at least establish a heartbeat and get him to the hospital. There is a narrow window for this to happen. The most common time frame given for brain death is lack of oxygen for four to six minutes after the heart stops beating.

This character would have to time his heartbeat stopping and then EMS arriving around four to six minutes after. I actually would probably not choose a gunshot wound to the head. There could be a couple of things problematic with this. EMS might not choose to treat if the wound looked particularly devastating. Also, if there were damage to the facial structures, particularly the airway itself, resuscitation to even get a heartbeat back would be challenging.

I think an injury caused from anoxia (or lack of oxygen) would be your best choice. Of those, I would think drowning, hanging, ingestion of sleeping pills and/or drugs (that wouldn’t cause heart damage), and possibly carbon monoxide exposure might be your best options in my opinion.  However, there is discussion in the literature whether or not it is wise to donate the organs from someone who died as a result of carbon monoxide poisoning.

Hope this helped and good luck with this story!

Author Question: Use of Tranquilizer Dart

/ Jordyn Redwood / Leave a comment

Christian Asks:

I am writing a book about a 22 y/o male. I want him to be knocked out via tranquilizer dart. I was wondering a few things. Would it work? How long would it take to knock him out? Could he pull it out without falling asleep? If he was sweaty, would the dart still work?

Jordyn Says:

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

Yes, using a tranquilizer dart should work to knock your character out. How long would it take? It depends on the medication they use in the dart. You can specifically Google the specific medication you choose and how long before it takes effect intramuscularly which would be the route using a tranquilizer dart. As a generality, intramuscular medications can take 2-4 minutes (for these types of drug classes) to work so he could pull the dart out without falling to sleep.

Would the dart work if he was sweaty?  I don’t see a reason why not. I think whether or not the dart pierces the skin and muscle is a matter of velocity rather than how sweaty the skin surface is.

You can read two other posts here and here that I’ve also done on tranquilizer guns.

Hope this helps and good luck with your story!

Author Question: How Do You Develop a Vaccine From Blood?

/ Jordyn Redwood / Leave a comment

Ruby Asks:

I’m currently writing a sci-fi story where a pharmaceutical company has created something that could possibly cure any disease and behaves similar to a virus. Unfortunately, it falls into the wrong hands and is used to harm people. It is decided that a vaccine could help if developed from someone’s blood who carries antibodies to this substance.

Can a vaccine or antidote be made using a blood sample? Also, what would be the proper term for this? Is it a vaccine, antidote, or a serum?

Jordyn Says:

Hi Ruby! Thanks so much for sending me your question. This was pretty fun to research as I learned quite a few new things.

First, let’s define these three terms: vaccine, antidote, and serum.

A vaccine is a “preparation used as a preventive inoculation to confer immunity against a specific disease, usually employing an innocuous form of the disease agent, as killed or weakened bacteria or viruses, to stimulate antibody production”.

An antidote is a “medicine or remedy for counteracting the effects of a poison, disease, etc.”

Blood serum is the substance that remains after the blood forms a clot. Serum is the liquid that “blood cells move through”. It is used for the creation of antiserum. “Because blood serum contains antibodies as well, doctors can also use serum samples to develop what is called antiserum: essentially, blood serum containing resistances to specific illnesses and ailments. When transferred into a non-resistant patient’s bloodstream, antiserum allows that patient to gain resistance to illnesses they may have otherwise been vulnerable to.”

A vaccine is usually considered to be a preventative– the person has never had the disease and they get inoculated to keep them from getting it. This would be diseases like measles and mumps.

An antidote usually reverses the effects of a medication or poison and not a biological agent. For instance, Narcan, given to reverse the effect of an opioid overdose could be considered an antidote. Medical people refer to these medications sometimes as reversal agents.

An “antiserum” would be the best term for you to use, as this is giving someone antibodies who is currently infected with the disease. For instance, Dr. Kent Brantly, who contracted Ebola while providing medical aid in Liberia, was treated with antiserum.

So, ultimately, you would need to research how an antiserum is developed. Generally laboratory animals are used and then exsanguinated to be able to collect large quantities of antiserum. So– if you want this character to live– this may not be a good choice for your story. Though, you as the author could also use the death of this character to create conflict in your story, too.

For further articles on developing antiserum you can look here and here.

Best of luck!

Author Question: Bone Infection after Orthopedic Surgery

/ Jordyn Redwood / Leave a comment

Sarah Asks:

My character was assaulted and, among other injuries, her right forearm was fractured severely. It was surgically repaired using pins.

My question is: Is it possible for her to develop osteomyelitis after a blunt-force trauma (that does not result in a fracture) two years after the original injury? If not, is there another scenario that could cause osteomyelitis after the fact like that? And what would be the immediate treatment plan following the second injury and osteomyelitis? Also, if left untreated for a period of time, could osteomyelitis become life-threatening?

Jordyn Says:

The first part of your question does not seem plausible to me. First, you imply that there isn’t a fracture associated with the second injury to this arm and the length of time doesn’t quite work. The arm should be fully healed two years post surgery to repair the fracture.

If this character were to develop osteomyelitis near the site where she received a blow by a blunt object, but that arm had been previously fractured two years prior, I don’t see the medical staff thinking these two things are related. They are just too far apart.

I don’t know of another scenario that could cause this to happen two years out– that the blunt force blow (that doesn’t break the skin or cause fracture) somehow ignites an osteomyelitis at a previous surgical site. If it did, I think it would be considered happenstance.

Ostemyelitis generally happens when bacteria gets to the bone through an open wound (open fractures are a great way to write this complication) or the infection to the bone is seeded from another area in or on the body (a septic joint for instance). The infection will generally develop within two weeks.  Even in the article linked in this paragraph, chronic osteomyelitis usually develops within two months. Nothing even close to two years.

The course of treatment for osteomyelitis would depend on what bacteria (or fungus) is causing the infection. Surgery could also be indicated.

Yes, any infection can become life threatening particularly if the bacteria or fungus gets into the bloodstream.

Hope this helps and good luck with this story!

Author Question: How Long for Toxicology Results?

/ Jordyn Redwood / Leave a comment

Susan Asks:

If suicide is suspected due to the mental health of victim, and it appears alcohol and opioids were involved, how long will it take to get a toxicology report back after the autopsy?

Jordyn Says:

Usually results such as these through a medical examiner’s office are 4-6 weeks.

However, if the patient was a medical patient and seen in the emergency department, these tests likely would have been done and would be resulted fairly immediately. The family could request a copy of the chart through the medical records department which should be more readily available. Or, if being investigated, the police can go through the courts to obtain a copy as well.

At times, in the event of a patient death, the doctor may choose to disclose medical findings to next of kin to explain the death and might choose to give these results, but likely wouldn’t give a physical copy of the lab report in something sensitive of this nature. The doctor might choose to say something vague such as, “We suspect your loved one died due to respiratory failure that could have been induced by drugs in their system.” Or they could leave out the suspected drug component all together due to concern over legalities.

Hope this helps and best of luck with your story!

Author Question: Bullet Graze Wound Near the Ribs

/ Jordyn Redwood / Leave a comment

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?

/ Jordyn Redwood / 2 Comments

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!

Author Question: Help Me Knock Out My Character!

/ Jordyn Redwood / Leave a comment

Elizabeth Asks:

I need to temporarily drug character. She will ingest it unknowingly (probably through coffee). I’m also considering having her drink one glass of wine, so the culprit could be the drug itself or the combination of the two, but I’m open to other possibilities.

It would need to be an OTC drug or something with easy access. Also, the drug would either have to wear off on its own or need be handled by an EMT without access to a hospital or medical equipment. What drug would get the job done? Would sleeping pills work and if so which kind would be best? How much would the character need to ingest? And how long before it takes effect and wears off?  Thank you!

Jordyn Says:

Hi Elizabeth!

Thanks for sending me your medical question.

You specify that the drug would need to be over-the-counter or something with “easy access”. Your two possibilities would truly be something over-the-counter or a prescription medication is stolen from someone else.

There are plenty of over-the-counter medications that cause sleepiness. The three most common would probably be diphenhydramine (Benadryl), dimenhydrinate (the active ingredient in the Dramamine that causes sleepiness), and doxylamine succinate. Several combination medications contain these active ingredients. For instance, if you look at multi symptom cough medicines, you’ll likely see one of these medications. Same with Tylenol PM or Advil PM. To a lesser degree, Melatonin and Valerian Root can also cause drowsiness.

The problem with all of these over-the-counter preparations is that they don’t have the same predictable impact. One person might take one of these medications and fall asleep in fifteen minutes. Another might take it and not be sleepy at all.

A safer bet would be to have this character steal a prescription medicine from someone. This opens up your possibilities of what drug to choose that would have a more predictable effect. Some of those drug categories would be benzodiazepines (such as Valium and Xanax), opioids (like morphine and fentanyl), and the hypnotics (like Ambien and Lunesta). Also, muscle relaxers like Soma and Flexeril have sleepiness as a side effect.

Then, of course, your character could obtain an illegal drug like Ketamine or GHB (aka the date rape drug).

The OTC medications will probably have the least disastrous side effects if given in normal doses. Your chances of injuring your character go up exponentially with these other drug classes if proper medical attention isn’t give if the character stops breathing. This would be the leading cause of medical calamity using a prescription or illegal drug.

In the end, it’s up to you to decide. I think the best thing for you to do would be pick a drug from each of these classes: over-the-counter, prescription, and illegal— and research a few to decide. If you type in the exact name of the drug and the question you want answered (like dose, onset of action, etc) you will usually find drug guides that can answer these questions for you.

Hope this helps and good luck with this story!

Author Question: Prioritizing Medical Care

/ Jordyn Redwood / Leave a comment

Ethan Asks:

My main character was in a fight. He has a skull fracture with epidural bleed, a dislocated shoulder, and a twisted ankle. He arrives at the hospital unconscious. Would the ER try relocating the shoulder right away or wait for him to regain consciousness first? Just a common anterior shoulder dislocation. Also how? I’ve seen too many videos to know the ‘tried and true’ from a best guess. How would you do it?

Jordyn Says:

For this patient, the neurological injury would take precedence. It doesn’t matter much about his shoulder if he never wakes up. So, if he does have an epidural bleed, that would be the surgical priority. When he’s under anesthesia for the surgery and his epidural bleed has been stabilized, they could relocate the shoulder intra-operatively.

The videos you’ve seen are probably accurate— yanking and pulling a certain way to get the shoulder back in. Sometimes, if the patient is just sedated enough, the shoulder will relocate on its own, but it is more common to have to pull it back in to place.

The only thing that might make them rush with the shoulder is if they felt that the patient wasn’t getting blood flow into his hand on that side. Since he’s unconscious, he really couldn’t say if there were any numbness to that hand that would also be an indicator he might be having trouble with blood flow into the hand.

That being said, I’ve not personally seen neurovascular compromise with a “simple” shoulder dislocation (though I’m sure it does happen on occasion) so precedence would be his head injury.