Pat I. Asks:
I needed help with a scene for my book and Bonnie said you might be willing to share your nursing expertise.
The scene– in an early American historical:
A young woman has a sack thrown over her head. In the next instant, her head is pushed down and she’s driven forward into a tree trunk face/head-first.
She’s found a few minutes later unconscious and the sack is removed. What kinds of injuries would she sustain?
I’m hoping such a blow is not hard enough to kill her or give her a skull fracture (attacked by another woman of equal strength), but wonder about sustaining a concussion? Also what kind of bruises on face or nose?
Thanks so much for taking the time to help me out with this!
The frontal bone is the thickest part of your skull and therefore hard to fracture. A concussion is reasonable to give her if you’d like. These would include global headache (not just pinpoint to the area her head hit the tree trunk), nausea, vomiting, confusion, balance problems etc.Also a broken nose would be reasonable if she took the brunt of this blow there.
The covering over her face will provide a barrier to direct injury from the tree especially if it’s just one quick smack and not repeated. What I would imagine would be some bruising/swelling to the area that was hit. Maybe some abrasions. You can get burst type lacerations (like when a kid pops his chin open) just from pressure so this would be reasonable, too. You have some leeway with what you’d like to do.
On every crime show where a murder has occurred, there’s usually a big scene with the medical examiner asserting time of death or determining the time of an injury. In pediatrics, this becomes important when we look at timing a child abuse injury so we can place who was with the child during the suspected event.
The question is, can bruising give an exact time for the injury?
Bruising happens when an object comes into contact with the skin, and the small capillaries underneath break open and cause bleeding. Generally, patterned shaped bruises are more suspicious for intentional injury. For something to make a pattern on the skin, it generally needs speed or velocity to imprint the pattern onto the skin. For instance, it is far different if I tap you with a belt versus swinging and slapping it down.
Point blank, bruising is not a good way to determine time of injury. Bruising is influenced a lot by the individual person. Are they on blood thinners? Do they normally heal quickly? Age factors influence speed of healing as well. Bruising can give a time frame but color of bruising is also open to interpretation. Here’s one set of guidelines.
Color of Bruise
Red– swollen/tender: 0-2 days
Blue/Purple: 2-5 days
Green: 5-7 days
Yellow 7-10 days
Brown 10-14 days
As you can see, 48 hours is a large time frame. In the case of pediatrics, imagine the potential of how many people could have come into contact with an infant.
Interesting bruising fact: Bruises generally heal from the inside out. If you watch a bruise you have, you’ll notice they become lighter at the center as healing progresses.
Did you think bruises could give an accurate time frame for injury?