Treatment of Car Accident Victim with a Brain Injury

Leslie Asks:

My character has been in a car accident and sustained head damage (swelling to the brain)— is there a medical term for that? Also, the swelling becomes so bad the doctors have to remove part of her skull— is there a name for that? How long does that swelling usually take before it goes down so they can replace the skull? Does the character regain consciousness? I have her in an induced coma which I want her in for a while.

Jordyn Says:

Upon further clarification of this question from the author, she says there is not a significant description of the motor vehicle collision in the manuscript and the scene is being told from the POV of a nurse.

The brain swelling is called cerebral edema. Usually, if it’s a significant car accident then there is usually bleeding as well. This is why I ask about the car accident. It should be pretty serious.

A nurse will use language that a family can understand. So, I might actually avoid a lot of medical terminology when speaking to the family unless I also clarify what the words mean.

I might say something like, “Your mother (or whatever relation) has a lot of swelling in her brain as a result of the car accident. We call this cerebral edema.”

A craniectomy is where they remove a portion of the skull.

Peak brain swelling is generally 48-72 from the time of injury and diminishes from there. Induced coma is a reasonable medical scenario here.

Whether or not this patient regains consciousness is up to you as the writer. Statically, the odds are pretty low for her to be the same person she was before. If she does wake up, she’ll have extensive rehab needs for sure– but you could write it either way.

Best of luck with your story!

Author Question: What Happens to the Child of an ER Patient?

Susan Asks:

I am wondering what happens when a mother is injured and her seven-year-old child is with her. The unconscious woman is discovered by a passer by who calls 911. She wakes up, an ambulance arrives and she is taken to the ER.

I assume the child who is fine would go with them if the police haven’t been called. The woman is from out of town and knows no one in the city so the child can’t be picked up by anyone. The mother has a concussion and is kept overnight for observation. I am most interested in learning what would happen with the child at the point that they arrive at the ER while the mother is being examined.

Jordyn Says:

From the EMS standpoint— yes, they would bring the child with the parent.  As far as in the ER, if the mother is awake, the child would be in the room with her. The ED staff can assist with care of the child until the mother is feeling like she can manage. A child this age could be given activities to keep them entertained (coloring, snacks, a movie, etc).

If the child needs more than that then a member of the staff (like an ED tech or volunteer) could provide some assistance until the mother is feeling better and able to care for the child on her own.

Also, a concussion is not a reason for admission to the hospital. Not even overnight observation. Concussion patients are generally not admitted— even with a loss of consciousness at the scene. Even a minor car accident with loss of consciousness does not require admission if everything else is okay.

You don’t specify her mechanism of injury in your question. For concussion we want to see them alert and oriented and that their concussion symptoms (headache, dizziness, nausea) improve or resolve. CT scanning is more common in the adult population for head injury so if that shows no bleeding then there’s really no reason for her to stay in the hospital. If you need her admitted, I can help you have the character meet admission criteria.

Hope this helps and happy writing!

Medical Review of The Shack

There’s nothing like a Christian movie to create a firestorm of controversy. I am a Christian and saw the film and I thought the biggest failure of the film was actually medical in nature.

That’s right . . . medical.

There have been plenty of articles written on The Shack’s theology, but I doubt anyone has touched on the medical inaccuracies which I’ll do here. If you haven’t seen the movie and don’t want any spoiler alerts then stop reading . . . like right now.

The story revolves around a man named Mack who early in the film narrowly misses a major collision with a semi. At the end of the movie, it’s revealed that he’s been in a coma (he’s been unresponsive) for approximately 2-3 days. Our first glimpses of Mack post accident are in a regular patient room. He has an IV, IV fluids and is on a monitor.

Problem One: If you’re broadsided by a semi, you should actually look injured. Mack is relatively uninjured as a result of this accident. He has but a few scrapes (not even stitches) on his face and none of his bones are broken.

Problem Two: The IV pump is not running. If you watch the film, the IV pump is off. If it were on, you’d see numbers lit up on the screen.

Problem Three: If a patient is unresponsive, you have to provide a way for things to come out. Think about it, do you ever go three days without peeing? Neither does a comatose patient. Plus, we need to ensure kidneys are functioning properly which means we need to monitor urine output. This is the type of patient where the phrase “a tube in every orifice” means exactly what it means. Also, there is a significant amount of literature that patients should be nourished with tube feedings much earlier. In real life, Mack would likely be in the ICU, perhaps even on a ventilator, until he woke up. His only medical support would not just be IV fluids.

Next time Shack, call me.

Author Question: Family Notification of Death

Themelina Asks:

I have read some of your posts and I am wondering if I could please have some help regarding a book I am writing. I have three scenes in my book that are in a hospital. The background story is that a girl gets notified that her mom and sister have been in a car crash. Her mom has died and her sister is currently in surgery. Is it right that a police officer comes to her house and lets her know or does something else happen?

After she finds out she faints, and hits her head. I don’t want to make this part sound too serious. However, I still want her to go to the hospital. So what floor would she go to? How long would she stay?

Lastly, the third scene is where the sisters see each other after surgery for the first time. She is paralyzed. How could she communicate with her?

Jordyn Says:

Thanks, Themelina, for sending me your questions.

Question #1: Who would notify the family of the death? I could see this happening a couple of ways. If the mother was declared dead at the scene of the car accident then the police would notify the family. If the mother is transported to the hospital and the hospital team declares her dead then it probably falls on the hospital team to notify the family.

We don’t generally like to give death notifications over the phone. I’m not saying it’s not ever done, but not preferred. We would likely call the family and ask them to proceed quickly, but safely, to the hospital. This might also be preferred because the sister is requiring surgery and except in the most extreme cases surgeons generally like consent before they operate. If there is not a parent to give consent (you don’t mention a father in your scenario) it could fall to the sister, if she is eighteen or over, to give consent for her sister’s surgery.

Question #2: People who pass out and hit their heads are rarely admitted to the hospital. I’m assuming you want this sister to suffer some form of concussion. She gets the awful news about her family, passes out, hitting her head in the process. If she wakes up rather quickly (a few minutes or less), is oriented to person, time and place, and doesn’t show neurological signs of a brain injury that might require surgery then she would get a physician evaluation, a few hours of monitoring to be sure her symptoms are improving, and then she would be discharged home. There would also be no need to wake her up through the night. This is a myth.

Question #3: You don’t specify in your question the level of the sister’s paralysis. Her ability to talk will depend on the level of paralysis. Patients paralyzed from the neck down are, at least for a while, on a ventilator. When a person has a trach, there are special adapters for the trach that allows people to talk. However, a trach is not placed at the beginning and it takes time for a person to learn to talk with the special valve. If she is on a breathing machine and can’t write (because her arms are paralyzed), but is awake and can understand questions then we use a system of eye blinking for responses. One blink for “yes”. Two blinks for “no”. And obviously more simply phrased questions.

Hope this helps and good luck with your story!