Author Question: Brain Bleeding 1/2

I’ll be handling Christy’s question in two parts. Part one today.

Christy Asks:

A bullet grazes my hero’s brain. He’s taken to the hospital where he has an intracranial hematoma.Would he be in a medically induced coma after this? If so, for how long? When do doctors decide to take someone out of a medically induced coma? What would a victim be like after the fact? Sedated? When would they know the extent of the injuries?

Jordyn Says:

It depends. Let’s start from the top.
A bullet grazing someone’s brain. Okay—well in order for it to even hit the brain it has to come through the skull. So, it’s not going to be a minor injury considering that. Not like a bullet grazing your arm.
An intracranial hematoma means you have bleeding on the brain but you haven’t really specified the area. For instance, epidural hematomas occur between the dura (which is a tough membranous covering) and the skull. These are almost always taken to surgery.
In a subdural hematoma the bleeding occurs between the dura and the arachnoid layer. These are not always evacuated by surgery. It depends on their size. Intracranial bleeding can mean a lot of things—that the bleeding is just within skull (which includes the two things I’ve mentioned) or in the brain tissue itself. Bleeding within the brain tissue itself is much harder to deal with.
Would he be in a medically induced coma? It depends. The decision to put someone in a medically induced coma is more based on whether or not the doctors think the brain will swell as a result of the injury and not necessarily because there was a bleed. For instance—epidural hematomas are generally taken to surgery and evacuated without the patient needing to be put into a coma.
If they think they see a significant amount of swelling of the brain tissue then a medically induced coma is more likely. A patient is generally placed into a coma through the period of peak swelling which is generally 48-72 hours post injury. The patient gets a special monitor (a bolt) that monitors their brain pressure (or ICP—intracranial pressure). 
After that peak period of swelling comes and goes a decision will be made to wean the patient off their sedation. The pressure may stay high. If the pressure stays high the patient may proceed to brain death (caused by herniation or hypoxia related to the pressure), or significant brain injury, or recover. It may not be known for several months what the outcome is though generally if a patient is going to suffer brain death they will do it in that 48-72 hr window. Past that, if they live but the pressures have been high—more a vegetative state or significant neurological impairment. If pressures have stayed lower—the patient may recover okay.
I have seen miracles, though, too so this is not cut and dried.
As far as knowing the extent of injures—they’ll know that pretty quickly based on CT imaging. However, what won’t be known is the affect on the patient. People can have the same exact brain injury—some die—some fully recover so there is a lot of writing leeway here. It may not be known for years how the patient will recover or what their lives post-injury will look like. 
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Christy Barritt is an author, freelance writer and speaker who lives in Virginia. She’s married to her

Prince Charming, a man who thinks she’s hilarious–but only when she’s not trying to be. Christy’s a self-proclaimed klutz, an avid music lover who’s known for spontaneously bursting into song, and a road trip aficionado. She’s only won one contest in her life–and her prize was kissing a pig (okay, okay… actually she did win the Daphne du Maurier Award for Excellence in Suspense and Mystery for her book Suspicious Minds also).

Her current claim to fame is showing off her mother, who looks just like former First Lady Barbara Bush. When she’s not working or spending time with her family, she enjoys singing, playing the guitar, and exploring small, unsuspecting towns where people have no idea how accident prone she is. For more information, visit her website at: www.christybarritt.com.

Author Question: Death by Trophy

Susan Asks:

I have a woman murdered when she is hit on the back of the head with a metal trophy. The trophy is cup shaped so the largest part of it is a thinner metal. I expect the trophy will dent from the impact, but I’d also expect that there would be blood as a result of the injury. Would this kind of injury cause bleeding and if so can you give me a general idea of how much?

Jordyn Says:

It depends. Blows to the head can go either way. They can just cause internal bleeding (intracranial hemorrhage) and/or an external scalp laceration that would bleed A LOT depending on it’s size and depth. Scalp wounds are known for being pretty bloody.

These injuries can be nice for your character as you have some leeway medically to do them in as you please.