Author Question: Motor Vehicle Collision 2/2

Today, we’re focusing on Susan’s questions surround two victims of a car accident. You can find the first post here.

Let’s turn our attention to the second patient.

Patient #2: The passenger (the above’s twenty-six- year-old sister) flies from the convertible.
1. If she was found unconscious about 20 feet from the vehicle without any injuries, how would EMT’s treat her?

2. Would she still be in her own clothing while unconscious at the hospital?

3.What sort of treatments would they give her, if any, at the ER? IV’s, examinations, etc?

We find out later that the passenger actually was near death and healed by a supernatural character. She actually hit her head (skull fracture?) and is close to death when he finds her

4. Is this scenario even possible or would she have immediately died from the injury?
5. If her survival was impossible, what can I make her injuries so she can be healed by the other character?
6. How would she appear? Eyes open, eyes closed, or would it matter? Vomit? Skin coloring?
Jordyn Says:
1.  One, they’ll assume she could be gravely injured considering her mechanism of injury. They’ll first check to see if she’s breathing and has a heartbeat. At the same time, they’ll be stabilizing her spine by putting on a C-collar and placing her on a backboard. If she’s breathing on her own at an adequate rate, they’ll give her some oxygen via a mask. If she’s not breathing or doesn’t have a pulse then they’ll begin resuscitation by giving her breaths and doing CPR. After those major things are taken care of, they’ll start an IV to give her some fluid. Then begin to look for secondary injuries. An unconscious patient thrown from a vehicle will have presumed traumatic brain injury or TBI.
2. If the EMS team can provide her adequate care without cutting off her clothes, then they’ll leave her that way until she gets to the hospital.

3. In the ER, we start where the EMS team left off. We’ll start our assessment much in the same way the EMS team does. We continue any care they’ve provided. If they were unable to get IV access—we’ll start to work on “getting a line”. We’ll do a detailed secondary survey looking for other injuries which means entirely undressing the patient, log-rolling them to their side and checking for injuries to their back as well. A catheter would be inserted into her bladder and the urine tested for blood and she’d also likely get a pregnancy test.

Additional tests in the ER for this unconscious patient would be: x-rays of her spine, CT of her brain and likely chest and abdomen. Some baseline labs: blood counts, electrolytes, labs that look to see if organs have been injured and bleeding time studies. They’d likely “type and cross” her for blood products. Any other injuries would be x-rayed as well—for instance if her arm were misshapen or significantly bruised.

The unconscious patient is challenging because they can’t tell you what hurts.

 4. Skull fractures can run the gamut and there are several different types of skull fractures. A patient could have a traumatic brain injury that eventually causes death but just have a simple linear skull fracture. Or, a patient can have a depressed skull fracture and be awake and talking to you. As an author, you have a lot of leeway here.

5. I guess it depends on what you mean my “healing”. Do you want her to have evidence of injury but be fine?

6. I’ll go with the assumption that she presents to the ER unconscious. An unconscious patient can look relatively well to nearly dead—again, you have a lot of leeway here. They can “appear to be sleeping” except they’re completely dead weight. There are specific vital signs a patient will demonstrate when their brain is swelling but I’m not sure you want to go that route.

Hope this helps and good luck with your novel!

Author Question: Motor Vehicle Collision 1/2

Susan Asks:

I found your site while I was researching some things for a story I’m writing. I’m not sure I will ever try to get this story published or anything, but I wanted to get all my details as accurate as possible.  
In the story two people are involved in a car accident.

Patient #1: The driver, twenty-three- year-old male. Hits the steering wheel and ruptures his aorta. This character dies.

My questions are

1.  Could he be conscious immediately following this?
2. Would he make it to a hospital about 4 miles away in an ambulance or likely die at the scene?
3. How would he look in the hospital after death (coloring, would they leave his clothing on if he just died)?
4. Would they let his sister see his body?

Jordyn Says:
1. Would he be conscious? Yes, it’s possible but for a very short amount of time following his injury. Your aorta is a very large vessel that comes right off the heart. If it is entirely ruptured—you’ll bleed out in one to two minutes. The quicker the blood loss the sooner unconscious sets it because blood supplies oxygen to the brain and the brain is a very oxygen sensitive organ.
2. This character would likely die at the scene.
3. What you might want to look into is reasons an EMS provider is allowed to call death at the scene. Patients who are obviously dead may not even go to the hospital. Let’s say they do “work” him and bring him to the hospital where he is declared dead shortly after. Likely, his clothes are on with the exception of the care EMS provided. It’s atypical for them to cut off all their clothes like a trauma center will. He’ll be extremely pale with areas of blueness. Livor Mortis begins fairly quickly where the blood will be begin to settle in dependent areas of the body. This looks like bruising. If he lying on this back—it would settle all along his backside.

4. Yes, the sister would be allowed to see his body. Nurses are pretty sensitive to this so they’ll try to make the body as presentable as they can and explain what the sister will see before she views the body.
We’ll tackle Susan’s second patient in the next post.