Respiratory

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!

Dianna is back for her monthly EMS post. I’d like to pass along my congratulations to her for winning in the ACFW Genesis contest this year! This is a much sought after award and will turn the heads of editors her way. I know we will be seeing her books published in the coming years.

Today, she focuses on the aspects of a respiratory call. This will help add those factual details for your scenes.

EMS 18, respiratory distress at 1234 Greene Road, at 1234 Greene Road on TACH channel 7.

joeyvest

As we climb into our ambulance posting (parked) at our station, my partner and I radio in we’re en route to the above scene. Lights and sirens, we rush out of the garage. En route, we’re notified via our computer that the patient is a 24-year-old female and is conscious and breathing.

Once on scene, we find the scene is safe and no dispatched law enforcement. Typically a fire crew arrives on scene first (prior to us) since there are about three times more firehouses than EMS stations globally, thus they’re closer than we are. However, fire is not always dispatched along with EMS, so for this sample EMS call we’ll say fire wasn’t dispatched.

Upon our arrival at the patient’s side, my general impression of her is she’s SOB (short of breath) and in respiratory distress (dyspnea). She’s sitting in the tripod position (leaning far forward with her palms on her kneecaps) and she’s breathing shallow and fast (tachypnea). She’s not cyanotic (blue lips or fingernail beds), so she’s perfusing fine at the moment and not hypoxic (lack of efficient oxygen), but that can quickly change.

I won’t discuss everything we’d do on a respiratory call like this, but if you need clarification or further explanation for your fictional writing needs, please do not hesitate to ask me.

julezcourt

As my partner whips out a non-rebreather mask and connects it to the oxygen tank at 15 lpm (liters per minute) then slips it over her mouth and nose, I assess her breathing rate and quality and find it definitely out of range, certainly labored and not efficient to sustain life, so I assemble a BVM (Bag Valve Mask), and my partner bags her.

As I continue with my patient assessment, and notice she’s diaphoretic (cold and clammy skin) I consider assembling a nebulizer (I’d squeeze atrovent and albuterol into a tiny circular plastic cup and attach the nebulizer contraption to the NBR (non-rebreather).

I attach her to our cardiac monitor via a 12-lead (ECG patches) to interpret her heart rhythm and heart rate, and I slip a pulse-ox on her finger (pulse-ox is attached to the monitor) to obtain her blood oxygen level.

I won’t go into any detail about heart rhythms, but I’ll simply say she has a dysrhythmia, her heart rate is at 118 (tachycardia = too fast), and her SAT is 87% (blood oxygen saturation), which is too low. Via my stethoscope, I auscultate her lungs and heart. I hear normal heart sounds, but I hear rales in her lungs. We insert a line (IV).

Our patient falls unconscious, and remains unresponsive. Cyanosis (blueness) begins to appear. She still has a pulse, but she’s no longer breathing, so she’s in respiratory arrest (apnea).

Based off my assessment and what information I gained from her roommate on-scene, I believe the diagnosis is pulmonary edema (various causes that I won’t go into). As I assemble the CPAP—Continuous Positive Airway Pressure—and attach it to her face, my partner pushes (inserts into the line) vasotec and fentanyl.

We place her onto our stretcher and load her into our ambulance for transport. En route, I monitor and reassess her constantly, perform any and all interventions as necessary, and retake all vital signs very five minutes.

Thank you in advance for reading and for your comments.

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After majoring in communications and enjoying a successful career as a travel agent, Dianna Torscher Benson left the travel industry to write novels and earn her EMS degree. An EMT and Haz-Mat Operative in Wake County, NC, Dianna loves the adrenaline rush of responding to medical emergencies and helping people in need, often in their darkest time in life. Her suspense novels about characters who are ordinary people thrown into tremendous circumstances, provide readers with a similar kind of rush. Married to her best friend, Leo, she met her husband when they walked down the aisle as a bridesmaid and groomsmen at a wedding when she was eleven and he was thirteen. They live in North Carolina with their three children. Visit her website at http://www.diannatbenson.com