The Use of Hypothermia Post Cardiac Arrest

Emily Asks:

I am playing around with one of my character’s being shot life threateningly, but of course it’s gotta be something he recovers from with time.

This character is in his late 20s and in good health before the incident takes place.

At first, I was toying around with the idea of making the gunshot wound similar to what Kate Beckett had in the show Castle at the end of season three. The trouble is, I do not know how medically realistic her wound was, as you have pointed out Castle’s medical inaccuracies before. If you have possibly seen the episodes in question, could you give me some feedback on the medical aspects of Beckett’s shooting?

In relation to this, her heart supposedly stopped twice during the whole ordeal. I have been researching induced comas, and while they seem to be used for patients having more of a direct injury to the head, in the case when a victim’s heart stopped twice and is resuscitated both times, would there be any reason to keep them in an induced coma for a time due to lack of oxygen to the brain?

Then, after researching, I am playing around with giving this guy a collapsed lung from the bullet, which is small caliber.

1. In what hypothetical cases would this kind of injury require immediate surgery?

2. Are there any complications that could be serious enough for the said character to have to go back into surgery at a later time?

3. My character happens to be a bass singer for an acapella band. Would a collapsed lung affect his career at all even after he made a full recovery?

Thank you for taking the time to read and respond to my questions!

Jordyn Says:

Beckett’s Gunshot Wound:

I had to go back and find some videos that were related to this. Shockingly, I found this scene pretty medically accurate. I found one that showed her coding one time. Though I definitely could have missed some. The determination to put someone in therapeutic hypothermia or targeted temperature management (as now termed) related to their heart stopping is dependent on whether or not they wake up immediately after their code.

A patient that wakes up spontaneously and quickly after a pulse is restored has intact neurological function. Those that remain comatose have a concern for neurological injury related to oxygen loss to the brain during the resuscitation and therefore the medical team could choose to put the pt in a “hypothermic” state to try and prevent this neurological injury.

This is slightly different from a medically induced coma that patients with traumatic brain injury might be placed in to prevent brain swelling. The difference is actively cooling the patient. I have not seen the use of hypothermia in the traumatically brain injured population (though this does appear to be an area of study), but use of medically induced comas, yes.

There are definite guidelines that the American Heart Association has put out that outline this course of treatment. You can find one such article here.

If your character codes and doesn’t wake up– then this would be a reasonable course of action medically, but written under the guidelines in the article.

In regards to your specific questions.

1. It’s more likely than not that a gunshot wound to the chest would go to surgery, particularly if the patient presents with any abnormal vital signs especially low blood pressure. There’s just so much there that could be damaged. The heart. The lungs. The blood vessels.

2. Yes, there could be a number of scenarios where the character could require more surgery such as a blood vessel that’s leaking that’s not found the first time during surgery and continues to bleed. Infection– specifically some sort of abscess formation could be another reason, but that would take some time to develop.

3. I don’t personally foresee a problem with his acapella career after his lung is healed. It would take time to get to the point where he was. If you wanted to affect his career, a patient who is intubated (placed on a breathing machine) can develop vocal cord damage as a rare complication.

Best of luck with your story!

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: Motorcycle Injuries

Tory Asks:

I’m currently writing a fan fiction and the two main characters get in a motorcycle crash. The female just found out she was pregnant. I have three (very unrelated) questions. Could the crash send her into cardiac arrest? Would the male (who was driving) be able to survive with just a broken arm and a sprained ankle? And would the baby survive?

Jordyn Says:

Hi, Tory. Thanks for sending me your questions.

1. Yes, a motorcycle crash could send someone into cardiac arrest.

2. Could the male survive with just a broken arm and a sprained ankle? Sure, this is possible, but I don’t know if it’s probable. When looking at accidents, medical people always look at the injuries of the other people involved to determine how serious everyone’s injuries might be.

If the female in the accident suffers a cardiac arrest, it would be surprising that the male walks away with just, essentially, a broken arm. You could make it more believable in the description of how the accident happens. For instance, the female is thrown from the bike, but the male is trapped underneath it. You could also have them differ in the type of protective equipment they’re wearing (helmet, jackets, etc.)

3. Would the baby survive? Again, it depends on a lot of factors. How far along is she in the pregnancy? Cardiac arrest— how long is she pulseless? What other injuries does she get in the accident? The sicker she is from her injuries, the more likely she will miscarry the pregnancy. The body will defer energy and resources to the mother over the pregnancy. Then again, some women have maintained a pregnancy through terrible injuries so you would have some leeway as an author here.

If the mother is far along in the pregnancy (at least 22-24 weeks along) and in cardiac arrest the providers might consider C-section to save the infant. So, without more details as to the nature of the accident, her injures and the state of her pregnancy, it would be hard to say if the baby would likely live or die.

Good luck with your story!

PSA: Drowning Doesn’t Look Like Drowning

This is an educational post from your friendly neighborhood pediatric nurse.

During summertime, pediatric nurses are confronted with an increasing incidence of preventable injuries— the biggest one in my opinion is drowning.

It is not uncommon to get pediatric near-drowning cases in the summer. Obviously, more kids are playing in large bodies of water whether it be a shallow baby pool, regular pool, lake or ocean. Kids can drown in very shallow water. Also, just because your child has passed a few swimming lessons doesn’t mean they won’t drown. Kids in open bodies of water should be wearing life jackets.

The classic set-up is a party where there is some type of pool where all the kids are enjoying themselves. The adults are drinking and socializing and no one is watching the children play. Some adults feel that the older kids can keep an eye out for the younger ones— I cannot scream enough at the top of my lungs how patently false this is. If you have a teen who is a certified lifeguard and is tasked with watching the children in the pool I might agree. Otherwise, no.

At any party where kids are swimming, including a little tiny baby pool, there needs to be a sober adult who is watching the children AT ALL TIMES! I truly cannot express this enough. Drowning can happen in a minute or less. You cannot merely check on them every ten to fifteen minutes— that can be too late.

Also, drowning may not look like drowning and I’m including a couple of videos that highlight the point.

Enjoy the summer, but be safe! Keep an eagle eye on those kiddos enjoying the water.

Author Question: Gunshot Wound to the Torso

Heather Asks:

If my hero gets shot in the torso, is there somewhere it can hit that won’t be fatal? It can be a “miraculous” miss, that kind of thing. He can be weakened and bleeding, but I just need him to stay conscious for maybe five to ten minutes after? Any ideas?

Jordyn Says:

Sure, there are always miracles.

In medicine we view the torso as including the chest and abdomen. Generally the diaphragm is the dividing line between the two. So the chest is everything above the diaphragm and the abdomen is everything below it.

Gunshot wounds to the chest not hitting anything is tough. Think about everything that’s there. The heart, lungs, major vessels and arteries. Can a bullet pass through and miss everything— or hit something less minor and just cause bleeding? Sure. Anything is possible. I would recommend staying away from the left side of the chest for the wound— just so much there. The right chest and lower might be more believable because it’s just the lung sitting there. There are major blood vessels that underline each rib so nicking one of those could cause the bleeding you want. Hit outside or inside enough and you could miss the lung.

Abdominal wounds could go either way. A lot to hit in the belly as well, but also good odds for missing. If he’s wearing a bullet proof vest, you could have the bullet enter through his side and low– just under the lung and diaphragm. Problem is you have highly vascular organs on either side– the liver on the right and the spleen on the left. So, I’d aim below that as well or merely have them be grazing wounds to these organs. This could also cause significant, but survivable bleeding.

Hope this helps and happy writing!

Author Question: Flesh Wound to the Stomach

Heather Asks:

If someone got sliced by a knife (lightly— not deep) in the stomach, I know they’d get stitches, but would they be able to move around the next day or would it take a couple of days or more? If so, I’d better move that slicing injury. The slice did not go through the muscle.

Jordyn Says:

If the cut doesn’t go into the muscle, the character should be fine getting stitches and then being able to move. It might be mildly sore, but not crippling by any means.

Keep in mind, depending on the size of the wound, a lot of movement can pop stitches. If he’s doing a lot of strenuous activity, and the wound is large, even if it doesn’t go through the muscle, the movement could pop the stitches and open the wound.

Also, any wound, even stitched close, is at risk for infection. Could be another complicating factor for your character.

Happy writing!

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!