Author Question: Emergency Care of the Suicidal Patient

Riannon Asks:

I’d really appreciate your help in answering some questions. I’ve Googled as much as possible, and I just can’t seem to find answers for some things.

At one point in a play I’m writing, a character attempts suicide. His goal is not actually to die, but he does go through the process. What happens is that he’s very drunk and it’s a combination of probably alcohol poisoning and a lot of pills, something relatively accessible lying around the house, but potentially lethal in a high dose and then he calls 911 right afterwards.

So my questions are:
1. Would he be allowed to have visitors the next day? Essential for plot reasons.
2. Would visitors have to be family members or something or would friends/acquaintances be able to fudge their way in?
3. Before someone visits a patient, is the patient told that they’re coming and who they are? (I have very little knowledge of how hospitals work.)
4. How screwed up would he be physically?
5. Would he have to be committed to psych, and if so, when?
6. What could he have overdosed on?

Jordyn Says:

Hi Riannon!

Thanks so much for sending me your questions.

1. Would he be allowed visitors the next day? Depends on where he is at in the process. I’ll give you the process a patient goes through at our hospital, but you might need to adapt it if your play is located in a specific town, state, etc.

When a patient comes in with a suicide attempt, they are placed on 1:1 observation. The patient must be “medically cleared” before they can participate in a mental health evaluation. What that means is that they are no longer in danger medically from what they ingested AND that they are clear mentally to participate in the process. For instance, our patients would have to be below the legal limit for alcohol in order to participate. During the time of medical clearance and during the mental health evaluation (as for pediatrics parents are involved in the process) the patient is allowed to have visitors. A limited number. We try to keep it to two at a time and generally only immediate family.

If the patient is deemed to be a danger to themselves and does not voluntarily consent to treatment, then they are placed on an M1-Hold. This will have different names in different areas, but it is a legal document where the patient is involuntarily committed to a mental health institution for stabilization for about three days. Most mental health facilities will strictly limit visitors and may not let anyone visit during the initial 24-48 hours. Depends on the facility.

2. Could family/friends fudge their way in? I think I’ve mostly answered this above. If the patient is at a mental health hospital probably not without inside help. These are generally locked facilities that will keep a close eye on who is coming and going.

3. Is the patient notified of visitors? I can give you the ER answer and that is it depends. If the patient is unconscious then probably not. If the patient is conscious then we do want to inform the patient of who is there, but we would likely keep it to immediate family. We don’t want to inflame an already volatile situation so if the patient would become harmful to themselves or others then visitors are restricted. Pediatric patients will sometimes try and not have their parents visit, but parents are part of the process, so we encourage them to be at the bedside as long as the patient can be safe.

4. How screwed up would he be physically? Depends on a lot of factors. What he took. How much he took. And how long before he sought medical care.

5. Would he be committed to psych? If so, when? Yes, in this instance, he would be committed involuntarily if he did not agree to a voluntary admission. This would happen once he’s medically stable and after his mental health evaluation. Sometimes, patients may not be medically cleared for 12-24 hours (sometimes longer depending on the drug’s half life). Then we have to wait for an available mental health counselor which can take an additional 3-6 hours. Then waiting for placement could be another 3-24 hours. It can be a very lengthy process. Mental health beds are not that easy to find at times. Patients are held in the ER until they have a bed placement. It is also a requirement of our hospital that patients be transported by ambulance to their mental health facility and generally family members are not allowed to ride in the ambulance with them. This is a safety concern for the EMS crew.

6. What could he have overdosed on? This is really up to you as the author. Any drug can be toxic given in enough quantities and alcohol ingestion on top of that can make things much worse. Some of the more common medications most people have at home that can become easily toxic, in my opinion, would be acetaminophen (Tylenol), aspirin, and diphenhydramine (Benadryl).

Hope this helps and best of luck with your novel!

Author Question: Surviving Stab Wounds to the Abdomen

Anonymous Asks:

I have a character in my story who is stabbed three times with a three inch, narrow blade trench knife in the abdomen. I’m trying to avoid the guts or arteries and make it as non-lethal a spot as possible. He is a doctor and also a spy. I would like him to live and make a complete recovery.

He is two hours away from a hospital and has a friend to help him get there. Here are my questions:

1. Would it be feasible for him to live that long while he gets to the hospital for treatment?

2. Would he want to leave the knife in during travel time so he doesn’t bleed to death?

3. Or do I need to rework the scene so he’s closer to the hospital? If two hours is too long, what’s the maximum time he could have in travel before it’s too late?

Jordyn Says:

anatomy-254129_1280This is an example of all things are possible, but not necessarily probable. Of course, people survive devastating injuries every day. Miracles do happen. This is the category I would put your character in to.

The largest problem with him surviving these injures in the length of the knife and how many stab wounds he has. Three inches is long when it comes to knife wounds— particularly if the full length is buried into the abdominal area. We have to operate on a worst case scenario until the patient proves otherwise. Looking at the picture to the right, you can see all that is located in the abdomen and how likely it is that something devastating to this patient would be punctured or nicked.

If you want to keep the scenario as is, then I would have all the punctures be to the lower abdomen and to either side. This could puncture the intestines and bladder. These would need to be surgically repaired, but should be survivable (if the bleeding is minimal) for a couple of hours.

You’d definitely want to avoid the left upper and right upper abdomen which house the spleen and the liver. If these are punctured, your character would likely bleed out within two hours. Also, more midline to the abdomen is the descending aorta (a very large blood vessel), which also would lead to rapid hemorrhage and low survivability.

Leaving the knife in is up to you as an author. I could see his friend doing either thing. In a panic, he removes the knife. Or, maybe he has some medical knowledge where he thinks leaving it in place might be a good idea. I would pick whatever increases the tension for your scene.

Two hours is reasonable if you pick the injuries I describe above. I would caution you, though, to give the reader an image that there is little bleeding and the pain is somewhat tolerable. Rapid bleeding, a hard distended belly, accompanied by signs of shock (rapid heart rate, rapid breathing, sweating, paleness, clammy skin) would be poor prognostic indicators for surviving two hours.

Hope this helps and good luck with your novel!

Can Cadmium Poisoning Mimic Pregnancy?

Laura Asks:

Do you watch the television show Scorpion? If you do watch the show— you may not to read any further as this question may contain spoilers. In a recent episode, a character finds out that she is not pregnant, but instead is suffering from cadmium poisoning, which caused a late period and morning sickness. Is that possible?

Jordyn Says:

periodic-table-42115_1280Well, this is an interesting question. I had to do a bit of digging before coming to a conclusion.

The first research I did dealt extensively with chronic cadmium poisoning in a CEU article published by the CDC. For each of these effects from cadmium poisoning you could probably find research articles supporting and denying the correlation between cadmium and these disease processes so keep that in mind when you read this list.

Chronic exposure to cadmium fumes or dust, in some studies, have been associated with COPD, emphysema, and lung cancer. Animal studies show that exposure raises blood pressure.

The kidneys are the organs most affected by cadmium poisoning and the damage is dose related. Of interesting note was some studies that showed an increased likelihood of kidney stones in populations that had exposure to this heavy metal. Some studies have also shown bone lesions leading to fractures and osteoporosis.

In animals, cadmium in large doses crosses the placenta and led to birth defects, severe placental damage, and fetal death. This, however, has not been proven in the human realm but some studies show women exposed to cadmium may have a higher risk of premature labor.

Surprisingly, in this extensive article, nothing was said about cadmium’s effects on the menstrual cycle so I began to search just for that issue. I did come across this study which showed that cadmium could effect hormone levels involved with menses, but by mildly reducing some that are involved with pregnancy so, in essence, cadmium exposure shouldn’t mimic pregnancy.

All this being said, stress can always alter a woman’s cycle and nausea can be a sign of anxiety, but correlating these with cadmium exposure might be stretching it.

Author Question: What Kind of Trauma Causes Blindness?

Belle Asks:

One of my characters is in a minor plane accident. When you see him next, he is blind. What could cause him to be blind as a result of this accident?

eye-211610_1920Jordyn Says:

A character can lose vision as a result of this accident in one of two ways. Either direct injury to the eyes themselves or injury to brain centers that are involved in the processing of visual information.

Direct injury to the eye could include the eye itself or bones around the eye could become fractured and impinge on certain nerves that could ultimately lead to blindness. You could also have traumatic retinal detachments that if not repaired could lead to blindness.

Many areas of the brain are involved in processing the information our eyes takes in. Any injury to any one of these centers could lead to blindness even though the eye itself looks perfectly normal. This article gives a basic outline and would probably be a good jumping off point for further research. As mentioned in the piece, some of these conditions would be called “cortical visual impairment, cerebral visual impairment, neurological vision loss, brain-damage-related visual impairment, and vision loss related to traumatic brain injury”.

Best of luck with your story!