5 Tips for a Character’s Stroke

Even some famous authors get medical details wrong.

In a New York Times bestselling novel, the author presented his main character’s mother with a stroke. Almost all the details were accurate, except for the origin of the blood clot in the mother’s leg. This is where the author needed more research and clarification.

For example:

If the blood clot broke loose from the arteries of the leg, it travels to the toes and become lodged in the tiny capillary vessels, never reaching the brain.

If the blood clot broke loose from the veins of the leg, it travels to the heart, out to the lungs and becomes lodged. This obstruction can be fatal and is called a pulmonary embolism, not a stroke.

Therefore, when giving your characters a stroke, let’s get the details right by asking the following questions:

What kind of stroke does the character have?

There are two types:

Ischemic Stroke occurs when blood vessels in the brain become blocked by a moving obstruction that has traveled to the brain and lodged within the vessels, cutting off oxygen supply. These moving obstructions or emboli and most often come from the heart or carotid arteries.

Hemorrhagic Stroke occurs when excessive bleeding in the brain, either from a ruptured blood vessel or from trauma, places pressure on the brain tissue. This cuts off the oxygen supply in that area.

There are two types of hemorrhagic stroke:

Intracerebral – located inside the brain
Subarachnoid – located outside the brain

What are the characters risk factors for a stroke?

Characters need to exhibit a pre-existing condition that contributes to a stroke. Such as:

High blood pressure
High cholesterol
Smoking
Heart Disease
Head Trauma
Drug Abuse

What are the characters symptoms?

Think FAST:

Facial drooping
Arm weakness
Speech Difficulty
Time to call 911

Strokes on the left side of the brain will contribute to symptoms on the right side of the body and vice versa. If the stroke affects the cerebellum or brain stem, then symptoms can affect both sides of the body.

What is the characters treatment?

Ischemic Stroke: t-PA therapy is provided by licensed medical professionals and needs to be administered within three hours of onset symptoms.

Hemorrhagic Stroke: Blood thinner meds are halted and blood pressure meds are administered to decrease bleeding.

What types of medical procedures are provided for a character experiencing a stroke?

Ultrasound of the carotid arteries may be performed to determine blockage in the arteries carrying blood to the brain.

CT or MRI scan of the brain to identify the cause and location of the stroke

For an Ischemic stroke, an angioplasty or endarterectomy is performed to open the narrowed channel and provide blood flow to the brain again.

For Hemorrhagic stroke, a procedure may be performed to place a coil, clip or glue in the affected area to try and stop the bleeding.

Follow these tips and you’ll be thinking FAST in no time!
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Shannon Moore Redmon writes romantic suspense stories, to entertain and share the gospel truth of Jesus Christ. Her stories dive into the healthcare environment where Shannon holds over twenty years of experience as a Registered Diagnostic Medical Sonographer. Her extensive work experience includes Radiology, Obstetrics/Gynecology and Vascular Surgery.

As the former Education Manager for GE Healthcare, she developed her medical professional network across the country. Today, Shannon teaches ultrasound at Asheville-Buncombe Technical Community College and utilizes many resources to provide accurate healthcare research for authors requesting her services.

She is a member of the ACFW and Blue Ridge Mountain Writer’s Group. Shannon is represented by Tamela Hancock Murray of the Steve Laube Agency. She lives and drinks too much coffee in North Carolina with her husband, two boys and her white foo-foo dog, Sophie.

 

Author Beware: Inaccurate Ultrasound Scenes Part 2/2

Today, we’re concluding Shannon’s series on how to write medically accurate ultrasound scenes. You can find Part I here. Today, Shannon is covering tips #3-#5.

Welcome back, Shannon!

Tip #3: Sonographers scan in the ultrasound department most of the time.

Most scans are performed in the designated ultrasound department for their exams, unless they are in active labor, in the ICU or for some astronomical reason, cannot leave their room. Even in the emergency department, if the patient can be transported to the department, then they will be.

Portable ultrasounds are performed on serious cases when the physician does not want the patient moved for some pertinent reason.

 For Writers: If your character needs an ultrasound exam, is conscious, can move well, or sit in a wheelchair, send them to the ultrasound department.

Tip #4:  Sonographers like top of the line equipment.

One television scene at a top-rated hospital showed a tiny little ultrasound machine from the 1990’s being used for the exam. Seriously?

Get rid of the outdated equipment. The machines in top-rated healthcare systems are the best of the best, large and full-sized pieces of equipment.

Modern portable systems look like laptops, are smaller, and are taken to the inpatient rooms or ICU.

Some facilities provide their ER and L&D doctors with tiny devices the size of a cell phone to carry in their pocket for quick peeks, not full anatomy exams.

For Writers: When describing the machine look at top of the line equipment with GE, Philips, Samsung or other manufacturers. This will give you a good idea of what is being used in the real medical world.

Tip #5:  Sonographers know where to place the probe.

Make sure the anatomy showing on the screen matches the location of the probe and the anatomy being discussed is displayed.

One television scene I witnessed had the actor place the probe in the middle of the abdomen, but a kidney presented on the screen. Sonographers know the kidneys are located on the sides of the abdomen, not in the top middle.

If you’re listening to the baby’s heart on a second or third trimester baby, then the heart will display on the screen. Not the brain, fingers, and toes.

If investigating the liver, then the probe needs to be placed on the right side of the abdomen. With the spleen, move the probe to the left side.

If it is a first trimester scan, then a vaginal exam will be performed. If the baby is in the second or third trimester, then the probe is placed on top of the abdomen.

For writers:  Research anatomy and physiology on the internet or in books before writing the ultrasound scene. Make sure the location is correct and the disease process is represented accurately. If unsure, then find a nurse, physician or medical professional to ask or connect with Jordyn and me.

When researching a specific topic, perform a google search, but select a credible source. Choose sites that end with .edu, .org, or .gov. Those tend to be most accurate. Sometimes I will use others, but always back it up with a healthcare system education site like Mayo Clinic, Cleveland Clinic, or the government site (ncbi.nlm.nih.gov).

Don’t be like one famous author, whose patient’s venous blood clot, located in the leg, traveled to the brain and caused a stroke. However, in real life, strokes most often come from the carotid arteries and heart. Venous blood clots in the legs kill when they break off and travel to the lungs.

Shannon, thank you so much for this valuable insight. I know I learned a lot.

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Shannon Moore Redmon writes Romance Suspense stories, to entertain and share the gospel truth of Jesus Christ. Her stories dive into the healthcare environment where Shannon holds over twenty years of experience as a Registered Diagnostic Medical Sonographer. Her extensive work experience includes Radiology, Obstetrics/Gynecology and Vascular Surgery.

As the former Education Manager for GE Healthcare, she developed her medical professional network across the country. Today, Shannon teaches ultrasound at Asheville-Buncombe Technical Community College and utilizes many resources to provide accurate healthcare research for authors requesting her services.

She is a member of the ACFW and Blue Ridge Mountain Writer’s Group. Shannon is represented by Tamela Hancock Murray of the Steve Laube Agency. She lives and drinks too much coffee in North Carolina with her husband, two boys and her white foo-foo dog, Sophie.

 

Author Beware: Inaccurate Ultrasound Scenes Part 1/2

Redwood’s Medical Edge is pleased to host Shannon Moore Redmon, an ultrasound sonographer, and she’s offering her insights on how to write ultrasound scenes accurately. I know I’ve learned a few things for sure. Today, we’ll cover tips #1 and #2.

Welcome, Shannon!

Americans love to watch medical television shows, like Grey’s Anatomy, ER, or House. We buy up the latest medical thriller and discover the scientific world of healthcare.

What many fail to recognize are the glaring inaccuracies associated with the ultrasound profession and the exams being performed on the television screen. Such scenes contain incorrect anatomy, probes placed in wrong positions, or actors who need more camera face time and scan patients backwards.

Doesn’t Hollywood consult experts when they use ultrasound to determine an abnormality of a baby or find cancer in a patient’s liver?

As a registered diagnostic medical sonographer for over twenty years and an instructor who teaches others to utilize this amazing modality, here are five tips to make those ultrasound scenes more accurate.

Tip #1:  Sonographers perform the majority of scans.

Whether in a hospital setting, an outpatient center, most OB/Gyn offices, vascular offices, and general imaging facilities, registered sonographers are the ones who perform the majority of ultrasounds on patients . . . not doctors.

In my experience, sonographers scan the patient first and sometimes are the only one who take the images. If a patient is high-risk OB, a sonographer will scan her first, then a maternal fetal medicine doctor will scan after to confirm the diagnosis.

When abdominal or vascular ultrasounds are performed, sonographers scan these patients and the reading physician or surgeon may come into the room to discuss with the patient. More than likely, they will read the images from a digital archiving system located in their office down the hall, then attach a report to the patient’s medical record.

Most episodes on television have a doctor performing the exam. Where have all the sonographers gone? Having lunch together down by the river?

For writers: When writing your ultrasound scenes, let the sonographer take the images and discuss the case with the reading physician. If you want to ratchet up the drama, then let them have a heated discussion over what the sonographer believes she sees versus what the physician thinks he knows.

Great radiologists and reading physicians will critique a sonographer’s images and call them out on sloppy pictures. Sonographers will defend their opinions and their patients when a doctor minimizes the seriousness of the findings with a list of differential diagnoses or refuses to discuss the diagnosis with the patient. This happens in real life.

Tip #2:  Sonographers turn off the sound of the heartbeat.

In the famous Doritos commercial, granted the scene is a comedic parody, but if you listen close during the entire exam, the heartbeat is playing in the background and there is no Doppler technology activated. This is also the case in many television scenes, depicting actual exams.

In real life, the heartrate sound does not play during the entire exam. Sonographers know the heart rate plays only when we turn on the Doppler technology, drop the gate into position and hit the update key. We listen for a few seconds, acquire a heartrate strip along the bottom and then turn the sound off.

For writers: If there is background noise, it comes from the cooling fan on the machine.

Next post: Tips #3-#5.

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Shannon Moore Redmon writes romance suspense stories to entertain and share the gospel truth of Jesus Christ. Her stories dive into the healthcare environment where Shannon holds over twenty years of experience as a Registered Diagnostic Medical Sonographer. Her extensive work experience includes Radiology, Obstetrics/Gynecology and Vascular Surgery.

As the former Education Manager for GE Healthcare, she developed her medical professional network across the country. Today, Shannon teaches ultrasound at Asheville-Buncombe Technical Community College and utilizes many resources to provide accurate healthcare research for authors requesting her services.

She is a member of the ACFW and Blue Ridge Mountain Writer’s Group. Shannon is represented by Tamela Hancock Murray of the Steve Laube Agency. She lives and drinks too much coffee in North Carolina with her husband, two boys and her white foo-foo dog, Sophie.