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!

Author Question: Complex Traumatic Injury

Rachel Asks:

I love your blog, and I have a fictional medical question for you.

motorcycle-654429_1280I have a young teen character in the near future (about 2075) who is a motocross racer. She has a horrible crash near the end of her freshman year of college and suffers a large injury – she has to stop school.

I want her to recover in 3-6 months, well enough to go to school, and show up full of plates and wires. I was thinking a severe shoulder fracture would do it, and assuming she got good enough PT, she could eventually race again (and even move onto a more demanding kind of racing.)

Is this a likely enough scenario? What would be a typical range of wires and plates to put in? I want a specific number for her to obsess about as she overcomes her fear of biking. Other injuries you could suggest? What about the recovery timeline? I need her off the bike for about 6-9 months, but some of that could be psychological, not physical recovery.

In this novel, there is some integrated AI technology. Obviously, the answer can incorporate speculative medical advances, but I’d like to know what is typical today so I can make them sound convincing.

Jordyn Says:

My first impression is that the shoulder may not be the best option if you want lots of plates and screws. You have to consider the bones that make up the shoulder and how those injuries would be treated. The scapula is very hard to fracture and likely wouldn’t be repaired that way. I’ve only actually seen one scapula fracture in my entire ICU/ER career in the span of almost 25 years. Collar bones we basically let heal on their own without surgical intervention. Even the upper arm— at least in kids— is not even splinted if you can believe that (most often)! Ligament repairs, labral tear, rotater cuff repairs, etc, could potentially take your time frame (with some complications) but would not involve a lot of plates and screws.

If you wanted to stick with an upper body injury— you could do amputation and then have your character learning to use a prosthetic which might tie in nicely with your integrated AI technology.

If you want to stick with a ton of plates and screws, alternative injuries could be a pelvic fracture or a complex upper or lower (or both) leg fracture. For instance, you could probably Google– x-rays of pelvic fractures repaired using plates and screws or x-rays of lower leg fractures repaired using plates and screws as references to come of with a specific number for her obsessive counting, etc.

Hope this helps and good luck with your story!

Medical Scene Diagnosis: Part 1/2

This medical scene was submitted by a fellow writer who wanted some critique and agreed to allow me to post my suggestions leaving her name off the piece. The scene begins with a victim of a motor vehicle collision coming into the ER. His car rolled several times during the accident. What follows is her scene. My thoughts will be in parentheses at the end of the sentence in red. I’m only going to comment on the medical accuracy. Grammar editing is not the focus.

crash-1308575_1920Tony screamed out to God, and flung his hands over his face. Rough hands grabbed his hands as he tried to pry off whatever was smothering him. (This is good as patients often feel like an oxygen mask is smothering. Kids particularly aren’t fond of them.)

“Hey, take it easy. You’re all right. You need that oxygen.”

Tony opened his eyes, blinking rapidly in the bright lights. As his blurred vision came into focus, he tried to see who was holding his hands.

Blue scrubs. Dark face. The whitest of teeth. Name tag. Arnold.

Tony tried to speak, but his throat was dry. Arnold reached over, raised the mask on Tony’s face, and placed something cold and hard in his mouth. Making sure the mask was securely replaced, he sat back in his chair. (In the initial evaluation of a trauma patient in the ER, a patient is never given anything by mouth until it is ruled out whether or not they need surgery. The more the stomach is empty, the less likely the risk of aspiration during intubation. In this situation, aspiration would refer to inhaling vomit into your lungs while the endotracheal tube is placed. Aspiration can mean different things in the medical arena. And I also don’t know too many nurses who actually sit vigilant at a patient’s bedside.)

“It’s an ice chip. It’s all you can have right now.” (I know, we’re mean. But not even ice chips.)

Tony nodded his gratitude and slowly savored the small chip. It may have just been ice, but at that moment, it was like ambrosia to his parched throat.

Swallowing carefully past the pain in his throat, Tony lifted the mask and tried again. “Where am I?”

“You keep that mask in place. You can talk through it just fine.”

He waited until Tony complied before continuing. “You’re in the Regional Medical Center in San Jose.”

“Accident?”

Arnold’s smile faded. “Yes. Doctor said you’re lucky to be alive.”

Tony nodded towards the container of ice. Arnold placed another chip in Tony’s mouth, replaced the mask, then set the cup where he could reach it on the bedside table.

“Where is the doctor?”

“I’ll go have him paged.” Arnold rose and left the room. (This is a situation where it is reasonable for a nurse to give the patient an update on his status and condition without needing to page the doctor. I may say something like, “Your leg is broken, but your other tests looks good. I’ll let the doctor know you’re awake and he’ll come in and talk things over with you in more detail.” Also, in the ER, doctors are generally present, and there may not be a need to have them paged. This can be very unit specific so you’d have some latitude as a writer.)

Tony surveyed his situation, beginning with his toes, and moving up to his hands. While he was achy all over, his feet and legs seemed to be unscathed. His chest and abdomen hurt, burning all the way through to his spine, and were heavily bandaged. (Saying his feet and legs are unscathed may be reaching a little. Remember, he rolled his car several times. At a minimum, there should be some bruising, cuts, or abrasions.)

His hands were bandaged but usable, and he took this opportunity to pop several chips into his mouth, crunching them to make them go down faster. Feeling with his hands, he knew his head was bandaged. Vaguely he remembered blood running into his eyes.

We’ll resume the analysis of this medical scene next post. Any other medical aspects you would change?

Author Question: Car versus Pedestrian

Alex Asks:

My character suffers the following injuries. I want the injuries to be severe enough that they require immediate surgery, but also that he recovers after about a month in the hospital and a stay in rehab.

carpedistrian1. Character is standing in the road, tries to run but is hit by the car front on.  Body smashes into the windscreen, sending him up into the air.

2. Hits his head on the pavement on landing and suffers broken bones as a result.

3. He blacks out from the impact and wakes up several hours later. In this instance, would he be able to survive for several hours with the kinds of injuries he could have?

4. Possible injuries I thought he could have included: bleeding on the brain, broken leg/s and/or arms, fractured ribs which could cause a puncture to one of his lungs.

5. As a result he suffers from retrograde amnesia when he wakes up at the scene because of the injuries to his brain. Cannot remember his name/where he is or other events in his memory. Again here I am not sure what kind of specific head trauma could cause this.

6. After surgery to the brain, he is put into an induced coma to monitor the swelling. He will eventually wake up from this about a month later.

Jordyn Says:

The accident you describe would include some very serious injuries— perhaps not even survivable. It’s not just the injuries the character suffers getting thrown from the impact onto the pavement, but also the injuries he suffers from getting hit by the car. An impact that is so violent that it throws someone into the air would also likely shatter the windshield indicating to EMS responders that there was a lot of violent energy associated with this collision— which means bad things for the patient.

My first opinion is if you want this character to wake up in a few hours would be that he doesn’t fall directly on his head after he’s thrown into the air from the first impact. Overall, for your scenario, you might want to lessen the violence of this crash if you want him up in a few hours. It wouldn’t be surprising for this patient to require surgery to fix broken bones and/or internal bleeding.

A pedestrian surviving this crash is not impossible but it is more on the improbable side. This patient will have a lengthy hospital stay. May not wake up for days or months— not just hours. What you outline is a high speed impact to a pedestrian.

To answer some of your medical questions— surgery may be required for the bleeding on the brain depending on its location. All patients who have a brain bleed do not necessarily go to surgery. A punctured lung will require a chest tube to be placed which further complicates your patient’s medical picture. This patient would be placed on a breathing machine for sure to stabilize him until all these injuries could be sorted out.

Could a patient with a significant brain bleed be conscious at the scene after the accident? Yes. There is a specific type of brain bleed that fits this scenario called an epidural bleed. It does have a characteristic lucid period before the patient becomes unconscious again. It does require surgery to correct. If no surgical intervention is done then the patient will likely die. Honestly, as a writer, you have a lot of leeway in regards to what to do with amnesia. Any type of traumatic brain injury (and this certainly qualifies) could cause amnesia.

Medically induced comas are used frequently in medicine as a way to help control brain swelling. However, the medicines are not used forever. Peak brain swelling usually occurs 48-72 hours after the injury. After this time has passed, the medical team will evaluate when to decrease the medications keeping the patient in the coma. Keep in mind, even after these medications are discontinued, the patient may never wake up. Further studies would need to be done to determine the extent of the damage to his brain. These changes will evolve over time becoming more stable the more time that goes on.

My recommendation would be to lessen the severity of the crash. The car hits him, he hit the windshield, breaks it and then falls to the ground. This alone could cause a femur fracture and brain injury for which he could suffer amnesia and require surgery. If it’s an epidural bleed then he gets surgery, perhaps with some swelling and therefore the medically induced coma, but wakes up in a month. The leg is set in surgery with pinning or a rod. I think just having these two things is enough for your scenario.

All the rest might prove too complicating.

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!

Author Question: Stab Wound

Sandi Asks:

Where can you place a stab wound that wouldn’t instantly kill your character, but keep him around for a few hours?

diagnosis-1476620_1920-1Jordyn Says:

You have a couple of options here. One would be a stab wound into the right side of the chest. This could partially collapse a lung and cause some bleeding as well. Think of the lung as a balloon. A small nick to the lung could cause it to slowly leak air into the chest, keeping the character alive for a few hours, but killing him in the end if the collapsed lung isn’t treated. The more collapsed the lung is, the less it is able to function. The more air that accumulates in the chest, the more it will push other structures.

We call this a tension pneumothorax.

Imagine the right chest is now full of air. Air will keep building unless it is given a way out (like a chest tube) and can actually squish the heart and lungs on the other side of the chest to the point where the heart may not beat anymore.

If a tension pneumothorax is left untreated, this will cause the patient to die. They may die from blood loss, or low oxygen levels, or from the heart being impinged to the point where it can no longer beat.

Why not a stab wound to the left chest? This has an increased chance to kill instantly because you have the heart and several large blood vessels that come off the heart that sit there. Can anyone say aorta?

Another option would be to have a stab wound to the belly. All sorts of stuff in there. If you wanted the character to die in a few hours, this could happen from untreated bleeding. There are two organs that sit in your abdomen that have a rich blood supply— the spleen and the liver. The medical term is highly vascularized . . . meaning rich with blood supply. You could also have an infection set in and this could keep him alive for a couple of days until he is overwhelmed by sepsis.

What signs and symptoms would a patient with a collapsed lung (pneumothorax) have? What’s the difference between and sign and symptom?

Author Question: Gunshot Wounds and Rib Fractures

Shanda Asks:

I have a scene where (in my mind at least) someone very physically fit is shot in the torso as they dive to save another from being shot. They then land excruciatingly hard on the edge of raised concrete (think like the front of an outside step) and break three ribs but that injury goes unnoticed as a result of the gunshot wound.

human-skeleton-163715_1280So my questions are as follows:

1. Would it be possible for someone to pick up the injured and run say a mile or two to get them to where help is waiting?

2. Could it be possible to have surgery for the gunshot would and the rib injuries be missed and hours later cause internal bleeding?

3. What would be the typical recovery time for the first and the latter?

4. Would it be realistic that after the second surgery (for the internal bleeding) the patient could not wake up for days having had two trauma surgeries so close together?

Jordyn Says:

Thanks so much for sending me your questions.

1.  Can someone carry an injured person one to two miles for treatment? It would depend on the physical characteristics of the character who is lifting the other person. Carrying someone one to two miles is a long way. I could possibly imagine a man doing this for an injured female and possibly a very fit male for another male, but a female doing this for a male might be stretching it. It would have to be a very fit female character.

On the other hand, could a character with these injuries get themselves to the hospital? The three cracked ribs are definitely going to slow them down and it also depends on what the gunshot wound has injured which you’re not clear on here. If the gunshot wound deflated a lung then they are going to have a lot of trouble breathing.

2. Could the broken ribs be missed on the first medical exam? Probably no. Any patient with a gunshot wound to the torso is going to get plain x-rays of the chest and probably a CT scan of the chest as well— both of which would show the rib fractures. So in the setting of modern medical care it would almost rise to the level of negligence to miss the rib fractures with a gunshot wound to the torso. I don’t see that happening.

3. To determine your typical recovery time I really need more information on this gunshot wound. Where was the character shot and what was injured specifically? The rib fractures themselves will take 4-6 weeks to heal. Rib fractures are very painful and could inhibit breathing based on their location. Also, successive ribs that are broken in more than one place can create a free floating segment that can be very detrimental to breathing as well.

4. A patient could still develop internal bleeding and need to go back to surgery even if the rib fractures are found right away. This would not be a rare event. It is reasonable for a patient to not wake up for a couple of days if they suffered a code during the second surgery due to extreme blood loss and had flat lined for a period of time.

Even the stress/shock of the surgeries close together might be enough for the brain to check out for a time. The problem with a comatose patient is they have to be in the ICU, on a vent, with a tube in every orifice as they say. For instance, a patient can’t be out cold and have no way to pee— so a catheter has to be placed so the urine can come out.

Going down that road can get very complicated for a novel depending on whose POV you’re telling it from.

Best of luck with your novel!