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Last updated May 26, 1999
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specifically to help FANFIC and other FICTION WRITERS who want to make
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Miscellaneous
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Events when paramedics arrive
at the scene of an accident
Blind Man's Bluff query
CPR and potential damage
PCP interaction with alcohol
Wound to the kidneys
Stab wound to shoulder
Hyperbaric chambers
What kinds of things would the paramedics say when they arrive at the scene of a car accident? And what does the term "crashing" mean?
A: After the police, firefighters, and/or paramedics pull the victim out of the car, they follow the ABC's of trauma resuscitation -- check airway, breathing, and circulation. They might say stuff like "He's not breathing! Check his airway! Let's start bagging him! I don't have a pulse! Start chest compressions (CPR)!" After they've done CPR for a couple minutes and the victim still doesn't have a pulse, they would shock (defibrillate) him. They would also be taking the victim's blood pressure and it would probably be really low (like 70/50 -- that would be really bad) if he was having a lot of bleeding. They would say something like "Blood pressure 70 over 50! and dropping!" One other thing that is very important is that the paramedics would stabilize the victim's neck ("protect his C-spine") if there was any chance that the neck might be injured (a given in car crashes). They do this by putting a stiff plastic and foam collar around the victim's neck and then taping the neck brace and the patient's forehead to the board that they are lying on. As soon as they've done all this, they put the person in the ambulance and drive to the nearest hospital, sirens screaming. See the ER page to find out what happens when the patient reaches the ER.
When you say someone is "crashing" it means their life signs are rapidly going bad--either their blood pressure is dropping like a rock or their pulse disappears or they stopped breathing or their heart stopped. This could happen in seconds to minutes. This is when the medical personnel prepare to start doing CPR and/or prepare to defibrillate the person or intubate them.
Blind Man's Bluff query -- What might have happened between the time Blair passed out after coming off the car hood and when we see him later in the hospital?
A: That is an interesting question. The answer has to be somewhat speculative since I'm not really sure what effect the drug had on Blair aside of the fact that he was hallucinating. In the hospital scene where Jim is sitting beside Blair's bed, you can see a tube coming out of Blair's mouth, which means he was intubated, which means that sometime either he stopped breathing or had a hard time breathing. Also Jim said he was "fading in and out." So something like the following may have happened after Blair collapsed.
Someone called the paramedics. Either they or Jim would have checked to see if Blair was breathing and if he wasn't, they would've started giving artificial respiration to Blair. And if his heart stopped, they would've started CPR. Maybe they shocked him if necessary. When Blair arrived at the hospital, they would've started IV's, put in a urinary catheter, hooked him up to a heart monitor, etc. My ER page explains what they would do in general.
Sometime during this whole thing, they intubated him. This would require them to give Blair a muscle relaxant, such as succinylcholine, to paralyze him. They also would have sedated him with a benzodiazepine, such as Versed.
Since there was no antidote that we know of to Golden, they couldn't give him that. So they would have just supported his vital functions (breathing, heartbeat, keeping him hydrated) until his body excreted the drug. I don't know how Golden is excreted, but many drugs are excreted in the urine. They would have made sure that he got a lot of IV fluids so he would pee a lot and get rid of the drug quicker. The most common hallucinogen in the US is LSD, which is an acid compound, and if Golden (also a hallucinogen) had a similar chemical structure, then a physician would probably attempt to alkalinize (make the pH more basic) Blair's urine so that the drug would be excreted faster. The most common way of alkalinzing the urine is to give a solution of sodium bicarbonate (baking soda) by IV carefully.
After doing these things, the doctors would have to wait with Jim and Simon for Blair to wake up.
If you have a person with broken ribs, flail chest, or large amounts of internal bleeding in the chest, don't you risk sending a rib into a lung or doing some other kind of damage with CPR?
A: Very astute question! The answer is yes, absolutely, you do risk broken ribs and internal bleeding and punctured lungs when you do CPR, and they happen rather often (broken ribs, anyway). But the person's going to die if you don't do CPR, so you do it anyway and worry about the ribs and lungs after they're breathing and the heart's working.
How does PCP interact with alcohol?
A: To be honest, I'm not really sure. Alcohol is a sedative (i.e. you drink too much and you pass out). Some people also can get combative and angry when they're drunk. PCP was originally designed as an anesthetic (it's related to some general anesthetics out there that doctors use). People who take PCP get violent partly because they don't feel pain. So I suppose a person could become even more violent with alcohol + PCP. Or some people might just "pass out" quicker.
Would a stab or gunshot wound to the kidneys be fatal by themselves, or would more damage be required?
A: Well, a wound to the kidney could eventually be fatal if you didn't get help soon enough, but it wouldn't be like a wound to the heart or spleen -- something with a lot of blood where you could bleed to death in minutes.
The main problem with a stab or gunshot wound to the kidney would be that the kidney might go into "failure", meaning it would stop producing urine. Fortunately, most people have two working kidneys, so if one dies, the other one can take over and you would not need dialysis to get rid of all the waste products in the blood. If both your kidneys died, it'd probably take days to die from that. The waste products (namely ammonia) would build up and you'd evenutally go into a coma and die. Another type of kidney failure (which actually happens first, before it totally quits making urine) would be that the kidney makes a whole bunch of very dilute urine. You could die quicker from that because you would get dehydrated pretty fast. Again, it would take many hours to die from that too, though. You'd probably die from electrolyte imbalances or lack of fluid (your blood pressure drops too low).
Bleeding and infection are also possible, but not as much of a danger as with other organs.
The other thing that prevents people from dying right away just from a kidney wound is that you've got two kidneys (at least most people do -- some people don't, and don't know it, or they have only one that works). You have to knock both of them out to have a problem big enough to kill you right away. And in a shooting or fight, it's not very likely that both kidneys would get badly wounded. Also, if your kidneys stop working, there's always dialysis. People live for years without working kidneys -- they just have to go to dialysis several times a week. It's a very hard life and not any fun, but they can live, hopefully long enough to get a kidney transplant.
Basically, if you wanted to kill a character off right away, you'd better pick something besides or in addition to a kidney wound. If you want a long, drawn-out death, kidney wounds would work. Now doesn't that sound morose?
Please give some information on a stab wound to the shoulder.
A: Okay. First I have to say Ouch! <g>
The first thing you need to know is the exact direction the person's getting stabbed. A lot also depends on how deeply the blade enters, and how muscular the victim is (gotta go through all those layers of muscle before you get to bone). I'll assume the blade is about 4-5 inches long and the victim is fairly muscular.
Knife blade enters shoulder anteriorly (from the front, victim facing forward):
If the blade is more at the top of the arm, then you're talking about the biceps and deltoid muscles being stabbed. The bicep allows you to flex at the elbow joint (like doing curls with a barbell). The deltoid allows you to abduct your arm (lift your arm straight out sideways from your body). However, I don't imagine that a single stab wound would totally inactivate either muscle. These movements would be very painful, and the person would be weakened from the mere pain, but not because the muscle was disconnected from its attachment. I guess it's possible that the biceps tendon could be severed; that would probably require surgical repair, because the tendon attaches the muscle to the bone. The pectoral muscles are located more medially (they form the upper chest muscles that are pretty obvious in a muscular guy). If these were stabbed, you would have pain with movements requiring you to adduct your arm (bring it closer to your body). Depending how muscular the person is and how deeply the knife goes in, it could reach arm bone (the humerus), or if it went more medially, you could theoretically penetrate down to the scapula. That'd have to be a pretty deep wound, though, because the scapula is your shoulder blade. If it went that deep, it'd probably penetrate the lung and the person would get a pneumothorax (see Trauma page for more info on pneumothorax). The pneumothorax would likely be immediately life-threatening, unlike a simple shoulder wound.
There's also a danger if the knife entered more medially (at the point where the arm joins the chest) that it would slice part of the brachial plexus, which is a large group of nerves that travels down the arm and allows you to move all arm and hand muscles. This would be a lot worse than merely getting the muscles themselves stabbed. If a nerve is damaged or totally transected (cut in half), surgery is often required to repair the nerve and regain use of the affected muscles. Nerve injury will also result in loss of sensation over the area supplied by that nerve (part of the person's hand or arm goes numb). Since all the arm and hand nerves travel in this big bundle in the upper arm, theoretically any number of them could be damaged by a knife wound. Also, major blood vessels (the axillary artery and vein) travel with the brachial plexus and if they are cut, the person will have a lot of bleeding. An important point here for doctors is that you should not try to clamp a severely bleeding artery with a metal clamp if at all possible (you should use direct pressure or a tourniquet instead) because if you use a clamp you might accidentally clamp some of the nerves in the brachial plexus and cause the person permanent nerve damage.
The last thing you have to mention with any kind of wound is that there's always a risk of infection. The wound would have to be cleaned thoroughly, sutured if necessary. The person should receive a tetanus shot if they are not up to date with their tetanus immunizations (you need one every 10 years).
Knife enters laterally (from the side) -- similar to how a nurse gives you an injection in the shoulder
There'd probably be less damage with this scenario, because the deltoid is thicker in this direction. Also, there's no major bundle of nerves or blood vessels here. So you'd have pain lifting your arm up and away from your body. The risk for infection is the same.
As for permanent damage, if the knife only penetrates muscle, the person should be able to recover with minimal trouble. If nerves or tendons or major blood vessels are cut, surgery may be necessary to repair them.
Hospitalization would only be necessary if surgery was deemed necessary, and if there were no complications with the recovery the person would only have to stay overnight, probably. Otherwise, simple suturing and wound cleansing can take place in the ER with the patient going home afterwards.
The need and time for rehab depends how bad the injury was. If only muscle was damaged, the person would need minimal to no rehab -- they could just be taught exercises to do at home. I'd expect them to be significantly better by a couple weeks. If there were more problems with healing, or if nerves and tendons were damaged, the person would almost certainly need physical therapy to help regain function, and even then they might not totally regain all the function they lost. It could take several weeks to months to get better.
What is it like to be in a hyperbaric chamber?
I don't have any personal experience in a hyperbaric chamber, but I have seen the hyperbaric chambers at my hospital, so I can tell you that they look like gigantic glass tubes with a hatch at both ends. You slide the person inside, shut the hatch (not good for claustrophobia, that's for sure), and pump the oxygen inside. People usually remain inside for a hour or so each treatment, I believe. At my hospital they have TVs positioned outside the chamber where the person can watch it through the glass walls (they give them a control inside the tube so they can change channels).
I don't know how it would *feel,* though, since I haven't had any patients who have gone though this and I haven't been through it myself. I haven't heard of hyperbaric treatment done for anything other than wound healing and certain infections, and even then it's not used too often. Usually the person's wound is left open so the oxygen can penetrate the wound and hopefully get it to heal faster. I don't think the treatment hurts or anything. I have heard of people getting a "high" off breathing 100% oxygen for a long time; I guess it makes some people feel really good or something. I think part of it (the good feeling) can be psychological too.