Research help

meanmaryjean, DNP, RN · Jul 13, 2015

Interestingly, I know several writers, and have helped them with just this type of problem. Your patient is going to be on a raft of antibiotics as well (an open fracture is a dirty wound). Several ribs, he's likely going to have a chest tube. And if the cervical fracture has resulted in paralysis is a major concern for your patient (and your audience).

Once you have 15 posts on his site, you can send and receive private messages. Why don't you poke around and respond to a few (like 'great' or 'funny' to some humorous ones) and then you can PM me and others for more in depth assistance.

schavis · Jul 14, 2015

Will do! Thank you so much! I appreciate your help :)

Tzs1981rn · Jul 17, 2015

I'm not sure if your character is a minor or not, but if they are, I can offer some perspective as I work in the PICU (peds icu). We sedate with fentanyl and versed, and may add precedex for difficult to sedate kids. We only use propofol for planned extubation and for no more than 24 hours (risk of propofol infusion syndrome in kids is too great).

You would also have child life specialists involved to work not only with the patient, but also siblings to help prepare them for what they will see, and to explain things on their age level. If your character has kids or young siblings, that might work to include.

With car accidents you also may have psychosocial and legal ramifications that need to be explored.

You can feel free to message me as well ðŸ˜ƒ

Here.I.Stand, BSN, RN · Jul 22, 2015

Generally, if there's a brain or spinal cord injury, those take priority over ortho injuries.* The femur would have to wait.* Since the ankle is open, they'd do what is known as a "washout" in the OR and cover with a sterile dressing.**

Propofol and Fentanyl are the common drugs for sedation/pain control in my ICU.* Both are continuous infusions "drips."*** For an open fracture, he'll need antibiotics.* Decadron possibly, to reduce swelling of the spinal cord (given as an IV injection 3 or 4 times a day).* He might need a blood transfusion, given blood loss from his liver lac, displaced rib fracture, etc.* Intubated patients (if more than a couple days) usually have a nasal-jejunal feeding tube placed for nutrition.* And then IV fluids.

Like another poster said, a rib puncturing the lung will need a chest tube.* The injury causes a hemothorax and a pneumothorax--blood and air in the chest-- often called a "hemo/pneumo" in hospital vernacular.* The chest tube removes the blood and air which compress the lung and makes breathing extremely difficult.*

Will he have a spinal cord injury?* Some people do manage to escape them even with spinal fractures.* If so, you'll want to decide what level his SCI is--this will tell you what his level of functioning is expected to be.

*Levels of Injury - Understanding Spinal Cord Injury

Unstable c-spine injuries are generally* treated with fusion surgery and a halo brace (you can Google it.)* More stable ones can be treated with a rigid collar.*

The femur fracture can have traction applied to align it and reduce discomfort; or for a more severe fracture, an external fixator "ex fix" applied in the OR.* This is a temporary solution until he can go back to the OR for a permanent fix.

A grade I liver lac (pronounced "lack" in our vernacular) shouldn't need surgery.* If you want your character to have surgery, make it a grade III-V.*

How long one stays intubated is widely variable.* Some trauma patients are extubated in under a day, some for a week or two; if the pt still needs the ventilator, ideally they would get a tracheostomy at that point. They can stay on the ventilator indefinitely that way without the risks of being intubated (mainly ventilator associated pneumonia "VAP"), plus they usually don't need to stay sedated once they have the trach.*

Someone with a chest wall injury might need extra help to breathe because it's so durn painful.* Also, for a multiple trauma pt who will need serial trips to the OR, lots of times they opt to leave them intubated.* Plus, the amount of pain meds needed can oversedate them and depress their breathing.*

Assuming no complications like pneumonia are keeping him from vent weaning, several OR trips, maybe 4 or 5 days.

When it's time to extubate, we gradually reduce the infusion rate on the propofol.* Propofol can be weaned quickly, often in less than an hour.* If they're still quite sedated we'll decrease the Fentanyl.* Once extubated, our docs like to change them from the Fentanyl drip to a Dilaudid patient controlled analgesic "PCA"--you can Google it.*

Hope that helps!* You should let us know when it gets published--I love to read! :)

Here.I.Stand, BSN, RN · Jul 22, 2015

Generally, if there's a brain or spinal cord injury, those take priority over ortho injuries. The femur would have to wait. Since the ankle is open, they'd do what is known as a "washout" in the OR and cover with a sterile dressing.

Propofol and Fentanyl are the common drugs for sedation/pain control in my ICU. Both are continuous infusions "drips." For an open fracture, he'll need antibiotics. Decadron possibly, to reduce swelling of the spinal cord (given as an IV injection 3 or 4 times a day). He might need a blood transfusion, given blood loss from his liver lac, displaced rib fracture, etc. Intubated patients (if more than a couple days) usually have a nasal-jejunal feeding tube placed for nutrition. And then IV fluids.

Like another poster said, a rib puncturing the lung will need a chest tube. The injury causes a hemothorax and a pneumothorax--blood and air in the chest-- often called a "hemo/pneumo" in hospital vernacular. The chest tube removes the blood and air which compress the lung and makes breathing extremely difficult.

Will he have a spinal cord injury? Some people do manage to escape them even with spinal fractures. If so, you'll want to decide what level his SCI is--this will tell you what his level of functioning is expected to be.

Levels of Injury - Understanding Spinal Cord Injury

Unstable c-spine injuries are generally treated with fusion surgery and a halo brace (you can Google it.) More stable ones can be treated with a rigid collar.

The femur fracture can have traction applied to align it and reduce discomfort; or for a more severe fracture, an external fixator "ex fix" applied in the OR. This is a temporary solution until he can go back to the OR for a permanent fix.

A grade I liver lac (pronounced "lack" in our vernacular) shouldn't need surgery. If you want your character to have surgery, make it a grade III-V.

How long one stays intubated is widely variable. Some trauma patients are extubated in under a day, some for a week or two; if the pt still needs the ventilator, ideally they would get a tracheostomy at that point. They can stay on the ventilator indefinitely that way without the risks of being intubated (mainly ventilator associated pneumonia "VAP"), plus they usually don't need to stay sedated once they have the trach.

Someone with a chest wall injury might need extra help to breathe because it's so durn painful. Also, for a multiple trauma pt who will need serial trips to the OR, lots of times they opt to leave them intubated. Plus, the amount of pain meds needed can oversedate them and depress their breathing.

Assuming no complications like pneumonia are keeping him from vent weaning, several OR trips, maybe 4 or 5 days.

When it's time to extubate, we gradually reduce the infusion rate on the propofol. Propofol can be weaned quickly, often in less than an hour. If they're still quite sedated we'll decrease the Fentanyl. Once extubated, our docs like to change them from the Fentanyl drip to a Dilaudid patient controlled analgesic "PCA"--you can Google it.

Hope that helps! You should let us know when it gets published--I love to read! :)

schavis · Jul 29, 2015

Thank you so much. Sorry it took me so long to reply. We had a death in the family, my brother-in-law and it has been rough. I am still working on my novel, fitting things in and changing things here and there. I really appreciate your reply, and giving me the Ok to message you. I may take you up on that offer. Thanks again!

schavis · Jul 29, 2015

Thank you so much for the wealth of information you provided. Wow, that will help tons. I am sorry it took me so long to reply, we just had a death in the family. I will be glad to keep all of you updated on the progress I'm making. I just finished my first novel, and I am working on editing and revising it, as well as working on this novel. I take my writing very serious when it comes to being realistic with the facts. Even though it is a work of fiction, there are elements of fact involved and I want to be sure to be as accurate as I can when writing about experiences like this, so thank you again!

Here.I.Stand, BSN, RN · Jul 30, 2015

I'm very sorry for your family's loss!

(Strange, I just realized my post was there twice. I wasn't sure where all those asterisks came from so went back to edit them out.)

As a reader I appreciate accuracy. :) Years ago I used to watch this medical drama on Lifetime called "Strong Medicine." I never liked how they portrayed nurses as doing very little--except for one of the main characters who was a male Certified Nurse Midwife, but they sometimes had him functioning as a bedside L&D nurse with a physician managing the delivery... and had the main MD characters being everything--OB-GYNs and other specialties (I even seem to remember one doing brain surgery on a baby in one episode), nurse, social worker, etc. Not accurate at all, but I did enjoy the storylines.

Anyway, I watched a bunch of episodes on You tube last summer. In one OR scene, the patient was intubated (of course--she was under general anesthesia). She just had the ETT (tube) sticking out the corner of her mouth. Nothing was securing it, not even with simple twill tape tied to the tube and around her head. Just sticking out her mouth. The first thing the staff does after placing that tube is secure it so it doesn't come dislodged and ineffective. It made me crazy. :wacky: