# Hope this is a good place to post my questions



## Rayanna (Jun 7, 2011)

I've been trying to do some medical research for a story I am writing, and I came across this forum. I would absolutely love some help. I am not a doctor, EMT, nor do I have any experience in the medical field, so I was hoping to find some experienced people to teach me a few things.

I want my story to be very realistic... here is what is happening.

One of my main characters (23 year old female) is brought to the hospital. Her friends bring her because they claim they came home and found her unresponsive.

What would be the first thing to be done with her? What tests? What would you look for, and what would be normal? What would you ask? 

I know that you'd look for trauma, but what happens if there is no sign of injury? What then?

Again, I'd appreciate anything you can tell me!


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## foxfire (Jun 7, 2011)

Now I am coming from a prehospital point of view. And would looking into a lot of This stuff to rule out possible causes.
 I would look at the vitals, too high or low. Could be dehydrated, or hypertensive and having a stroke.
 Is she hypoxic? ( lacking oxygen)
Blood glucose reading
Toxicology possibilities 
Heart monitor, is the ticker working as it should. 
Try and get any history from friends or family.
is the pt conscious now, does pt have any memory of incident. Leading up to incident.
History of seizures?
That are some of the things that come off the top of my head. Maybe we can round up a few er people to give some perspective.
another thing you can do is Google Some for some of the info. Put on your detective hat.h34r:B)


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## Rayanna (Jun 8, 2011)

Thank you so much!!! this is awesome!


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## nerdyEMS (Jun 8, 2011)

Depending on if the girl was brought in by her friends or ambulance, it will affect the initial treatment of the patient. Airway, breathing and pulses would be accessed. In an EMS setting, if pulses are not present, cpr would be started right away. Paramedics would be able to push meds after they gain IV access. Cardiac 12 lead would be done, if the heart is in a shockable rhythm, patient will be shocked. if the patient is breathing in adequately, she would be intubated and ventilated via bag valve mask. All these steps would take place in the hospital, if not previously started on scene by EMS personnel. En route to the hospital, EMS would alert the recieving facility of the patient's condition, so they are prepared with staff and equipment to work on her right away. upon her arrival to the hospital, she would normally be brought into the truama room where a team of clinicians and nurses would assess her, much like how they depict on tv etc. I imagine they will also take her to MRI/CT right away to rule out bleeds etc and draw labs ... ideally, in the hospital, they want to find out WHY this incident occurred and how to fix it, where EMS is more concerned with treating immediate compromises. Hope this was useful!


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## Melclin (Jun 20, 2011)

If I were writing realistically about the assessment of an unresponsive person viewed through the eyes of a lay person, I would make note of a few things.

-How casual the staff/paramedics seemed. How it was nothing like TV with their fast talking paramedics bursting through the doors, high voices and emotion. They talk about their day, they smile and laugh. Nobody looks tense.  Everything happens slowly but efficiently. For the pt its the worst day of their life, but its just another day at the office for medical staff.

-How odd scenes like medical procedures and assessments look without fast editing and emotional music. Seen from a static point of view without anything to set the tone. Its a lot less exciting unless you are academically interested in what's going on. 

-How ugly everybody is. The cast of greys anatomy a real hospital staff is not.

-The amount of old people in ED. They never capture that on TV. Its all heart attacks and car accidents. Its never 95% old people with miscellaneous diseases associated with age.  

-Constant alarms that nobody seems to take any notice of. 

There is not real standard treatment or test for "unresponsive". It depends entirely what kind of unresponsive she is, which takes you into the complexities of the field. What specifically turns out to be wrong with her? Perhaps we could shed more light on the actual things that would be done if we knew what ended up being wrong with her.


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## wandering_idiot (Jun 20, 2011)

Melclin said:


> -How ugly everybody is. The cast of greys anatomy a real hospital staff is not.



Speak for yourself


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## mycrofft (Jun 22, 2011)

*Three points*

1. Write what you know about. (After this, you will know about it!).
2. If the hospital admission is just part of the character's progress through the story, your editor may ask you to condense the medical tech to make the story move onwards. If it is part of a "procedural" (a tech-based story such as an episode of CSI or a Tom Clancy novel) then detail should be correct, but again, shave it down to make it move. Maybe describe it from one character's POV instead of trying to convey an omniscient total picture.
3. A lot happens simultaneously. Careful how you use this, it can speed things, but it can lose readers.
Very best luck!!!!!!


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## Lifeguards For Life (Jun 22, 2011)

Melclin said:


> -How casual the staff/paramedics seemed. How it was nothing like TV with their fast talking paramedics bursting through the doors, high voices and emotion. They talk about their day, they smile and laugh. Nobody looks tense.  Everything happens slowly but efficiently. For the pt its the worst day of their life, but its just another day at the office for medical staff.



Sounds boring, just the way it really is.


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## Melclin (Jun 23, 2011)

Lifeguards For Life said:


> Sounds boring, just the way it really is.



I don't think it has to be flashy and loud to be impressive. 

I'm a bit of a movie buff and something that always bothered me about a lot of war movies were the explosions. All flame and now power. I suppose the idea was that things are more impressive when they're bright and firey, but I always thought they were missing out on the impressiveness of the sheer and obvious power of a real explosion. That instant cloud, the camera shake and the way dust leaps off everything for miles around. 

I'd reckon its similar deal with high stress medicine. There is something so subtly impressive about a trauma team kicking into gear or a well run resus. Its quiet and powerful. Nobody it stradling gurneys and screaming "live god damn it", but I think its all the more impressive because they're not. I reckon if you can capture how impressive that quiet efficiency in the face of a life threatening situations, you'd have a pretty decent bit of story. No need for accurate ventilator setting and drug dosages.


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## Rayanna (Jun 25, 2011)

Sorry for my delay! I work in the school system, and this is a busy time of the year for me. Got caught up with end of the year things.

Thank you all for the responses!! They are very helpful. To answer your questions--this is a sci-fi story, and there will be nothing "wrong" with the patient, but she appears to be in a coma. I need a lot of research on comas, so if you have any good sites or info for treatment, please let me know.

I know it is important to have a person in a coma see a physical therapist or something like that so the muscles do not atrophy. 

I especially love the boring ugly details LMAO! I could definitely use that =) 

No need for CPR, as she is breathing, just unresponsive. I get that they would check her eyes with flashlight, check her BP, heartrate and other stats. Do you think they would call the police to investigate? isn't that a law? 

Toxicology would take at least an hour to receive? How would they test for dehydration, hypertensivity, or hypoxic-ness? Sorry if I'm butchering the lingo =(

Could someone explain a cardiac 12 lead? 

Thanks again!!! You all rock!


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## Melclin (Jun 27, 2011)

I'd be careful of delving too much into the actual conversations of healthcare types about a pt, or you'll end up writing something like this:

[YOUTUBE]http://www.youtube.com/watch?v=lJuP9c3c2MI[/YOUTUBE]


Other than the fact that it would be very hard for a non-healthcare professional to write that sort of thing, you also have a lot of slang and location/speciality based differences. I had to learn a whole new set of terminology to understand what the hell people were on about on this board because of the differences between Australia and the states. To add to that I have a friend who is a nurse on a cardiothoracic ward and she can't understand a word of the emergency/ambulance talk. I can't understand half of what she's on about. Not because of the subject matter, but because of the colloquialisms. 

If you really wanna heavily research it, here's the skinny. What was done first would depend very much on how deeply unconscious she was and the probable cause of her unconsciousness. The ABCs come first but realistically it all pretty much happens at the same time. The team of doctors and nurses would be looking to answer the following both to keep the person alive and to collect information about why the person is unconscious :

-Can she protect her own airway: this has a lot to do with how deeply unconscious she is. (look up intubation and Glasgow Coma Scale on wiki).

-Is she breathing deep enough and often enough to get enough oxygen and blow off enough carbon dioxide.. (wiki: "Oxygen Saturation"/SpO2/pulse oximetry, End Tidal CO2 or arterial blood gas ).

-Is the relationship between blood pressure and heart rate appropriate such the enough blood is getting to the important organs (wiki: "shock" and "perfusion").

-What is her exact level of unconsciousness, pupil appearance and reactivity and other neurological observations.

-All her clothes cut off and body examined looking for relevant information or injury.

-Intravenous access would be a must and would happen simultaneously. Once that was established blood would be drawn for tests. 

-Some of the following may be inserted depending on findings and probable causes of illness: breathing tube (endotracheal intubation), tube into the stomach via the mouth or nose (orogastric or nasogastric tube), into a main vein near the collar bone, neck or groin and up into the heart to monitor various pressures, give certain drugs and measure how well the heart is working ("central line", CVC, pulmonary artery catheter, swan-ganz catheter), into a small artery to accurately monitor blood pressure (arterial BP, "art line"), into the urethra to measure urine output (more important that it sounds).

- Again depending on the information collected there would then be further investigations. ECG(what was called a "cardiac 12 lead" earlier in the thread) investigates the electrical activity of the heart (abnormal rhythms, heart attacks, abnormal size or electrical conduction and can also show abnormalities when things are wrong elsewhere in the body too). Cat scan of the head looking for blockages or bleeds (strokes, they happen in young people too). Blood tests measuring electrolytes (salts), sugar, oxygen, carbon dioxide, acidity, number of different blood cells, ability to clot, proteins, bacteria, various illicit drugs (particularly in an unconscious young person, etc 

- Chest xray looking at the lungs and heart and rib cage. 

- Ultra sounds of the abdomen and heart.

Wiki this stuff and you should have a reasonable idea of what will go on. One further point: if you're writing dialogue for docs/nurses, don't use formal terminology. Nobody says, "nurse can I please have you perform a 12 lead electrocardiogram, draw blood to measure the ammount of postassium, sodium, then we'll get a cat scan of his head, while I perform a rapid sequence induction for the purposes of airway capture and mechanical ventilation". It would be more along the lines of, "Umm nah we'll tube...Sharon can you do drugs, Mike have we go that fluid up? Yep, righto, lets get some bloods first, tube...yeah 6.5, ahh I hate these new bloody masks... ah and then CT brain if they're ready down there". Most conversation is clarification and discussion because mostly everyone knows what needs to be done. Eg. A doc won't have to ask for IV access, but a nurse may say something like, "Its looking a bit sparse, are you happy with 20?" How you can really replicate that though without spending a lot of time around docs and nurses, I don't know.

"Stefan Timmermans: Sudden Death and the Myth of CPR" is a pretty good look at the emergency department through the eyes of a lay person (he's a sociologist and makes a lot of very interesting obsevations.

I have something of a special interest in how medical procedures/conditions/treatments are explained to lay persons so feel free to pm me and keep us updated on how its going. I'd love to read it when its done, or if you want advice


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## mycrofft (Jun 27, 2011)

*Why not make your character catatonic?*

Like "amnesia", it will fly with readers without going into terrific detail, and could, if handled porperly, save you some details about feeding and sanitation; being psychological, you don't have to worry about the medical damage which put her in a coma. Would still require professional physical therapy or the equivalent, be unresponsive, and not prone to stasis ulcers or pneumonia if the patrient can be led about and positioned.

In true coma, muscles not only atrophy, but due to the higher inherent strength in the contractor versus extensor muscles of the extremities, the extremities curl/contract.


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## Rayanna (Oct 3, 2011)

Back again. 

What would preliminary bloodwork detect and how long would it take for it to come back with results? 

I'm trying to think of some news the family can receive within the first few hours, but it sounds like not much will be accomplished?


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## Papa (Oct 3, 2011)

wil aney of these tecknical detales realy make or break your story?

or will they bore the reader and make them stop raeding you're book.

also its not like the avarige member of the puhblic is smart enouf to know if you're rite or wrong.


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## Papa (Oct 3, 2011)

Rayanna said:


> Back again.
> 
> What would preliminary bloodwork detect and how long would it take for it to come back with results?
> 
> I'm trying to think of some news the family can receive within the first few hours, but it sounds like not much will be accomplished?



it dipends on waht is being tested for. some tests can be done relitively qukly. others take more time. and of corse it depends on how long it aktualy takes the lab to run the tests!


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## FFEMT427 (Oct 3, 2011)

Rayanna said:


> Sorry for my delay! I work in the school system, and this is a busy time of the year for me. Got caught up with end of the year things.
> 
> Thank you all for the responses!! They are very helpful. To answer your questions--this is a sci-fi story, and there will be nothing "wrong" with the patient, but she appears to be in a coma. I need a lot of research on comas, so if you have any good sites or info for treatment, please let me know.
> 
> ...



Depending on the patient presentation and the staff they may not have to have a tox screen back before they begin to treat for some overdoses they may choose to use certain meds that will reverse certain types of overdoses i.e. if your patient has respiratory suppression and/or several other signs they will give a med called narcan (watch a scene in the Nicholas Cage movie "Bringing Out the Dead") dehydration they will check the eyes and mouth for dryness as well as skin temp lack or presence of sweat the heart rate and BP. "Hypertensivity" or Hypertension means high blood pressure. "Hypoxic-ness" (I love that you through a "ness" in there by the way....lol-ness) means lack of oxygen and they can tell this by the presence of cyanosis(blue color) of the skin nail beds etc. also they will put the patient on a SPO2 monitor which tells them how much oxygen is bound to the hemoglobin in their blood(not sure how much detail you want)
Another thing they will check on your character is called a Glasgow coma scale but no matter how many details you put in its important you get the order in which the interventions should be performed correct.
Now to the important question if you use any of our advice do we get to know what the story is about before it goes to print? lol


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## IRIDEZX6R (Oct 3, 2011)

Melclin said:


> -How ugly everybody is. The cast of greys anatomy a real hospital staff is not.



Ya, I'd take that one back... I've had some partners that put Megan Fox and Jessica Alba to shame. And no I'm not kidding...


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## mycrofft (Oct 4, 2011)

*You forget your Star Trek TNG  rules of writing*

When in doubt, drum up something about a subspace field, tachyon bursts, and something or other in the space-time continuum. And kill a couple of nameless redshirts.

Dumb question: why not draw suprapubic urine and do a quick Valtox on it, like a parole office would do with a voided specimen?


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## Sasha (Oct 4, 2011)

Are red shirts like brown coats?

Sent from LuLu using Tapatalk


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## mycrofft (Oct 4, 2011)

*Maybe with tan khakis.*

I have a white coat for you, sleeve length extra looooong....


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## Melclin (Oct 4, 2011)

Rayanna said:


> Back again.
> 
> What would preliminary bloodwork detect and how long would it take for it to come back with results?
> 
> I'm trying to think of some news the family can receive within the first few hours, but it sounds like not much will be accomplished?



There isn't really a standard "preliminary blood work".

Do you really need the details? The docs aren't going to hit the family with a long list of abnormal blood test results and discuss the differential exactly at the moment that the come back from path. 

All it needs is some reference to either waiting for hours, or getting the results pretty much instantly (most emergency departments have a certain amount of on site testing). Then some non specific words about whats wrong with the pt, or that they don't know, they'll do further tests and take good care of her and thats about it. Its all the family would get, I don't see why the audience needs any more.


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## mycrofft (Oct 4, 2011)

*Maybe the wait could generate tension*

Otherwise, fake it like they do with their 23rd century computers and photo enhancers on "CSI".


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## Melclin (Oct 4, 2011)

mycrofft said:


> Otherwise, fake it like they do with their 23rd century computers and photo enhancers on "CSI".



Yeah in the end, all the accurate detail in the world doesn't make good story and I'm happy to cop some inaccuracies for story that is good. 

But then, I watch Grey's Anatomy, which is neither accurate or good in any sense, so there you go.


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## Rayanna (Oct 4, 2011)

I'm actually quite insulted, Papa.

At the end of the day, it's not that I care to "wow" anyone with my knowledge of hospital proceedings. And it's not like I'm going to "bore" people by stating around using hospital terms that are above everyone's head--including my own.

The fact of the matter is, I know so very little, and I don't want to over-dramatize things. From what I've read and heard, the hospital scenes I am familiar with (on TV) are over-dramatized. I'm trying to avoid this and just stick with the facts. Also, I would prefer not to look like an idiot by using factually inaccurate material in my story.

I could just make something up, or I could do a bit of research and make it all the more believable. 

I have worked too hard on this story to blow the authenticity by "winging it" and if that is what you would do in my situation, so be it. But there are things I am passionate about, and writing is one of them. I don't expect you to understand, though. 

Thanks all who replied with more helpful answers.


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## Rayanna (Oct 4, 2011)

Meclin,

That is exactly what I am trying to avoid--writing the wrong thing. I don't want people reading my story saying, "What a moron, that would never happen."

Yes, details are important to my story. I want to write an all-around good story, is that a crime?

I feel like after a few hours of being in the hospital, they would have to have something to tell the family. Blood work was all I could think of that would be fast and accurate. I know toxicology take a while to come back. I'm just looking for some sort of medical proceedings to take place amidst the other action.


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## HMartinho (Oct 4, 2011)

Rayanna said:


> Meclin,
> 
> That is exactly what I am trying to avoid--writing the wrong thing. I don't want people reading my story saying, "What a moron, that would never happen."
> 
> ...



Well,I'm just an EMT-B, not a doctor or a nurse, but:

-Full neurological exam
- chest X-ray
- EKG-12 leads
- Head CT-scan
- Check cardiac enzymes
- If the patient has difficulty to breathing/dyspneia/respiratory distress, the Nurse should take and ABG (arterial blood gas)
- Check electrolytes
- Echocardiography
-Tx screen


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## firetender (Oct 4, 2011)

*From writer to writer*

Be there.

Make arrangements with your local hospital to be an Observer in each of the services you are writing about. It is not unheard of to schedule ride-alongs either. At any rate, I highly reccommend making the effort to live it, if only for a little while. I promise you that you'll pick up details that will spin EVERYTHING in a new and better direction.

Yes, it won't be easy, but you're intrepid, I can feel it!


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## mycrofft (Oct 5, 2011)

*LIke Tender says*

If we were all red hot writers, would we be sitting here wasting our time instead of shaping up our latest film treatment or e-novella?


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## EMS123 (Jan 3, 2012)

wandering_idiot said:


> Speak for yourself



I bellieve he was referring to the ER staff so the Medics and EMTs can be casted as studs/studettes ... like Pameila Anderson running to the ocean.


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