Monday, June 21, 2010

Medical Mondays: BBQ Ribs



This week's post is courtesy of Tricia J. O'Brien. She has a BBQ (Broken Bruised Question) about the ribs. Sorry if that made you hungry. But it got your attention, didn't it? :)

One of my characters has fractured a rib and has a contusion on her lung. She is taken to ER where she is scanned. Can you tell me what the ER doctor would do first? Once it's determined she is in danger of respiratory distress, would she be put in ICU? And what would they do to a semi-conscious, weak person with such an injury--oxygen, IV, any thing else?

Great question. I'm not sure what caused the accident, but someone with rib fractures and a pulmonary (lung) contusion probably recieved a strong, blunt trauma to the chest. These days the most likely cause is a motor vehicle accident.

In the ER, when a person comes in with trauma, shortness of breath, chest pain and a history of blunt trauma, several things will probably happen at once. The sicker the patient looks, the faster it happens. If they came in by ambulance, some things may have already been done (neck immobilized in a hard brace; IV running already, part of the history obtained.) They might be strapped to a hard board to keep their spine straight and help transfer the patient.

1. A nurse (or several nurses) will get vital signs. The patient be hooked up to a monitor to show blood pressure, heart rate, breathing rates, and an oxygen monitor will be placed on their finger. A nurse or technician will probably try to insert an IV and obtain blood tests. Likely oxygen via facemask or nasal cannula will be given. Once the IV is in, fluids will probably be administered. The neck may be immobilized until there is evidence that there is no cervical spinal injury.

2. A doctor or triage nurse will obtain a history about what happened. If the patient can't tell, the family, witnesses, or ambulance crew will be giving this info.

3. Another doctor will start examining the patient while this is all going on. They'll assess how the patient is breathing, check the vital signs, listen to the heart and chest, and check for signs of trauma to the head and neck, do a neuro exam.

4. As for scanning, a portable chest X-ray might be done in the middle of this. The team will scatter to avoid the radiation for a few seconds and come back to the bedside. In some major trauma centers, if the patient is stable enough, they'll just take them directly to get a CT scan of the chest. Sooner or later, the CT will eventually be done.

5. Some trauma centers may also do a bedside ultrasound to look for air between the lung and the chest wall (pneumothorax) or fluid around the heart (pericardial effusion or tamponade).

I'd assume that this patient is so sick that they have signs of a pulmonary contusion (blunt damage to the lung) and AT LEAST 3 broken ribs. If the ribs are broken each in two places, they might have something called a flail chest, when a chunk of the ribs don't move in concert with the rest of the rib cage.

If the patient is very short of breath, has low oxygen sats (hypoxia), they'd need to be admitted for observation. If the breathing problems are very severe, the patient would need to be intubated or put on a breathing mask to help. Anyone intubated would automatically be in an ICU setting. There, they would receive IV pain medicine and fluids. The respiratory status would be closely monitored. Antibiotics would be given if there are signs of infection (fever, developing pneumonia).

If the patient is semi-conscious, there has to be a reason for this. Pain medicine making them sleepy or a little fainting is one thing; semi-concious because of the accident is a signal that head trauma may be a factor, and that's a whole other kettle of fish! (or post, whichever!)

More likely, the patient will be anxious, short of breath, and in terrible pain. If you want them to have head trauma, you'll have to write that in too!

Hope this helps Tricia. And I'm sure I didn't answer all your questions, but if you have more, feel free to email me!

Please keep in mind this post is for writing purposes only and is not to be construed as medical advice!

If you've got a medical question, let me know! Post below or email me at


All I ask in return is that you become a follower of my blog and post a link on your blog when I post. Easy peasy.

Also, don't forget to check out Mental Health Mondays at Laura's Blog!

45 comments:

L. Diane Wolfe said...

You know your stuff!

Walt M said...

This post was interesting. I'll have to come back and look at it (and your blog) later. I sometimes have medical questions in my writing. (And since I write historicals, my issues are that what kills my characters is what's not known yet.)

Stina Lindenblatt said...

Oh oh oh, this happens to a character in a book I've just outlined. But my patient is involved in a car accident, and ends up in a coma (for a few days). He's 17. Healthy. What would his recovering be like, especially with his broken ribs? How long before he can do physical activity (like competitive Latin dancing)?

Thanks, Lydia, for the great post!

Terri Tiffany said...

I'm enjoying your information and am glad you're here to offer it!

Talei said...

You got me with the BBQ ribs I'll admit it! ;) Thanks for the medical writings tips too!

Melissa said...

Sometimes.... I feel like you know everything! But maybe that's just because I know next to nothing about this kind of thing.

How fascinating.

You tricked me with the BBQ....but this post was so fascinating I'll forgive you. :)

Piedmont Writer said...

Wow, with so much cool info, I think I'm going to make one of my characters have an accident!

JustineDell said...

Bookmark! I might need this information later!

You're so smart and helpful! Thanks for these great posts!

~JD

Aubrie said...

I love medical Mondays! Thank you for taking the time to answers these questions!

B.E. Sanderson said...

Excellent post, as always. Thanks. =o)

Tricia J. O'Brien said...

You are the best! That was so complete and fascinating. And will help as I fine-tune that chapter today.
I may email you, as well, to explain something I'm not ready to give away to the whole wide world yet. ;)
Thank you, thank you, thank you.

Renae said...

Once again another great post. How nice of you to take the time to answer questions.
Thanks!

Joanne said...

Oh, this sounds like a very painful situation, with lots of possibilities. It would definitely be fun to work into a story though!

Natalie said...

That is fascinating!

Carol Kilgore said...

More good info. I've seen broken ribs in action, but never written about any. Maybe one day now that I know where to find good info about them :)

Mary McDonald said...

If the patient doesn't go on a vent, be sure to give them an incentive spirometer so they don't get pneumonia. Oh, and if you want, you can call the respiratory therapist who brings them the incentive Mary. ;-)

Emily Ann Benedict said...

Love the BBQ ribs. :)
But seriously, you're giving flash backs to ER visits. ;)
I'll give you kudos for good writing.

bard said...

So at what point do you apply the BBQ sauce then?

Erica Mitchell-Spickard said...

I love your Monday medical posts. When one of my characters is about to get injured I know where to turn cause I know nothing about this stuff. And I want BBQ for lunch now haha. Great post :D

Mayowa said...

See now I'm considering having a character smash into a vehicle with his chest to see what happens lol.

Great post

Lydia Kang said...

Hi all! Sorry for the BBQ trick. Makes me want to have some for lunch too, ha ha!

so Stina--about your follow up question. It depends on the rib fracture--if it's a little crack vs a flail chest, there's a lot more pain with the latter. One broken rib? The pain is pretty bad for several weeks (up to 6 or more, depending). With pain meds, he could get dancing much sooner, but it will be very sore.

Mary--thanks for the note about incentive spirometry. It's a plastic device you do exercises with to help keep your lungs inflated. A good thing to do with people with these injuries (and after surgery, too).

Bard--people can put BBQ Sauce on their broken ribs but it's not recommended by any medical society I know of. Ha ha!

Janet Johnson said...

Totally made me hungry . . . until I read. Not so much, now.

As usual, fascinating. :) Love Medical Mondays!

Lindsay (a.k.a Isabella) said...

I love how each post gives me ideas for new wip. :)

Munk said...

Excellent post... Has the medical community found a way to suppress sneezes during recovery? ...or the giggles? For anyone who has broken their ribs, "it hurts to laugh" takes on a whole new meaning.

Sajidah said...

Lydia, you have an award on my blog! :)

Talli Roland said...

Another great Medical Monday post. Thanks Lydia!

Tricia J. O'Brien said...

Hi again, Lydia. I finally got my link back to you in a post today and I've added an award for you. Thanks!

Yvonne Osborne said...

I found you via Tricia's. Cool blog and now I have a medical question fro you. One of my characters falls through the ice far from civilization and is rescued but not before hypothermia sets in. Would she be confused about where she is and who she is? Memory loss? I've heard (and have written it so) that the best way to warm a victim after such trauma is to get them out of the wet clothes immediately and into a sleeping bag or under blankets, ideally with a healthy, warm individual who could best share their body warmth by disrobing and lying with the victim. Is this an accurate assumption? It makes for a steamy situtaion but I don't want to be too far off the logical track.

Thanks!

notesfromnadir said...

VERY informative! Hope it doesn't happen to anyone I know including my characters!

By the way, that BBQ RIB SPECIAL sign had me laughing so hard! :)

WritingNut said...

Yes, you were VERY creative with that sign! ;)

And as always, very informative. I love these posts!

Stina Lindenblatt said...

Thanks, Lydia. :D

Vicki Rocho said...

I know it's Monday, and that means medical theme...but I was expecting a BBQ recipe or something. hahaha. Must be hungry!

Sandy Shin said...

I always look forward to your Medical Monday posts, because as a pre-med, I learn so many things from it. I love this the most so far! I've always been interested in ER. :)

Jen said...

You are awesome at mixing food, doctor info and writing into one! You had me at BBQ and then I couldn't look away!!!

Lydia you rock!

Rachna Chhabria said...

Hey Lydia..as usual an informative post. Was licking my lips after reading the BBQ..but then you brought me down to earth with the medical information.
Lady you really rock!!

prashant said...

I sometimes have medical questions in my writing.
Banner Advertising Network India

Zoe C. Courtman said...

Definitely bookmarking this post! I love, love, love this series :D Thanks for sharing!!

Heather said...

Perfect timing! One of my characters cracks a rib. This information will help bring the page to life. Thank you!

Elana Johnson said...

Bookmarking this for later...

lbdiamond said...

Ouchy!!!! Can't imagine how painful that must be...

Ed Pilolla said...

i'm new to your blog, so forgive me if i'm covering old ground here. but the physical injuries of a character might reflect well the internal injuries or challenges the character is experiencing. ribs protect our chest cavities, the most vital organs. lungs bring nourishing fuel into our bodies. how a character responds to treatment might also be a good way to see what sort of qualities of the character possesses. maybe he or she is a fighter. maybe he or she is willing to die. each is honorable but wholly different in ways. great monday post idea you got here. got me thinking of my own characters and some situations in my stories. thanks.

Sharon K. Mayhew said...

I was so ready to tell you about the great vegetarian ribs made by morning starters...

You are such a great resource to us, Lydia! Thank you for Medical Mondays!

WritingNut said...

Ooh, by the way, I have an award for you on my blog! :)

Lydia Kang said...

To all the lovely commenters who want ribs...should I start a Tummy-Teasing Tuesday? Just kidding.
:)

Ed, great thoughts on expanding the obvious in our scenes and writing.

THanks Writing nut, going to go see now!

Anonymous said...

[color=#6131bd]Interesting post! thank you for sharing this information. lydiakang.blogspot.com really got under my
[/color] [url=http://nuscin-online.info]skin,[/url] [color=#6131bd]bookmarked... Keep up the great site...[/color]

 
ALL CONTENT © 2012 THE WORD IS MY OYSTER / BLOG DESIGN © 2012 SMITTEN BLOG DESIGNS