Monday, May 23, 2011

Medical Mondays: Head Banging Redux


Our poor characters. How many times must we whack them in the head?

Answer: Plenty.

I get lots of questions about amnesia and head trauma in fictional scenarios. Now, before you think it's cliché to have characters suffer from traumatic brain injury, or TBI, let's review some facts.

According to the CDC (Centers for Disease Control), TBI is a major, worldwide cause of disability and death. In the U.S., 1.7 million people sustain a TBI per year.

The causes include motor vehicle accidents, falls, being struck/striking head against something, and assaults.

And the groups most at risk? Ages 0-4, 15-19, and over 65.

So for many of us writing YA, this isn't a completely random, pull-an-injury-out-of-a-hat situation at all.

So on to our question! This week, Melody asks:

If hit with a blunt object (in my case, a gun) that knocked them out, how long would be a reasonable amount of time for someone (a teenager) to be unconscious, and, most importantly, how would they feel when they woke up? And is there any way to have a concussion and not lose memory?

Great question, Melody. She's already read my earlier posts on head trauma (getting shot in the head) and types of amnesia after head trauma.

First of all, let's define TBI vs. concussion. This is a little confusing. Mild concussion may be considered a type of TBI, where there is clear neurologic impairment at some point in time (confusion, amnesia, difficulty concentrating or feeling slowed down). Being unconscious isn't necessary for the definition of concussion, FYI.

Mild TBI is defined as a person who, 30 minutes after the trauma, knows who they are and where they are; can open their eyes spontaneously; and obeys commands.
In mild TBI/concussion, most people won't lose consciousness. If they do, it's for less than a minute. If Melody need her character to be unconscious for longer, the character would have to pay the price by having more issues with amnesia and other symptoms, and it would have to be clear that the hit to the head was quite severe.

Many people with mild TBI/concussion may have a loss of memory surrounding the incident. Even without losing consciousness, it's common for the sufferer to repeat questions over an over again ("What happened? How did I get here?"). However, that may not last for long. However, the longer the person stays unconscious from the trauma, the larger the period of time they might suffer from amnesia.

How would they feel when they woke up? Here's a run down of some common symptoms:
  • pain or swelling (the goose egg!) in the area of the injury; possibly broken skin over the scalp and a good bit of bleeding (scalps have a rich blood supply)
  • headache
  • dizziness and/or vertigo
  • stumbling; possibly unable to walk a straight line
  • nausea and vomiting
  • emotions out of proportion to situation
  • slurred speech
  • disoriented
  • inability to concentrate
  • vacant staring
  • slowed or delayed speech
Hope this helps, Melody, and thanks for the great question! And all of you out there--wear helmets when you should, and please avoid being pistol-whipped. I wish I could with the same for our characters, but then the stories would be less interesting, wouldn't they?

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 fictional medical question, let me know! Post below or email me at
All I ask is that you become a follower and post a link on your blog when I post your answer.

46 comments:

Vicki Rocho said...

Great post! I've bonked my head a lot over the years, but I STILL learned something. hahaha

Sarah said...

"Please avoid being pistol-whipped". *nods solemnly* Sage advice, as always. Thanks for this post--the knock-out is such fodder for fiction, but hard to get right.

salarsenッ said...

I'm shocked at that percentage. Wow! I had no idea. Thanks for breaking down some of the affects.

Laura Pauling said...

And I would say that a lot of characters get hit in the head in books! :)

Alex J. Cavanaugh said...

That's a lot of head injuries...

Carol Kilgore said...

One of my protagonists in a short story got hit on the head with a gun and got knocked out. I see I did it all wrong. Rats. Too late - the story sold.

B.E. Sanderson said...

Excellent post, Lydia. If your visitors would like more info on TBI, they can always visit The Brain Injury Association of America website (http://www.biausa.org/).

Laurel Garver said...

Characters being knocked out in books seems like such an overused device, but I think with adding these aftereffects would make it much less cliche.

Lydia K said...

Thank you B.E. for the weblink!

Munk said...

For symptoms, don't forget the "coming back to reality through a tunnel". It's real (or really imagined). I've woken up from getting smacked too often, hate it.

Rachna Chhabria said...

One of the characters in my books falls down and hurts his head really badly. This post will help me in giving the character and his injury and the subsequent problems that arise from that injury, an accuracy that was earlier missing. Thanks, Lydia.

Connie said...

I had no idea that head injuries were that common! Wow.

Melody said...

Thank you, thank you, thank you so much Lydia!!!!! :D This was incredibly helpful - really appreciate it!! :)

Susan Fields said...

Another great Medical Monday - thanks for the good information!

Lisa Gail Green said...

Oh goody!! Another way to torture my characters. Mwahahaha! Um, I mean thank you. That's great information.

notesfromnadir said...

Lydia,
Thanks for the information about variations of concussions.

Good advice about avoiding being pistol-whipped!

Linda Gray said...

This is excellent information, Lydia, thank you! I'm bookmarking it along with Laura's post on amnesia today. And Sarah's on getting the psychology right. You guys rock.

Magan said...

This actually really helps my WIP. Great answer and information!

Roland D. Yeomans said...

I actively try to avoid my characters being knocked out. Repeated head trauma has serious side-effects!! They may escape my novels and come "gunning" for me for a little payback. LOL. Roland

Colene Murphy said...

Amazing info here! I'm sure one of these days I will need to know this, so good to know it's available! When isn't a good knock on the head a good novel idea ;)

Tracey Neithercott said...

I love your Medical Mondays. I'm 1/4 hypochondriac so I love learning about these conditions!

vbtremper said...

Great question and answer! Good to know the at-risk age groups.

-Vicki

Hanny said...

Ouch! I'm wearing a helmet 24/7 from here on out!

Krispy said...

I guess I should stop making fun of all the times people get knocked out in teen dramas. Who knew head injuries were so common! Thanks for the info!

Giles Hash said...

I still love these posts! I make characters get hit in the head all the time. It's nice to know my symptoms are accurate.

Question: is it possible to bleed out from a major artery (in the arm or leg) without getting an external puncture?

Heather said...

LOL! Yes, we do whack them in the head a lot don't we?! I had no idea amnesia was so common. The things I learn from you never cease to amaze me!

Old Kitty said...

Oooh what a great post!! Thank you Lynda and Melody! Please be careful peeps and wear helmets and seatbelts!! Brains are fabulous but very very delicate!! Take care
x

Jennifer Hillier said...

Very very cool information. I haven't knocked out a character yet, but I probably will at some point!

lbdiamond said...

Nice post!

(Funny we had similar topics today. Great minds, I tell ya.;))

M Pax said...

I learn so much great stuff from your blog. Maybe I'm not maiming my characters enough ...

Olga said...

As always, a great post. I've had some experiences in my life when I knocked my head on something, and then had the feeling of disorientation, as if everything wasn't really happening to me.

Holly Ruggiero said...

I think in most novels I've read, every MC gets a good blow to the head at some point.

Ciara said...

I use to work ABI/SCI at a spinal center. It broke my heart watching families deal with personality changes. In many cases quiet, sweet individuals became vulgar and aggressive. I always thought about writing a story with a heroine caring for someone with an ABI.

Carolyn Abiad said...

Great post! I have two boys rapidly approaching that demographic. Wonder if them smacking each other all the time has anything to do with the statistics? ;)

Alleged Author said...

I have a friend who walloped his head in a car accident and didn't remember the specifics of the incident. Always wondered why. Great post!

Meredith said...

How awful! Remind me not to get hit over the head with a gun. :)

Slamdunk said...

Ha, I am with Vicki and her comment--I have modeled these symptoms several times before.

Liza said...

This gives me a reminder of sledding down a hill and hitting a tree...head first...out for a minute or two and dizzy afterwards (and very headachey). Must have been a mild TBI/Concussion. :)

Jonene Ficklin said...

That was great! I sure enjoy your posts - especially the medical ones. They're rich, insightful, and loaded with info. Thanks for helping all the writers out there!

Emily Rose said...

very interesting!

LTM said...

ahh, Lydia! What an awesome resource you are, my friend!

this is such great information. Thanks for making it so quick and easy to read and understand.

You rule~ xoxo

Kerri Cuev said...

I'm surprised there isn't a 25-35 at risk group....you know, homeowners who climb ladders. Lol.

The Red Angel said...

I always love your Medical Mondays, Lydia! Really interesting information here. :)

~TRA

http://xtheredangelx.blogspot.com

Stacy Gail said...

Ah, this brings back memories... or rather, a big honkin' lack of memories. :P Three concussions = temporary blindness, nausea, E.R. visits I barely recall, and absolutely no memory of any of the impacts. Fun times. :P

(No one tell me figure skating isn't really a sport. I don't wanna hear it.)

Great post, Lydia, and HIGHLY accurate!

Medeia Sharif said...

This is interesting. I don't always see the symptoms in books and movies.

LisaAnn said...

Have I mentioned how much I LOVE these posts?? Both for my writing and just for my general knowledge... I'm becoming freakishly smart as we speak! Thank you!! ;)

 
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