catastrophic injuries

caramelmachete  asked:

My main character was slammed into a brick wall and hit his head. He lost consciousness briefly, was alert for a few minutes, and now has lost consciousness again. His partner rushes over to my MC. Assuming that his partner has a very good understanding of first aid, what should the partner do? Will my MC's pulse and breathing rate be slower or faster than normal? An ambulance has already been called. What other steps should the partner take?

Your character is dying.

The strike / loss of consciousness / brief period of lucidity / re-loss of consciousness is pathognomonic (read: One True Diagnosable Sign) for a traumatic subdural SUBARACHNOID hemorrhage, which is an arterial bleed inside the skull. That blood expands and puts pressure on the brain, which has nowhere to go… but it will go there anyway.

Your character’s breathing will likely ramp up and then decelerate, with periods of just… stopping. It’s called Cheyne-Stokes respirations, and it’s the body trying to manage cerebral bloodflow. His pupils will be uneven, with one bigger and the other constricted. His pulse will be normal and dip down to slow and then back up to normal; as he worsens, it will simply be slow.

Understand that what you’ve given your character is a catastrophic injury. A great many SAH patients don’t live, and he’s going to, he needs brain surgery basically yesterday.

As for first aid, keeping the character on his side isn’t a bad plan (but first they should feel the spine to make sure the neck hasn’t been broken). This will help when the injured character starts vomiting profusely.

If you want to make this a less lethal event, I would consider either a) simply extending the period in which the MC is unconscious the first time (and not putting them out a second), or b) have them lose consciousness and wake up a few minutes later but be very confused and lethargic.  Trust me, a few minutes is still enough to indicate plenty of brain damage, and plenty of drama and fear, because the seconds stretch into minutes in those situations.

For further reading I suggest you take a look at the head injury tag and the TBI tag!

Thanks for your ask and I hope I could help!

xoxo, Aunt Scripty

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Raspberry Rain

@kurt-and-blaine-anderhummel prompted: I haven’t slept in like 3 days everything is funny and your hair smells really good (where Kurt is the one that hasn’t slept and Blaine sits next to him in class and he keeps leaning his head on Blaine’s shoulder and keeps telling Blaine that his hair smells good from his scented hair gel). Klaine Alternative Meeting AU. 4K [AO3]

“Okay, class. Settle down. Put your books, notes, and flashcards away - if you don’t know it by now, it’s too late for you to learn it. I’m going to start passing out the quiz in about one minute, as soon as it is officially 9:00,” Professor Francesca announces, her tone as cold and imperious as always. “You’ll have ten minutes to complete it and then we’ll start our new material in chapter four once they’ve all been turned in.”

Blaine shoves the color-coded note cards for his History of Theater course into his backpack, stealing a glance towards the door as he does. The seat next to his is still vacant which bodes very, very poorly for Kurt, the cute sophomore that sits beside Blaine typically. After all, their professor is a notorious stickler for punctuality. Anyone not in his seat at 9:00 am on the dot is marked absent and doesn’t get to take the quiz. And barring a catastrophic illness or injury, there are no makeups either. 

Keep reading

2

Garry Newlove, a married father of 3, lived in Fernhead, a close-knit community in Warrington, UK.  The area had increasing problems with drunken teens roaming the streets, an issue that came to a head for Garry Newlove on the evening of August 10th, 2007.  After confronting a gang of youths for vandalising his wife’s car, Garry was viciously attacked in front of his home. His 3 daughters witnessed the brutal assault, and tried in vain to ward off their father’s attackers.

After suffering numerous catastrophic head injuries within the space of 2 minutes,  Garry fell into a coma, and his wife Helen made the decision to turn off his life support machine a couple of days later.  Thanks to a number of eyewitness accounts, Adam Swellings, Steven Sorton, and Jordan Cunliffe (aged just 19, 17 and 16 respectively), were soon identified by police. The day of the attack, Swellings had been released on bail for assaulting another man just weeks previously.  Sorton had been identified by police as he was missing one trainer; the other had come off while kicking Garry Newlove in the head. A further 2 assailants were also put before the court, but are unable to be named for legal reasons.

During the trial, the defendants reportedly laughed and joked throughout the Newlove family’s witness testimonies, even dropping off to sleep at points in the proceedings.  However, they soon stopped laughing when all 3 named suspects were found guilty of murder and sentenced to life in prison.

One of the best things about bnha is the accurate representation of the human bodies physical limitations. You don’t see the superheroes shaking off broken arms at the end of every fight or magically bouncing back from a catastrophic injury with no consequences whatsoever.
Instead, we see Midoriya having a very real consequence of the loss of movement in his arms because of the constant strain he has been putting on his ligaments, Iida having lost some mobility in his left arm/hand after it being practically shredded, and All Might’s decrease of time where he can be in his superhero form because of the injury to his side, ultimately becoming unable to be in that form anymore are some examples.
These physical limitations make it feel like the characters of bnha are actually human instead of having us question how the hell their bodies can handle attacks of that severity and still be fine afterwards, and I admire the author for adding this detail that is looked over in a lot of superhero stories.

Nursing Reset

People often question why/how nurses get to the point of burnout so early on in our careers, and why it seems we are having a tough time with this profession, and sometimes, they are just irritated with our inability to deal with it all.
We spend our entire shift (and careers) caring for others, prioritizing their needs, listening & comforting people during their trials and their joys, all the while pushing aside how we feel, we push aside how the traumas and anguish affects us - and most of the time we don’t think about it, we just get on with it, over and over again….but sometimes the not thinking about it builds up.

I often think about the nurses who have been at this work for 20, 30 years - sometimes I hear people snipe about them sticking to one unit for so long, but I look at it differently, I have incredible respect for their daily endurance, and capacity to go back day after day during the toughest and most challenging times, unsafe staffing, absurd situations, bullying, favoritism, or extraordinary stress of each shift.

I haven’t been a nurse that long, only 8 years, and it occurred to me that the day I received my license, it was perhaps one of the most accomplished days I’d experienced thus far. Perhaps a bit materialistic - although sometimes the payoff for hard work is a glorious moment, if fleeting. Yet, now, 8 years later, it passes without my realization; how did this happen? A date I had looked forward to so much as a nursing student, now as an experienced nurse passed without so much as a pause to reflect and be grateful.

No, I wasn’t thankful. I was doing a per diem shift in the ICU, a unit I had returned to some months back, since I am between jobs and no clue what’s next as an educator. ICU was almost like coming home. A familiarity of controlled chaos, cardiac monitors, ventilators, IV pumps, and meticulous monitoring of patients at their most vulnerable and critical time. And the support of nurses & doctors who unfailingly take care of one another, no bullying zone.
No, I wasn’t as thankful as I had once been on this date. I spied a ventilator being rolled into my room, no warning that a cardiac arrest was on its way. But that’s ICU, anticipation and expectation of met codes, arrests, upgrades that are moved in quickly for stabilization, and ICU nurses springing to action. No, I felt removed from the nurse I once was - a sort of detachment as I hooked up my patient, listened to the code team’s report, and apology of the mess they were leaving me with. No, I wasn’t even annoyed. I knew they were doing the best they could, codes are messy - there is rarely getting around that. I wasn’t annoyed at all. I was void of emotion, which some may argue is necessary to logical thought process in critical situations. I spent the shift chasing my own tail, managing drips, labs, rhythms, carefully labeling lines, establishing a system in the room that was preparatory, anticipating life threatening events, collaborating with doctors, praying as we turned the patient to remove the blood soaked linen and clean the mounds of stool - for any critical care nurse knows the cardinal rule of post cardiac arrest patients: never turn them unless you want another code on your hands. Sometimes it works out, and sometimes you kick yourself for having made such a stupid decision when they go bradycardic and arrest, then expire.

End of shift. A marathon, really, that leaves you feeling as though you neglected your second patient, and didn’t save the first. What’s the point? Where’s the quality of care? Would I have entered this profession knowing I would feel empty 8 years later on the very same day?

I stood, at the end of shift in the now empty room that hours earlier saw crowds of caregivers, family sobbing, patient connected to supportive life devices, tangles of lines infusing medications, alarms blaring, and shouting of orders. I stood, thinking about how we reset each room after each loss…and how we reset internally. I thought about the countless catastrophic injuries and heartache this room has seen, the many, many crash carts stationed by this door, the lost souls of patients that may still reside in this room, in transition…and I thought about the squeaky clean, bleached floors, immaculate bed, neatly folded monitor leads, reset and waiting to admit the next patient - knowing not of the devastation that housed this room mere hours ago. I thought about the energy of the room, and wondered if the incoming patients felt it too.

Instead of being simply grateful for the simple things in nursing that once held my heart, I am burned out - it isn’t something I thought would happen, it isn’t only from working copious hours, or backbreaking work. Sometimes it comes from a place of self disappointment, sadness at not being the nurse you once were or hoped you would be, stress of not belonging/inability to find a job that fits. It’s both frustrating to realize people just don’t understand why we feel this way, why we aren’t handling it the way they want us to, expecting us to magically snap out of it, perhaps feel the necessity to mock it, or worse yet - pity us (that’s a misinterpretation of what we ask); and it’s frightening to realize this may be the end of a career I’d once worked so hard for.

I stick with it, because I remember the simplicity of appreciation I once felt. I stick with it, because I remember the feeling of being entrusted with the lives of others, and I stick with it because one day the burnout will be a distant memory.

Burnout isn’t something we should roll our eyes at. It’s devastating to a nurse.

If you’re a nurse who is experiencing this, has experienced this, or nearing this, I support you. If you are a friend of a nurse, I ask of you to simply support us.
4

My college buddy Zack Weinstein is in COLOSSAL at Dallas Theater Center. The play centers on a University of Texas football player, struggling to move forward in the wake of a catastrophic spinal injury. These production photos are beautiful, and mostly I’m proud because Zack is a quadriplegic actor, playing a quadriplegic role. And that’s fucking cool.

I remember

I remember the day I was accepted into nursing school, the thrill, the excitement, and I recall the fear.

I remember the first patient I took care of; elderly female, The simplicity; the meticulous care of a bed bath, brushing her hair into a high ponytail. I recall her smile.

I remember the first time I saw a vented patient, the stillness of the human form amid surrounding chaos: a tangle of IV lines, cardiac monitor beeping, peg feeding, multiple decubiti, contact isolation - so, so many gown changes. Family weeping, vent alarms, chest tubes and suctioning - oh my, the sensory overload. I recall the palpable fear - how in heck would I be able to do this every day?

I remember the late nights studying, researching, the repetition of skill practice, the solitude, the 3am feelings of wanting to quit nursing school, give up on a dream. I recall the group study sessions where I didn’t feel so alone, the wonder of new things learned in clinical, the relief of passing exams & evaluations, and I recall the support of Professors who believed in me when I didn’t.

I remember Pinning, and Graduation, the melancholy of no family in the audience, and I recall the realization that friends are the family we choose over, and over again.

I remember the agony of reviewing years of clinical and lecture information in prep for the NCLEX, I recall the 75 questions of terror, the certainty I’d failed, the loss of control over waiting for results, and the unparalleled relief it was all over with a simple word;
“pass”

I remember the joy of securing my first nursing job, the beginning of a new journey, the freshly ironed scrubs, squeaky clean nursing shoes and shiny stethoscope. I recall with wonder, signing “RN” after my name for the first time.

I recall the feeling of finally being on my own, no professor, no hospital educator, no preceptor - pure terror mixed with a sort of odd “thank goodness and about damn time”

I remember the overwhelming sensation of having too many patients, no breaks, difficult assignments, baby nurse hazing, and wanting to hide in the med room/patient’s bathrooms and cry.

I remember my first code - the chaos, the deathly gray pallor as we failed at reviving a patient, the sound of cracking ribs, pools of blood, crash cart supplies strewn all about the bed and floor. I recall the silence when everyone left the room and it was just me, the patient and a shroud.

I remember the feeling of failure and tears that would not come.

I remember wanting to quit more days than I wanted to work.

I remember my first DNR, the realization that when patient wishes are respected and managed well, there was dignity in death, and an honor to be the last person holding my patient’s hand as he moved onto the next world.

I remember the first time as charge nurse, the storm of chaos, the understanding you cannot please everybody (or at times, anybody), and I recall the immense relief of the silence at the end of the day.

I remember the traumas, the catastrophic injuries, the emotional and physiological distress, the cries of pain echoing down the halls. I remember the joys of a life saved, the simple pleasures of holding a patient or family in comfort, the mistakes, irritations, struggles, humor & humility of daily practice, and I recall the soul searching reflections of learning from my patients and coworkers every day.


There are definitive moments in a nurse’s career;
Great trial and great joy.
These are the moments we remember,
To carry on.

buzzfeed.com
BREAKING: Six Officers Charged In Freddie Gray's Death Will Be Tried Individually
A Baltimore court also ruled State's Attorney Marilyn Mosby does not have to recuse herself from the case.
By Nicolás Medina Mora

BALTIMORE — A judge ruled Wednesday that the six officers charged in the death of Freddie Gray, an unarmed black man who was allegedly killed by police in April, will have individual trials and that State’s Attorney Marilyn Mosby will not be forced to withdraw from the case.

Gray, a 25-year-old resident of the impoverished west side of the city, died on April 20 of a catastrophic injury he suffered while in police custody. His death sparked protests against police brutality, which in turn provided cover for rioters to take advantage of the disorder and loot several stores and set fire to more than a hundred cars.

The unrest came to an end on May 1, when Mosby announced her intention to charge the six officers involved in Gray’s fatal arrest with crimes ranging from misconduct in office to murder. All six officers pleaded not guilty.

Wednesday’s were the first two hearings in the case. Judge Barry Williams listened to debates on whether the court should dismiss the charges against the officers on the grounds that Mosby compromised their chances for a fair trial and on whether the officers should be tried together or separately.

During the first hearing, the defense argued that Mosby’s statements on May 1 prejudiced potential jurors against the defendants, in an alleged violation of ethics rules. They also argued that several lawyers in Mosby’s office had become potential witnesses in the case by conducting a parallel investigation into the facts of Gray’s death, a situation that the defense claimed should disqualify them from conducting the prosecution.

Andrew Graham, an attorney for one of the accused officers, took particular issue with Mosby’s use of the phrase “No justice, no peace,” a chant used by both peaceful protestors and rioters during the unrest, saying that the clear implication of Mosby’s words were that “if [the people] want peace in Baltimore, they have to convict the officers.”

“This was not an impartial, dispassionate discussion of a case,” Graham said of the May 1 press conference. “This was a motivational speech.”

For their part, Mosby’s team argued that her statements during the press conference came from the public record and did not constitute an invitation to convict the officers. They also argued that there are legal precedents for prosecutors to participate in criminal investigations without having to withdraw from the case.

“Forests have been destroyed by the amount of paper the defendants have used to talk about these issues, but they are trial issues,” said Chief Deputy State’s Attorney Michael Schatzow.

After an hourlong hearing in which he often asked tough questions of both sides, Judge Barry Williams decided to side with Mosby, but not without criticizing some of her actions.

Williams told the court that he was “troubled” by some of the statements that Mosby made on May 1 — particularly when she told reporters that some of the officers had made statements while others hadn’t — but added that her comments had not compromised the defendant’s right to a fair trial. He also said he had no power to decide whether Mosby had broken the ethics rules that govern the conduct of Maryland lawyers, a matter that falls under the jurisdiction of the state’s grievance commission.

When Schatzow, Mosby’s deputy, tried to argue that the prosecutor’s conference had helped “calm” the city after the unrest, Williams interrupted him.

“It isn’t the job of the prosecutor to calm the city,” the judge said. “It’s the job of the prosecutor to prosecute. That’s a statement, not a question.”

The judge also said the defense’s suggestions that Mosby’s marriage to a councilman whose district was damaged during the riots disqualified her from trying the officers was “condescending.”

“Do you not think she can think for herself?” the judge asked the defense.

As for the question of whether Mosby and her team became witnesses by investigating the case, Williams said that Maryland state law and the U.S. Constitution support a prosecutor’s right and duty to inquire into criminal matters. He said that granting the defense’s motion would set a precedent that would essentially prevent elected prosecutors from performing the tasks for which they were elected, and advised the defense to resolve their grievances through cross-examining witnesses during the trial.

After he ruled on the motions, Williams also warned both sides that he would not tolerate the kind of uncivil behavior he said they displayed in some of their motions, reminding them that resorting to “name-calling” is not good lawyerly practice.

Later that afternoon, the two sides argued on whether the officers should be tried as a group or not. The prosecution, led in this hearing by Deputy State’s Attorney Janice Bledsoe, asked the judge to have four different trials: one for Officer Caesar Goodson, Officer Edward Nero, and Sergeant Alicia White, and three individual trials for Officer William Porter, Lieutenant Brian Rice, and Officer Garret Miller.

Bledsoe argued that Nero, White, and Goodson had all neglected the same duty of care to ensure Gray was not injured, but to different degrees, which she said explained why the state’s attorney charged them with reckless endangerment, manslaughter, and second-degree murder. She said the actions of Nero, who arrested Gray, White, who was the supervisor in charge and allegedly knew Gray needed medical attention, and Goodson, who drove the van where Gray suffered his injury, constituted parts of the same arch and should therefore be tried together.

The defense for all six officers pleaded the court to grant them individual trials, arguing that evidence against some of the officers would not be admissible against others, and that trying cases with such different degrees of culpability together could result in a “transfer of guilt” or a “spill over effect.”

“It’s really two separate cases,” said Marc Zayon, and attorney for Nero, arguing that the actions of the officers who arrested Gray and the ones of those who transported him were independent.

In the end, Judge Williams sided with the defense and denied the motion to join the trials, effectively granting each defendant his or her own trial.

“Because of the way the state has charged this case, evidence against officers Goodson and Nero would be prejudicial to Sgt. White,” Williams said.

Before the case can proceed, the court has to decide whether the trials of the officers should be held in Baltimore City or moved to another part of the state. The defense and the prosecution will debate the motion to change venue on Thursday of next week.

17 year old jockey, Juan Saez has died after sustaining catastrophic injuries during the running of a race at Indiana Grand Race Course.

Everyone who knew him has told me what a wonderful person he was. Every picture I have seen or taken of him, 9 times out of 10, he was smiling.

Juan Saez radiated life, excitement, and passion for his job.  He was a true horseman, and will be missed by all who have had the chance to know him.

Ride on, Juan.

buzzfeed.com
BREAKING: State's Attorney Marilyn Mosby Will Remain On Freddie Gray Case
Wednesday’s hearing in the Freddie Gray case debated whether the court should sanction Mosby for alleged prosecutorial misconduct and force her office to withdraw from the case. BuzzFeed News’s Nicolás Mora is reporting from Baltimore.
By Nicolás Medina Mora

BALTIMORE — A judge ruled on Wednesday that State’s Attorney Marilyn Mosby will not have to recuse herself from the trial in the death of Freddie Gray, a black man who was allegedly killed by police in April.

Gray, a 25-year-old resident of the impoverished west side of the city, died in April of a catastrophic injury he suffered while in police custody. His death sparked protests against police brutality, which in turn provided cover for rioters to take advantage of the disorder and loot several stores and set fire to more than a hundred cars.

The unrest came to an end on May 1, when State’s Attorney Marilyn Mosby announced her intention to charge the six officers involved in Gray’s fatal arrest with crimes ranging from misconduct in office to murder. All six officers pleaded not guilty.

Wednesday’s was the first hearing in the case, and consisted of a debate on two defense motions asking the court to either sanction Mosby for alleged prosecutorial misconduct or force her office to withdrew from the case.

The defense lawyers argued that Mosby’s statements made during the May 1 press conference announcing the charges, prejudiced potential jurors against the defendants — in an alleged violation of ethics rules. They also argued that several lawyers in Mosby’s office had become potential witnesses in the case by conducting a parallel investigation into the facts of Gray’s death — a situation that the defense claimed should disqualify them from conducting the prosecution.

An attorney for one of the accused officers, took particular issue with Mosby’s use of the phrase “No justice, no peace,” a chant used by both peaceful protestors and rioters during the unrest, saying that the clear implication of Mosby’s words were that “if [the people] want peace in Baltimore, they have to convict the officers.”

For their part, Mosby’s team argued that her statements during the press conference came from the public record and did not constitute an incitation to convict the officers. They also argued that there are legal precedents for prosecutors to participate in criminal investigations without having to withdraw from the case.

“Forests have been destroyed by the amount of paper the defendants have used to talk about these issues, but they are not trial issues,” said Chief Deputy State’s Attorney Michael Schatzow.

After an hour-long hearing in which he often asked though questions of both sides, Judge Barry Williams decided to side with [Mosby or the defense].

Before the case can proceed to trial, both sides will have to debate a defense motion to move the trial to another jurisdiction, on the grounds that the publicity in the case prevents the officers from receiving a frail trial in Baltimore. A hearing for that motion is scheduled for Thursday next week.

Protests were underway Wednesday morning outside the courthouse with as many as 50 to 70 people blocking traffic. One protestor was arrested for blocking traffic and not moving after a warning, police said.

+ firing-red-arrows

It had been a…quiet week. By which he meant there’d only been one life-or-death incident, and neither of them were sporting any major injuries. Which was almost as bizarre as it was pleasant simply because it just didn’t happen. At least not to them. But he wasn’t about to complain about it–in fact, Jason was kind of reveling in it. What could he say? It had been a while since he’d gone this long without some kind of catastrophe or major injury ( it was always something; how his entire rib cage hadn’t collapsed on him by now was a mystery of cosmic proportions ). 

So while he was sprawled on the couch with his nose in a book he’d read a thousand times over and could probably quote word for word, naturally Roy was in the kitchen, about five feet away, fiddling with explosive arrow heads. And she wondered why the kitchen was always in a state of disrepair. Really, Jason’s learned to live with her using everywhere except her workshop for this sort of thing, and it’s not anything close to a surprise anymore. 

And yet somehow, he still jumps when there’s a bang coming from the kitchen, causing him to peer over the back of the sofa, eyes narrowed. “–Are you dead and is the kitchen ruined?” He called out, sounding only vaguely concerned. She’d yet to do herself any real damage. The kitchen however? God, the poor kitchen.

“Haha I’ve done it so many times and nothing bad has ever happened”

One of my best friends sent me this the day of our school ball. At the after party, he took LSD, freaked out and fell from a third story balcony. He died from catastrophic head injuries 2 days later

The Miracle of Hope in Nursing

In the ICU, we see patients at their worst, unresponsive, in a great deal of pain, sedated, intubated, attached to copious amounts of IV’s, drains, and an assortment of other invasive tubes. We take over, when the floors transfer a patient who coded, we receive the patients from the OR who perhaps went in for a simple procedure - only to come out with a vast array of complications, necessitating critical care. We see patients who are found by their families, paramedics, loved ones, or bystanders, after massive heart attacks, strokes, or pulmonary embolisms - with no hope of a meaningful recovery; We see patients time and time again who we transferred out, only to return in septic shock, or at the point of no return. In the ER, we see trauma patients with catastrophic injuries, and we see frequent flyers who chip away at our hearts a little each time they come back. In L&D, our souls ache, as we witness the greatest loss; And In MedSurg, we witness some of the most terrifying events, as patients hang in limbo, awaiting either rapid response, or a transfer to ICU. We see patients who spend Christmas, or Hanukkah fighting for their lives, we see loved ones grieve losses, asking for just one more day; And we see coworkers, as well as ourselves fall apart with the complexity of it all.

Yet, sometimes, there is unexpectedly a glimmer of hope; Sometimes, there are miracles -  like a patient who is found unresponsive on the outside, and somehow managed to defy odds to become alert and responsive at Christmas time; We see patients who had no hope for a meaningful recovery gradually become stronger, and return to their loved ones. In Maternity, we share the blessings and miracle of new life, in Home Care, we see patients with seemingly no quality of life find meaning in things we take for granted, and in Pediatrics, we see mini heroes endure surgery after surgery, with unrelenting strength, joy, and faith. We hold the hands of the homeless, or DNR patient with no families, wishing them peace as they take their last breaths, leaving this world to a place that is pain free. In the dimmest hours of despair, these are the patients who remind us the tears, frustrations, exhausting efforts, copious interventions, (and oftentimes no interventions - just comfort care), are, perhaps, worth the grief we are experiencing daily. 

Mindful, that this is a sensitive time of year for many experiencing difficulties; and grateful, to be a small part of a profession that has the ability to make a difference, especially when patients need us the most.