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Category Archives: Trauma

Q and A: Can A Blow To the Head Cause Unconsciousness and Amnesia?

Q: How hard do you have to be hit on the head to be knocked unconscious? Is there a particular place on the head, that if struck would be more likely to cause unconsciousness? How long does it usually last? How hard do you need to be hit to cause partial or temporary amnesia? What sort of things do people forget in these situations? How long does it usually last? Are there any other physical symptoms a writer should be sure and include in a scene with head trauma?

amnesia

 

A: In medical terms a blow to the head, or anywhere else, is called blunt force trauma as opposed to sharp force trauma as would occur with a knife or some other cutting instrument. When the blow is to the head, it is called a blunt head injury.

The degree of force required to render someone unconscious is completely unpredictable and varies from situation to situation and from person to person. Though a minor tap on the head is not likely to cause unconsciousness in anyone, almost any blow of significant force can. It makes no difference where the blow strikes the head as far as causing unconsciousness is concerned. That is, a blow to the front of the head is no more likely or less likely to cause unconsciousness than would one to the side or back of the head.

The period of unconsciousness in a simple concussion, which is what loss of consciousness due to blunt force head injury is called, is measured in seconds or minutes. Unlike Hollywood where the bad guy is slugged in the jaw, knocked unconscious, and then written out of the script after that — or at least the hero no longer has to worry about him — is not what happens in real life. Think about every boxing match you’ve ever seen. One guy smacks the other one, knocking him unconscious, and 30 seconds later the guy is awake and complaining that it was a lucky punch. This is what really happens.

Unconsciousness from a simple concussion can last several minutes and maybe even up to 10 or 15 minutes, though that would be unusual. Typically the person wakes up with a minute or so but might be slightly groggy or confused for a while, again for several minutes. But if he is unconscious for longer than a few minutes, the odds are that a serious injury to the brain has occurred or that bleeding into and around the brain has happened, Both of these situation are true medical emergencies. It doesn’t sound like that’s the situation you are posing with your questions.

Amnesia can indeed follow blows to the head. Typically the blow has to be powerful enough to render the person unconscious or at least woozy before amnesia enters the picture. But I should point out that other than the time period the victim is actually unconscious there is no loss of memory in the overwhelming majority of people who suffer head injuries. Amnesia is not rare but it is not common. But amnesia can occur after head injury, so you can absolutely use this in your story.

Amnesia is an extremely odd and actually not well understood medical condition that comes in many flavors and types. For easy explanation, amnesia is often divided into retrograde and anterograde types. Anterograde amnesia is very rare and is a situation where the person cannot form new memories. This was the subject of the excellent movie Memento. I won’t dwell on this since this is not the type of amnesia your questions deal with.

 

Memento

 

Retrograde simply means whatever came before. This type of amnesia is the most common in that the person forgets things that happened before the injury. This amnesia can cover events that occurred for only a few minutes before the injury, a few hours, a few days, weeks, or months, or can go back to forever. The person can forget some things and not others, such as he might not remember his name but might remember his address and phone number. He might remember some people but not others. He might recognize people but not be able to recall their names.

Or he could have what is called global amnesia in which he remembers nothing, not his name, not where he is, not where he came from, and virtually everything else. This type of amnesia can be temporary or permanent. It may only last for a few minutes, hours, days, or months or in some people it can last forever and be a permanent loss of memories.

When memories begin to return, they can come back suddenly and completely, partially, or in fits and spurts. The person might remember some things within a few minutes but other things might be lost in the cloud of amnesia forever. Virtually anything can happen so this means that your story can be crafted in almost any way you wish.

The other symptoms that can be associated with a concussion of this type are headaches, dizziness, poor balance, nausea, blurred vision, and generalized weakness and fatigue. These symptoms usually are minor and only last a few hours but they can become more problematic and last for many days and in some people for many months. There is no real treatment other than time and perhaps medications for headaches if they become chronic.

 
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Posted by on April 5, 2016 in Medical Issues, Trauma

 

FORENSICS FOR DUMMIES Release Day

FFD 300X378

 

Forensics For Dummies Updated 2nd Edition is now available.

Get it through your local Indie Bookstore or here:

Amazon: http://www.amazon.com/Forensics-Dummies-Douglas-P-Lyle/dp/1119181658

B&N: http://www.barnesandnoble.com/w/forensics-for-dummies-douglas-p-lyle/1013991421

 

Q and A: What Happens If My character Is Shot in the Abdomen With a Crossbow?

Q: My question is if a female victim, age 17-18, had a penetrating wound to the far left side of the abdomen just below the ribs, extending 2-3 inches max into the body, what organs if any would be hit and would there be any internal bleeding (if so what major arteries/veins)? The weapon is a barbed crossbow bolt that prevents manual removal. And for the internal bleeding would cauterization be possible without lasting effects? Also, what would be the estimated recovery time for this injury (victim able to walk without assistance)?

Rachel from TN

Crossbow

A: There are many possibilities and in fact there are hundreds of possible outcomes here. In the left upper quadrant of the abdomen the most likely structures that would be impacted would be the spleen, the pancreas, and the bowel. It is possible that an object that only embedded two or 3 inches into the body would not strike any organs but would rather be more or less a flesh wound. In this case she would be fine and able to do anything with some pain in the area of course. The only real danger here would be an infection in the wound but this would take many days to develop and many more days to become a true medical problem.

On the other hand the bolt could penetrate into the abdomen and this would be much more painful and there could be some bleeding within the abdomen which would cause a more or less diffuse pain throughout the abdomen which would be worse with movement, running, coughing, and almost any other activity. This pain would be sharp rather than a dull ache. Once again her life would not be in danger unless a secondary infection followed and she should be able to do most things though again with considerable discomfort.

If the spleen were punctured, they would be a great deal of internal bleeding and it could even be enough to cause her to slip into shock and die. Or she could simply lose a great deal of blood can be very weak and short of breath with

any activity but survived. Here the bleeding could stop as the wound in the spleen clotted and she could recover without any major intervention. Again if no infection followed.

If she punctured a pancreas then the pancreatic digestive juices would be released in the abdomen and cause what we call peritonitis – the inflammation of the lining of the abdomen. This would be extremely painful with almost any movement are activity and this discomfort would be spread throughout the abdomen. Here a secondary infection is

very high. Would she be able to do most things? Probably but this would be even more painful than the injuries described above.

If the bolt penetrated a bowel then the leakage of bowel contents in the abdomen would cause an infected peritonitis. This would be extremely painful and deadly without fairly quick surgical intervention. The bowel contents are loaded with nasty bacteria and once they entered the abdominal cavity they would begin to grow and inflame the peritoneum,

causing a severe infectious peritonitis. Here the pain would be worse but she could still move around and do things if she were tough. Within a couple of days the infection would be severe and she would have high fevers, chills, severe abdominal pain, and would ultimately slip in the shock and die from what we call septicemia – an infection in the bloodstream.

Cautery is simply the burning of the tissues and really has no place here as it causes more damage than help. The reason is that with a bolt such as this weapon there would be very little external bleeding in the cautery he could only be used to control that. It could do nothing for the internal bleeding. To control any external bleeding simply applying pressure with a towel, the piece of clothing, wadded up paper, or anything she had handy would stop the external bleeding.

 
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Posted by on October 20, 2015 in Cause & Manner of Death, Q&A, Trauma

 

Why Did Two girls Want to Kill For Slender Man?

Slender Man copy

I previously posted about the Slender Man hoax and how it went viral on the internet and led to the attempted murder of a young girl by two of her friends. The post centered around a Psychology Today article titled “Murder By Meme: Slender Man and the Wakefield Anti-Vax Hoax” by Travis Langley, PhD. An interesting article.

Thankfully, Bella, the victim of the murder attempt, survived the attack but now the Slender Man case is moving along. Morgan Geyser and Anissa Weier, the two young girls charged with the crime, have apparently plead not guilty so a trial will likely be forthcoming. It will be an interesting ride as there are so many aspects to this story that just make you shake your head.

More details of the bizarre, yet sad, case are revealed in an article in New York Magazine by Lisa Miller. Chilling and then some.

 

Q and A: Can a Crochet Hook Be Used For Murder?

Q: I’m wanting the victim in my next mystery novel to be murdered with a crochet hook. The attacker and victim would be facing each other. The hook would be grabbed off a table and could be either hook end out the thumb side of the hand or out the pinky side of the hand (depending on what you would determine to be the easiest for delivering a fatal blow). It is an impulsive act. The victim is a 5ft. 11in., 157lb. female. Murderer is a 6ft. 1in., 298lb. male. He is a chef.

What would be the most likely spots for inflicting a fatal wound? Would the hook need to be removed (the victim bleeds out)? Can the hook be left in and the wound still fatal?

The hook is a size F 3.75mm crochet hook made of Brazilian bloodwood by the Furls Fiberarts company. I know the different woods they use have different strengths as some do not come in the smaller diameter sizes. (For example: the olivewood hooks start at 4.00mm while the blackwood starts at 3.25mm.)

Pearl R. Meaker, Lincoln, IL.

Crochet Hooks

A: Since this style of hook is made of wood rather than metal, the attack would have to be to a relatively “soft” area. Not likely this could penetrate the chest and reach the heart or get thru the skull without breaking or shattering. But grabbing the thick end and using the pointed (hooked) end as the weapon could prove deadly.

Two areas could work:

The eye–the skull behind the eye is thin and fairly easily penetrated. So a stab to either eye could reach the brain cavity and cause bleeding into and around the brain that could prove deadly. Here there would be some external bleeding from the eye wound but most would be internal within the skull. Here it makes little difference whether the

device is removed or left in place after the attack.

The carotid arteries—there are 2 carotid arteries–one on each side of the neck in the soft area on either side of the trachea–windpipe. This device could easily penetrate one of them. These arteries supply 90% of the blood to the brain. If punctured, the blood would spurt out in great pulses. Here it would be best if the device were yanked back

out after the stab so the blood would have a clear path.

In either case, the victim could die in a couple of minutes or, in the eye stabbing scenario, it could take some time—even 30 to 90 minutes or longer. Anything is possible.

 

Q and A: What Happens When a Person Is Exposed to the Vacuum of Space?

Astronaut

Q: What sort of damage does the human body suffer in the vacuum of space?  How long can one survive and what will happen to the person who does survive?  My scenario involves an astronaut whose faceplate blows out, but not before he depressurizes his suit sufficiently to prevent immediate death.

A: First of all the victim would not explode as was the case in the movies such as Total Recall. But some very bad things do happen internally and they happen very quickly. Whether he depressurizes somewhat beforehand or not, his survival once he reached zero pressure (vacuum) would likely be measured in seconds.

Space decompression sickness is similar to that of a scuba diver that rises too rapidly after a prolonged exposure to the pressures of the deep. In this case the diver is going from excess pressure to normal pressure. In space the victim goes from normal pressure to zero pressure. Same thing physiologically.

In diving, the problem is that the excess pressure causes excess nitrogen (N) to dissolve in the blood. This N will come back out of the blood as the pressure is reduced. This should happen slowly to prevent decompression sickness or the bends. But, if the diver rises rapidly, the pressure drops rapidly, and the N comes out of the blood quickly, forming N bubbles in the blood stream. This is similar to popping the top on a soft drink. Here the release of the pressure allows the carbon dioxide (CO2), which was placed into the liquid under pressure, to come out of the liquid and form bubbles. We call this carbonization. A good thing for your soft drink, but not so good for your brain and heart and muscles.

In space decompression basically the same thing happens. Apparently the culprit is water and not N in this situation, however. With the sudden release of pressure, the water in the blood “boils,” becoming a gas, and bubbles form in the system. I should point out that in chemical and physical terms boiling simply means the changing of a liquid to a gas. This can be accomplished by adding heat (boiling water on a stove) or by lowering the ambient pressure (popping open a soft drink). In the case of space decompression it isn’t that the blood gets hot, but rather that the pressure that keeps the water in its liquid state is removed and the water changes to its gaseous state, or boils. Doesn’t sound very pleasant does it?

Though studies on the effects of exposure to a vacuum have been done on chimpanzees, there are no real data on what happens to humans exposed to zero pressure except for a couple of incidents where an astronaut or a pilot was accidentally exposed. Of course, rapid decompression has caused deaths in both high-altitude flights and in June, 1971 when the Russian spacecraft Soyuz 11 suddenly lost pressure, killing the 3 cosmonauts on board, but survivors are few and far between.

On August 16, 1960, parachutist Joe Kittinger ascended to an altitude of 102,800 feet (19.5 miles) in an open gondola in order to set a world record for high-altitude parachute jumping. He lost pressurization in his right glove but proceeded with his ascent and jump. He experienced pain and loss of function in his hand at high altitude but all returned to normal once he descended via chute to lower altitudes.

In 1965 at NASA’s Manned Spacecraft Center near Houston, TX, a trainee suffered a sudden leak in his spacesuit while in a vacuum chamber. He lost consciousness in 14 seconds, but revived after a few seconds as the chamber was immediately re-pressurized. He suffered no ill effects—due to his very brief exposure—but stated that he could feel water boiling on his tongue. This was actually the above mentioned boiling scenario in which water (in this case saliva) becomes a gas on exposure to zero pressure.

A case of partial, prolonged exposure occurred during an EVA (space walk) in April 1991 on the US space shuttle mission STS-37. One astronaut suffered a 1/8 inch puncture in one glove between the thumb and forefinger. He was unaware of it until later when he noticed a painful red mark on his skin in the exposed area. It appeared that the area bled some but that his blood had clotted and sealed the injury.

So, what happens to a human exposed to zero pressure? Since there is no oxygen in such an environment, loss of consciousness occurs in a matter of seconds. Also, if the victim held his breath (don’t do this during scuba diving when coming up from depths either), the air in his lungs would rapidly expand and his lungs could be damaged, bleed, or rupture. Better to open his mouth and exhale the rapidly expanding gas from his lungs.

Water in his blood stream would immediately begin to “boil,” filling the blood stream with water vapor (the gas form of water) and stopping his heart. Bubbles might appear in the blood stream and cause damage to the body’s organs, particularly the brain. As a result, the brain and nerves cease to function. As more and more gas formed within the body, the entire body would swell but it would not explode.

Exposure to heat or cold or radiation might also occur but it will do little harm since the victim would already be dead.

But what if the exposure were brief and the person rescued? Treatment would be to immediately return him to a pressurized environment and give him 100% oxygen. He may survive unharmed or may have brain and nerve damage which could be permanent.

For your scenario, whether he partially decompressed or not, he would be in trouble very quickly. When your victim’s faceplate ruptured he would hopefully begin to exhale air to prevent the expanding gases in his lungs from rupturing them. As air, and thus oxygen, flowed from his lungs and into space, the oxygen content of his blood would rapidly drop and he would lose consciousness in 10 to 20 seconds. He would then die in short order. If he were quickly rescued, he would be returned to the spacecraft, which would be pressurized, and would be given 100% oxygen via a face mask. He could survive intact or with brain damage. It’s your call. Either way works.

 

Would Lincoln Have Survived With Modern Medical Treatment?

Lincoln 1863

Lincoln’s assassination took place 150 years ago this evening. He died the next day, April 15, 1865. Since he lived overnight, could modern medicine techniques have saved him? Here is a question that appeared in my second Q&A book—FORENSICS AND FICTION

Would Abraham Lincoln Have Survived His Injuries Today?

Q: This is a pure curiosity question. Do you think that Lincoln could have been saved if they had today’s medical knowledge, techniques and equipment in 1864?

Martha Kuhn, Mt. Gilead, Ohio

A: Most likely, yes. He was shot in the back of his head, and the bullet apparently entered his brain. He lived for many hours so the shot was not immediately fatal. A surgeon probed the wound but feared removing the bullet, since it might cause bleeding. He probably should have, but we’ll never know.

Similar wounds today are treated by a trip to the OR, removal of the bullet, controlling bleeding, and preventing any subsequent infection. He would have had at least a 50 percent chance of survival. And since he survived several hours anyway his survival with modern techniques would likely have been much higher.

F&FCover400X580

 
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Posted by on April 14, 2015 in Medical History, Medical Issues, Trauma

 
 
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