Question about a severe concussion

Danalynn

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My 14 yr. old MC in my YA novel got a severe concussion from jumping out of a moving vehicle and hitting her head on the road. She then got beaten up by her father who gave her a broken arm and two broken ribs. He also choked her and was trying to kill her when someone pulled him off her.

She blacked out as soon as the ambulance showed up (there were various factors that kept her awake until they got there).

So my question is, is it possible to be unconscious for four days after that due to the severe concussion? (When she does wake up, she doesn't remember much of what happened.) Or is there a more realistic time frame that she would be unconscious for?

And is it possible for doctors to do surgery on her broken arm (they had to set the fracture with two metal plates screwed into the bone) if she is still unconscious?



ETA: I was also wondering if anyone knows how long your throat would stay sore after someone choked you. As in, when she wakes up four days later, would her throat still be sore and a little swollen?

And one other thing: If she wakes up and she doesn't remember much of what happened, would she remember what her dad told her after she hit her head but before he beat her? He reveals some important information in that time. . . . ;)


Anyone have any ideas or even just guesses? lol Any advice or input will be very much appreciated!
 
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GeorgeK

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With most concussions, the person is not truly unconscious as in obtunded. Usually they are in various states of confusion/combativeness with varying degrees of impared short term memory function, sort of like an alcoholic blackout; they might interact with people who might realize that their behavior is off, but the patient ends up having no memory of the events. The decision a surgeon makes in every instance is, "Is it in the patient's best interest to wait or to go ahead?" I'm not an orthopedist, but in simple terms the questions would be:

Is the closed head injury going to make it too difficult to assess safety of an anaesthetic? (They'd ask anaesthesia to assess the patient first. That kind of thing is not going to only be the surgeon's purview)

Is waiting going to risk a combative person worsening long term damage from bone shards cutting into other stuff?

As long as you don't go into detail of what the injuries are other than requiring surgery, you go take any of those paths. You could justify early repair or splinting and delayed repair.
 

JulieHowe

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My 14 yr. old MC in my YA novel got a severe concussion from jumping out of a moving vehicle and hitting her head on the road. She then got beaten up by her father who gave her a broken arm and two broken ribs. He also choked her and was trying to kill her when someone pulled him off her.

She blacked out as soon as the ambulance showed up (there were various factors that kept her awake until they got there).

So my question is, is it possible to be unconscious for four days after that due to the severe concussion? (When she does wake up, she doesn't remember much of what happened.) Or is there a more realistic time frame that she would be unconscious for?


If it's a concussion, she shouldn't be knocked out for four days. A head injury is more realistic for the kind of accident you're describing.
 

jclarkdawe

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My 14 yr. old MC in my YA novel got a severe concussion from jumping out of a moving vehicle and hitting her head on the road. She'd have other injuries as well. She would have done some sort of rolling, before either running out of energy or hitting something solid (which would have to be at a slow speed to avoid serious injury from that contact). Any exposed skin would probably have road rash from abrading against the road. Her head would probably have lacerations and the potential for hair being pulled out is high. If she jumped (realize that jumping from a van and a car produce different results), she would also probably have some sort of leg injury. There is also the potential for dragging injuries.

She then got beaten up by her father who gave her a broken arm and two broken ribs. He also choked her and was trying to kill her when someone pulled him off her.
Choking injuries can be very visual and result in police involvement very quickly.

She blacked out as soon as the ambulance showed up (there were various factors that kept her awake until they got there). As George said, she probably would not become unconscious. She'd more likely to be in a stupor, with minimal responsiveness to the world. She might be combative or maybe not.

So my question is, is it possible to be unconscious for four days after that due to the severe concussion? (When she does wake up, she doesn't remember much of what happened.) Or is there a more realistic time frame that she would be unconscious for? She could be withdrawn and uncommunicative for an extended period. But without the immediate unconsciousness from the injury, I doubt that she'd ever really become unconscious afterward.

And is it possible for doctors to do surgery on her broken arm (they had to set the fracture with two metal plates screwed into the bone) if she is still unconscious?



ETA: I was also wondering if anyone knows how long your throat would stay sore after someone choked you. As in, when she wakes up four days later, would her throat still be sore and a little swollen? It can stay sore for many days.

And one other thing: If she wakes up and she doesn't remember much of what happened, would she remember what her dad told her after she hit her head but before he beat her? He reveals some important information in that time. . . . ;) You can play this however you want, but my guess is she's probably not going to remember even getting into the car. She could have selective memories.


Anyone have any ideas or even just guesses? lol Any advice or input will be very much appreciated!

Best of luck,

Jim Clark-Dawe
 

chevbrock

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Hi DL - can't wait to read this one when it's finished! (hint, hint!)

I think for your MC to only have a concussion after jumping out of the car, the car would have to be moving pretty slowly. Even a slow speed of 20 or so MPH is still pretty fast to hit the ground. Someone above suggested there would be some rolling, and I would suggest that you have your MC roll across the road and then hit her head on a kerb opposite (??)

Is there some way you can have the MC come in and out of consciousness, rather than have a concussion. That may get around your problems in having to have her remember some stuff.

If you need her to be unconscious for a few days, could you perhaps have a small crack in her skull somewhere that may cause some bleeding or swelling, therefore having the docs induce a coma to settle it?

These are just some thoughts, and I don't know how feasible they are in reality.
 

Barb D

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I just wanna know why you have the grinning icon on a thread about a girl getting beat up and hospitalized with a concussion. That's all. Back to your thread. :D
 

Nick Blaze

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ETA: I was also wondering if anyone knows how long your throat would stay sore after someone choked you. As in, when she wakes up four days later, would her throat still be sore and a little swollen?

As a martial artist, I know this to be rather unlikely. Often we are choked to the point of our eyes blacking out, though never fully unconscious or anything dangerous, to create realism. Red and purple marks will adorn your neck, but the pain will be gone by tomorrow. However, we are trained and we have also been choked/strangled a hell of a lot. The average person could likely be sore for days, but it would not be great.
 

Izz

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As someone who's suffered from severe concussions (more than one, less than ten), i can tell ya you won't be knocked out for four days. However, as has been stated upthread, you'll likely remember little of the actual incident. It's also possible you'll suffer from memory blackout in the days or weeks following (depending on the severity of the concussion). Not entire memory blackout, but there may be times when you suddenly realize you've got no idea what you've been doing for the last half hour. You'll also have headaches, find it very difficult to concentrate, and struggle to do simple tests of logic. You may also (but not always) have no desire to communicate. Occasionally you might suffer from vision problems (fuzzy, double vision, etc). Immediately following the concussion it's quite likely you'll behave as if drunk (wobbly, unable to walk the direction you want, you may vomit or retch).

My worst concussion (and--so far--the last one on my list) took almost a month to right itself. During that time, whenever i tried to concentrate on something my head started hurting. While i remembered the incident in detail (rugby, my head, someone else's knee) and did not lose consciousness, the next day people could tell something wasn't right with me. My conversation was slow and awkward, and i looked pale and unwell. And over the course of the next four weeks i suffered from occasional lapses in memory. I felt the need to be around people, but had no desire to communicate with them.

Unfortunately, due to my previous concussion history, i'm likely at the stage where another concussion could risk permanent brain damage. So, sadly, i'm not playing any forms of rugby anymore.

Wiki: Concussion--particularly interesting is the concussion grading table midway down the article.

In your scenario, i think a concussion head injury is the least of the MC's concerns. It's likely she'll also suffer from whiplash, and there's a very real danger of cracking her skull, and of clotting or swelling of the brain causing a real possibility of permanent brain damage.

As Jim suggested, she'll probably have a host of other injuries, the most visual of which would be abrasions and bruising to skin. Depending on how she lands there's a high possibility she'd break a wrist or ankle. It's also more than likely her clothing (unless it's leather, and possibly not if it's denim) will be ripped and torn. The car would have to be travelling very slowly, or she be trained in the art of tumbling from vehicles, for this not to result in serious injury all by itself.

Re the sore/swollen throat question: that's variable on a lot of factors. I've been struck on the throat and had soreness swallowing for several days, but no bruising and little swelling. But that was a result of an elbow, not a choking. I would suspect (and i'm not a trained medical professional) the bruising will probably still be there to some extent after four days, particularly if your MC is someone who bruises easily. There's also the possibility of a scratch from a fingernail or ring or suchlike getting infected, in which case swelling may be quite severe and require antibiotics.
 

ideagirl

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With most concussions, the person is not truly unconscious as in obtunded. Usually they are in various states of confusion/combativeness with varying degrees of impared short term memory function, sort of like an alcoholic blackout; they might interact with people who might realize that their behavior is off, but the patient ends up having no memory of the events.

That's certainly one possibility, but it's quite common for people with concussions to have spent some time unconscious. My husband's cousin was in a motorcycle accident, which he survived only because he was wearing a helmet; he had a severe concussion requiring months and months of therapy to recover from, and for much of the time during those months he was as you describe--combative, not himself--and he doesn't remember that time now. But he was flat-out unconscious after the accident for at least 20 minutes, according to the EMT's.

If you google "concussion unconscious" (no quotes) you'll see that it's quite common for concussions to include unconsciousness. Sometimes it's just a momentary blackout; it can easily be 6 hours. For it to be longer, though, as the OP wanted... I think there's a point where if you're unconscious for more than X hours, you're officially comatose.

But it's quite possible that a seriously injured person might be purposely sedated into unconsciousness to aid their physical recovery--a medically induced coma, basically, to give the body time to heal when the person would be delirious and in severe pain if you left them awake. So that might be what happens to the OP's character.
 

Tsu Dho Nimh

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So my question is, is it possible to be unconscious for four days after that due to the severe concussion? (When she does wake up, she doesn't remember much of what happened.) Or is there a more realistic time frame that she would be unconscious for? It's common enough (for severe head injuries, that the patient is sedated and breathing controlled to minimize brain swelling) that could do the 4 days.

And is it possible for doctors to do surgery on her broken arm (they had to set the fracture with two metal plates screwed into the bone) if she is still unconscious? Yes, although they might just splint it ans wait until the swelling goes down.

ETA: I was also wondering if anyone knows how long your throat would stay sore after someone choked you. As in, when she wakes up four days later, would her throat still be sore and a little swollen? Been there, had that happen. The bruising/swelling goes deep and it's hard to swallow or talk for at least a week. (psych patient got me)
And one other thing: If she wakes up and she doesn't remember much of what happened, would she remember what her dad told her after she hit her head but before he beat her? He reveals some important information in that time. . . .
She could. Or she could remember bits and pieces and every day a bit more. Or she could come out of the drug-induced brain-protective unconsciousness and shriek, "OMG!!! Daddy told me he's an alien!"
 

jclarkdawe

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That's certainly one possibility, but it's quite common for people with concussions to have spent some time unconscious. My husband's cousin was in a motorcycle accident, which he survived only because he was wearing a helmet; he had a severe concussion requiring months and months of therapy to recover from, and for much of the time during those months he was as you describe--combative, not himself--and he doesn't remember that time now. But he was flat-out unconscious after the accident for at least 20 minutes, according to the EMT's.

But in this case, the original poster described the patient as being conscious until the EMTs arrived. If the patient had been knocked out by the original accident, you have one scenario. The patient would potentially be unresponsive to even pain stimuli. (There are various tests that easily determine this.)

In my experience as an EMT, a patient who is conscious until feeling safe does not produce the deep levels of unconsciousness that includes inability to respond to pain. It's more like a stupor. This is even with a head injury. They respond minimally to verbal stimuli (yelling), muscular resistance can be felt, and it's just different.

Best of luck,

Jim Clark-Dawe
 

Nivarion

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As a martial artist, I know this to be rather unlikely. Often we are choked to the point of our eyes blacking out, though never fully unconscious or anything dangerous, to create realism. Red and purple marks will adorn your neck, but the pain will be gone by tomorrow. However, we are trained and we have also been choked/strangled a hell of a lot. The average person could likely be sore for days, but it would not be great.

Choking in a ring is one thing, choking to kill is another. The sleep holds and such used for fighting are more designed to cut off the blood supply and make the person pass out. In fighting chokes the point is to break the hoyble and collapse the trachea. Since that puts a lot of stain on a bone and the cartalige area you can have pain for a significant amount of time.

I've never been seriously choked but I've had a good concussion.

I remember the fight very well, but filling out the police report and the hospital visit afterwards are all a blur. I remember they took a lot of pictures. All I remember of the next week or so is incredible pain. I hurt to much to move. He had attacked me with the intent to kill me, and had tried his best. By rights the skateboard should have done it.
 

Danalynn

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Thank you all for the replies! This helps tremendously.

I came to the realization that it's not important to the story if the concussion is severe, nor that she be knocked out for four days. I had just written that the other night, and then I was like, "Wait a minute, is that even possible to be unconscious that long with these injuries?" But I've realized that how long she is out isn't really relevant to the story.

So anyway, she is in severe pain from the broken arm and the broken ribs, not to mention the beating her dad gave her, and all she wants to do is go to sleep. So she does pass out once the ambulance and police show up (and the only reason she doesn't pass out before that is because she's litterally running and then fighting for her life -- which is how she got the broken arm and ribs, and then choked to within an inch of her life....), but I've got a lot of play there as to how long she is out for after she passes out.

The only thing that matters to the story is that she have enough injuries that she's kept in the hospital for a week (time for another character to get something accomplished before she gets released). But I've done some research, and just the surgery on the broken arm alone will keep her in there that long.


I think for your MC to only have a concussion after jumping out of the car, the car would have to be moving pretty slowly. Even a slow speed of 20 or so MPH is still pretty fast to hit the ground.

Yeah, I agree. The driver of the car slammed on the brakes and the car swerved and was almost to a stop when she jumped out, so I'd say the car wasn't going more than 5 or maybe 10 MPH. She hit her head when she landed, and did roll before she came to a stop. But she thought he was coming after her so she forced herself up and ran.

Choking injuries can be very visual and result in police involvement very quickly.

Jim, good points there! Thanks. And yes, the police arrive when the ambulance does, and Dad is arrested for attempted murder right away. ;)


Barb, LOL! Good eye. You're right, I didn't realize I did. ;) I usually put that smiley face icon on my posts, so it was a habit, I didn't even think about it when I did it. LOL!


Izz, thank you for all the great info! And OMG! That's a lot of concussions. Eeek.... Glad to hear you aren't planning on getting any more of them. :)


And thank you everyone for the input! This helps a ton.

:e2flowers
 
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Canotila

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My cousin jumped out of a sedan moving at 45 MPH. His only injury was a road rash that went from his shoulder to his hip. He was drunk at the time, so that may be a factor in him not breaking anything. He actually walked away from it and caused a frenzied search by police who were expecting to find someone with horrific injuries.

Now, as for blacking out I would think she would have blacked out during the choking from lack of air, or at the moment of impact when the head injury occurred. When I fell 30 feet out of a tree, I got a concussion. One second I was in the tree, and the next I was flat on my back unconscious. There was black, and it was like in a movie where the blackness peels away and there are blurry faces leaning over you. My brother said I was unconscious for about 20 minutes. Then they helped me hobble to my cousins house and we played his Sega Genesis for a while. I don't remember a lot of other details. I felt numb and stiff. It did cause a lot of short term memory problems. More than I was aware of initially. It didn't sink in how bad it was until people would refer to conversations we had days, hours, or minutes before and I had zero memory of them. The memory problems are still happening 16 years later but not as bad as at first.

Another time my ex pushed me down a flight of stairs. One second I was at the top, then everything went black. I don't even remember falling. Just waking up with a split open nose. Maybe there are other types of concussions that manifest in delayed unconsciousness, but I've never experienced one.
 

Izz

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When I fell 30 feet out of a tree, I got a concussion.
30 feet? Wow. You're lucky to be alive. That's also one helluva tree. In building terms that's about four stories up.
 

Canotila

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30 feet? Wow. You're lucky to be alive. That's also one helluva tree. In building terms that's about four stories up.

It was totally lucky. We have big cedars in this part of the country. Fortunately I landed on my side/back, and not straight up and down. I broke my right hip and had a spinous process fracture mid back (broke the little finny part of the vertebrae that sticks up like a shark fin) The stupid part is that the doctors didn't even x-ray me, said since I walked in I was fine. 4 years later was still limping so they did a barium bone scan. All I can say is thank goodness for chiropractors.
 

Nick Blaze

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Choking in a ring is one thing, choking to kill is another. The sleep holds and such used for fighting are more designed to cut off the blood supply and make the person pass out. In fighting chokes the point is to break the hoyble and collapse the trachea. Since that puts a lot of stain on a bone and the cartalige area you can have pain for a significant amount of time.

I've never been seriously choked but I've had a good concussion.

I remember the fight very well, but filling out the police report and the hospital visit afterwards are all a blur. I remember they took a lot of pictures. All I remember of the next week or so is incredible pain. I hurt to much to move. He had attacked me with the intent to kill me, and had tried his best. By rights the skateboard should have done it.
It's been a while since I checked this threat, but I'd like to point out that I'm not in the martial arts for sport. The martial arts were invented for the sole purpose of keeping you alive in battle, which meant killing as efficiently as possible. After ten years or training or so, your intent is to be able to kill and resist attacks with the intent to kill, not just to cut off the blood supply. In fact, the "sleep hold" isn't used often, if at all, in a normal session.
 

maggi90w1

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He was drunk at the time, so that may be a factor in him not breaking anything.
Hm? Why should alcohol protect his bones from getting broken?