Head Injury

kwilby said:

I'd like to inflict a head injury on one of my poor, defenseless characters and need to know what it would look like and how it would be dealt with.

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Head injuries can take many different appearances. Some can't be seen without close examination. I recieved a head injury in an attempt on my life a few years ago. The skin on the back of my head had been ripped open but not by much. My cousin had a boy push her down recently which caused her to fall on her face. her forehead was cut open all the way across.

Ideally the victim should be conscious enough to respond verbally, not necessarily coherently, immediately after the injury but lapse into full unconsciousness shortly thereafter. Due to the verbal response, the victim isn't immediately brought to medical care which will complicate recovery.

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This sounds like a concussion. While verbally checking you the doctor should be checking for other signs after a head injury. Although a significantly overloaded doctor might miss the symptoms.

Given that the perpetrator intends to cause memory loss (at the least), how would they go about hitting the victim?

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They would want to hit in the hippocampus (the part of the brain the handles memory), which is in the very center of the brain. Any injury that was able to hit that and doesn't cause a fatality will definately get some attention. Other than that memory loss is a very touch and go thing. Its not very common. I know that in my case I can remember every detail of the boy that attacked me.

What would be the most likely effect of the situation described above, and what would be externally visible? Hematoma? Skull fracture? Bleeding from the ear? Mis-sized pupils?

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the pupils would be the easiest symptom that could be observed. Depending on where the injury is buising would be noticable after a short period. Skull fracture would require x-rays, since any one of them that was larger would have likely killed. Bleeding from the ears would be a sign of serious injury and they wouldn't care how well he could talk.

If the victim were taken immediately to the emergency room, what would the ER see and what would they do?

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They would run an x-ray and CAT scan battery if he was stable, but only if they determined that he had a serious injury. Otherwise they would just keep him awake until his concusion went away.

How quickly (without treatment) would things go from bad to worse?

Thanks for your help!

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Very very quickly. A matter of hours. If he is bleeding in the brain the pressure could kill him. If he had brain swelling that pressure could also kill him. A concusion can cause all sorts of damage if you fall asleep during a bad one.

Day after symptoms of a concusion involve severe headache, vertigo, nausia and loss of dexterity.

I hope I was helpful.

edit: Oh and, welcome to the AW cooler.

My husband worked in the ER at one time. His job was to sit with patients who weren't safe to be left alone. One of the categories of people he had to sit with were head trauma cases. At that particular hospital if you came in with a head trauma it was an automatic overnight stay, so they could monitor for swelling and bleeding on the brain.

At the time he was working there he did a backflip into a pool and cracked his head open. He ended up getting sat by one of his co-workers, so that was kind of nice for him. He had to get his head stapled shut, he says they didn't numb it or anything. The doctor just stapled it really fast and he yelled at them. They made him stay for a couple of days, but he hasn't had any long term problems from it.

ETA:

Given that the perpetrator intends to cause memory loss (at the least), how would they go about hitting the victim?

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If the perp isn't very educated, they could just start hitting him about the head thinking that he'll wake up not remembering things. Then again, if they're a brain surgeon they will know that won't work without likely killing him. It really depends on the character.

My concussion

At the risk of inciting a legion of toppers, here's my acquaintance with concussions.

In 1981, I went to jump school. Hairy-hairshirt, size 40 chest, size 2 hat, all of that. After jump 5, I was relieved I'd never have to jump again.

Then I was assigned to a jump unit 2 1/2 years after my last jump. I remember standing at the door, wondering how I got into this again. I had taken refresher training, but it seemed odd that the ground was moving past my feet so fast. Then I hit the ground, put the bag containing my rolled up chute on my back, and walked off the drop zone, wondering how my ear had gotten so full of sand.

The place was a madhouse, jeeps driving all over, people running around. None of it mattered to me. Then a jeep pulled up and tossed my helmet at me. Funny, I had never noticed it was gone. Other things came to my attention. The side of my face was leaking blood. I was walking beside the 90 foot scrape my body made as it was dragged behind the still-inflated chute. The rivet in the helmet had dug a trench down the front of my nose. And my ear was still full of sand.

Turns out, the winds had picked up after we were dropped. We were slammed into the ground at higher than normal force. I had hit the ground and gotten knocked out, then dragged. I performed 12 distinct, complex moves to get out of the harness, find the kit bag, roll up the chute, stuff it in the bag, and put it on my back - and remembered none of them.

When I reported to the infirmary, my pupils were fine, I had a headache, and I felt a little nauseous. They sent me home to rest (bad move), and I eventually made a full recovery. And all of the sand didn't come out of the ear for a week.

If the idea of the attack is to generate memory loss, I would use the head injury to render the victim unconcious, then inject them with something to cause the memory loss.

I've only had trauma-induced memory loss once in my lifetime...

I was leaning forward on a horse that reared. The neck hit me in the face, breaking my upper jaw, knocking out three of teeth, splitting my face open and shattering my nose. I was knocked completely out, and woke up on the ground, looking up at my horse.

I was in shock, then, and mechanically went about putting my horse away, including all my usual rituals except for taking the time to brush her. I knew what happened, but I felt strange, cold, and detached. Then I walked home, dripping blood, but not as much as you'd think...apparently, shock keeps you from bleeding as bad.

A sort of extremely short-term amnesia set in...I would say something, then, sometimes even before being answered, I'd forget that I'd said it and say it again. A neighbor gave Mom and me a ride to the hospital. His five-year-old granddaughter was sitting beside me, staring at my busted face with a mixture of repulsion and terrror. I would say some version of "It's Ok, it doesn't hurt at all," (it didn't, yet) then turn to my mom and ask, "What happened to me?" Before Mom could answer, and sometimes while she was answering, the cycle would repeat.

I was in a hospital bed before I started to remember what happened. The memory of walking home came first, along with a sort of vague understanding that I'd had an accident on my horse. The other details came back peicemeal. It took a long time to remember the entire incident, and parts of the details at the barn are still sketchy. Remembering the actual impact took months, and it's sort of cinematic...the horse's neck comes up really quick, then there's blackness with a flash of red. I don't know if my mind just inserted that last part or what.

I would guess, from my experience, that a good recipe for memory loss would be a bone-shattering blow to the face, followed by unconsciousness and heavy bleeding halted by shock. It might help if the blow/attacker/event was emotionally traumatic, as well as physically.

I know that it's supposed to be really hard to induce memory loss without actually killing someone, but my teenage son has also reported memory loss from a blow--during a football game, he recieved a concussion but continued to play. He claims that he doesn't remember part of the game, even though he apparently continued to run plays. He says that he's not the only member of his team that this has happened to. I am SO GLAD that he's out of football now!

Hope this helps.

I've been readind this thread for a few days now and haven't had time to respond until now-
what you are describing- the victim being at first conscience followed by unconsciousness is caused by somethng called an epidural bleed- this is a slow bleed intot the epidural space of the brain- well not the brain but the layers surrounding the brain. when someone has a head injury that causes a slow bleed in the epidural space- this is life threatening and you will die without immidiate surgical intervention.

Mis-sized or unequal pupils are caused by pressure caused by swelling in one side of the brain- a hit to the head can cause this as can bleeding in the brain from something like a hemmoragic stroke can casue this as well,

As for memory loss- most head injuries will cause memory loss of the incident or the events immidiatly following or before the injury- but as for global amnesia- that is extremely rare- not saying it can't happen just letting you know it is rare and there is no set place to injure the head to bring this about.

Er- depends on the severity of the injury- if the patient is unconscious on arrival they will be intabated- have a breathing tube placed, a catscan will be done to determine the extent and the location of the injury, sometimes an intercranial bolt will be placed to monitor intercranial pressure and again depending on severity of injurythe patient might be placed in a barbituit coma and have a craniotomy (removal of half the skull) done to allow the brain room to swell without further causing injury to it (this will be done once the pt is in an ICU setting and out of the ER- Probably TMI- but there ya go-