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Zashi
09-11-2012, 06:57 PM
Hi, so my teenage MC has depression and hasn't been sleeping well or eating properly over a period of a few weeks, gradually getting worse. He was skinny to start with so the weight loss is pretty severe considering he was already underweight. Eventually this and the lack of sleep get to him and he just collapses, in public. (I'm guessing this is a plausible thing to happen, although if someone could explain to me exactly why/how it does, I'd appreciate it.)

Anyway so someone he knows calls an ambulance because, uh, generally people don't just collapse and he also looks pretty bad anyway. How many people (EMTs?) would be in the ambulance, and what would they do when they got to him? I assume he'd have to go to hospital, what would be the general course of events for him? Would they put him in hospital garments before everything, during, after or not at all? What's the policy on letting friends in during this kind of stuff (one of them was the one that called the ambulance)? I assume due to the malnutrition an IV drip would be involved at some point, when would they put it in? Would there be doctors involved? Would said doctors (or whoever's dealing with all this) be able to tell his friends what happened (i.e. malnutrition and exhaustion) or is that breaking the patient's confidentiality? What would they do if they found signs of self-harm on his body?

Also would this be considered fairly serious, him collapsing and all that?

More context: this doesn't take place in the US, or anywhere really although I suppose it's rather Western. I'm not worried about insurance things. The hospital is pretty close by, and the whole place is kind of a utopic university town slash boarding school. He doesn't have a parent or next-of-kin handy.

If you haven't gotten completely sick of my medical questions, here's some more for another scene ;)

This is actually before the aforementioned scene. If my MC were to be picked up by a large robot hand which slowly starts crushing him, but is rescued before anything too terrible happens, what kind of damage would you expect? I was thinking bruised ribs at the very least. He's not very well built, about 5'0" (yes I know extremely short) and ectomorphic.

Whatever injuries he gets, how would an EMT treat him? How would an EMT even figure out that he has bruised ribs or whatever? I'm aware that people with bruised/fractured/broken ribs tend to breathe shallower, is that enough of a sign? Or do they need to examine him? Do you think he'd start going into shock? (I tried reading up about shock but I couldn't figure out if it was only when you had massive trauma or what.) Also as soon as he's on the ground/out of the hand's clutches he sits in the fetal position and for some reason doesn't want to move or speak. Non-medical shock? I don't know. How would an EMT deal with him being uncooperative?

If someone actually answers all of my ridiculous questions, then they are simply amazing.

ULTRAGOTHA
09-11-2012, 08:04 PM
How is parental consent for the treatment of minors handled in your universe? Assuming your MC is a minor. In the United States care beyond lifesaving can be problematical if there's no parent or guardian available.

Is he a pupil at the school? In the United States bording schools usually have the authority to authorize treatment.

As for privacy, that would depend on the rules in your universe. HIPAA in the US is fairly strict--to the point that spouses cannot get medical information on each other unless they've signed a release form. Friends of the patient? No way.

As for helping him dress, etc, that really depends on you. Friends don't generally do that in US hospitals now, but it used to be that family and friends not only could provide basic care, but also brought in food. So what is your society like?

If he is going to the bording school, what did the teachers notice and what did they do about it when he started losing so much weight?

The basic medical treatment is probably the same from fairly developed world to fairly developed world. But the social issues surrounding the rest of your questions seem largely up to you. What's the norm in your society?

ETA: Welcome to the board!

jclarkdawe
09-11-2012, 09:40 PM
As Ultragotha points out, there's a lot of societal issues here, which I'm going to ignore. Big one though is the presumption that people who collapse are either drunks or druggies.


Hi, so my teenage MC has depression and hasn't been sleeping well or eating properly over a period of a few weeks, gradually getting worse. He was skinny to start with so the weight loss is pretty severe considering he was already underweight. Eventually this and the lack of sleep get to him and he just collapses, in public. (I'm guessing this is a plausible thing to happen, although if someone could explain to me exactly why/how it does, I'd appreciate it.) Probably low blood sugar, combined with dehydration.

Anyway so someone he knows calls an ambulance because, uh, generally people don't just collapse and he also looks pretty bad anyway. How many people (EMTs?) would be in the ambulance, and what would they do when they got to him? Normally two, but protocols vary from department to department. I assume he'd have to go to hospital, what would be the general course of events for him? Not necessarily. Candy bar and some water could perform miracles here. Would they put him in hospital garments before everything, during, after or not at all? Probably not. What's the policy on letting friends in during this kind of stuff (one of them was the one that called the ambulance)? Very limited. I assume due to the malnutrition an IV drip would be involved at some point, when would they put it in? If he's dehydrated enough to need an IV, you'd put it in at the scene. Would there be doctors involved? Probably not. In a hospital, IVs are put in by technicians who specialize in IVs. Would said doctors (or whoever's dealing with all this) be able to tell his friends what happened (i.e. malnutrition and exhaustion) or is that breaking the patient's confidentiality? Breaks patient confidentiality. What would they do if they found signs of self-harm on his body? Mental health consultation to determine whether he is a danger to himself or others.

Also would this be considered fairly serious, him collapsing and all that? Probably not, but it depends upon how screwed up are his vitals, including his blood work.

More context: this doesn't take place in the US, or anywhere really although I suppose it's rather Western. I'm not worried about insurance things. The hospital is pretty close by, and the whole place is kind of a utopic university town slash boarding school. He doesn't have a parent or next-of-kin handy. See Ultragotha's answer. He'll probably be held at the hospital until they sign him out.

If you haven't gotten completely sick of my medical questions, here's some more for another scene ;)

This is actually before the aforementioned scene. If my MC were to be picked up by a large robot hand which slowly starts crushing him, but is rescued before anything too terrible happens, what kind of damage would you expect? Bruising. Black and blue marks. I was thinking bruised ribs at the very least. He's not very well built, about 5'0" (yes I know extremely short) and ectomorphic.

Whatever injuries he gets, how would an EMT treat him? Not much you can do for bruising. Ice packs maybe to control swelling, aspirin, and see you later. How would an EMT even figure out that he has bruised ribs or whatever? They hurt when they're touched and how the person is breathing. I'm aware that people with bruised/fractured/broken ribs tend to breathe shallower, is that enough of a sign? It's one of the signs. Localized area will show black and blue areas. Or do they need to examine him? You want to rule out something more serious. Do you think he'd start going into shock? He could. Depends upon how seriously he's hurt. After all, if you squeeze the torso enough, the person dies. (I tried reading up about shock but I couldn't figure out if it was only when you had massive trauma or what.) Also as soon as he's on the ground/out of the hand's clutches he sits in the fetal position and for some reason doesn't want to move or speak. I doubt he'd pick the fetal position, but it's possible. Fetal position tends to stretch the ribcage. Try sitting in a fetal position and you can feel what I mean. More likely with bruised/cracked ribs, he'll be lying on his back, trying to breathe. Non-medical shock? Depends upon where he hurts. Position of a person is relative to where the person hurts. You try to find a position where the body hurts the least. I don't know. How would an EMT deal with him being uncooperative? Depends upon the circumstances. If he's uncooperative and he's of legal age and he doesn't look like he's dying, I'd probably get him to sign off on refusing treatment and go home.

If someone actually answers all of my ridiculous questions, then they are simply amazing. Or need to find a life.

You've got so many variables here it's hard to answer your questions.

Best of luck,

Jim Clark-Dawe

Goblynmarket
09-12-2012, 12:31 AM
Out of college I worked with a number of kids that issues similar your MC. Eating disorders, or just not eating because of depression, can do nasty things to the body. Dehydration and low blood sugar are pretty easy to treat, long term malnutrition isn't. In a weakened state like that collapse could have been caused by lots of things. Look into it if you can handle it.

As far as what the EMTs would do. I agree that there would most like be two. One to drive the ambulance, one to sit in the back. One of the first things they would do would be set a neck brace. Any fall, I'm assuming there is some type of fall involved in the collapse even it is just out of a chair, has the possibility of a c-spine injury. When I was a first responder and a lifeguard any injury that we didn't see got treated that way. Paramedics in my experience will sometimes let you ride in the front seat to the hospital with them, but I doubt they would tell a friend of the mc much.

From there it depends on what they think caused the collapse. The likelihood that a doctor was involved would increase with the worse the condition your mc is in. It could just be an IV, but I kind of doubt it unless the mc has a history of collapsing because of low blood sugar or dehydration. Signs of malnutrition and exhaustion are pretty hard to miss. It would take a pretty oblivious doctor not to notice.

As far as the robot hand thing, A Light injury would just be bruising,maybe some abrasions. There aren't a lot of things that can happen to your core that aren't potentialy life threatening.
It's really not a minor injury, but I seem to remember fetal position being the most comfortable for some one with a broken pelvis. I've never come across some one that had one, but I know it's a crippling pain. Maybe if your mc thought that had happened to him he would Curl up.

A little last bit to help with your research into shock, remember that there are more than just one kind, and they have different signs. Compensatory shock, elevated pulse and breathing, is the body trying to speed circulation in result to blood loss, non-compensatory shock is when the body can no longer pump enough blood to sustain itself. The transition from one to the other can be quick or slow depending on the trauma and treatment.

Psychological trauma can also cause shock, which I am guessing is your 'non medical' shock. I don't have any expirence with this but you could look at PTSD.

Good luck!

Zashi
09-12-2012, 04:36 AM
How is parental consent for the treatment of minors handled in your universe? Assuming your MC is a minor. In the United States care beyond lifesaving can be problematical if there's no parent or guardian available.

Is he a pupil at the school? In the United States bording schools usually have the authority to authorize treatment. Yes, he's a pupil. I assume the school has the right to administer treatment of any sort.

As for privacy, that would depend on the rules in your universe. HIPAA in the US is fairly strict--to the point that spouses cannot get medical information on each other unless they've signed a release form. Friends of the patient? No way. Okay, thanks. So what would the doctor say to someone if they asked what happened? Something like "When he wakes up he can decide whether or not he wants to tell you"?

As for helping him dress, etc, that really depends on you. Friends don't generally do that in US hospitals now, but it used to be that family and friends not only could provide basic care, but also brought in food. So what is your society like? Oh, I kinda meant if the nurses had to change what he was wearing to something more suitable, like a hospital gown. The hospital is pretty good in that it would provide all care and food.

If he is going to the bording school, what did the teachers notice and what did they do about it when he started losing so much weight? I think he just tried to avoid contact with pretty much everyone and wore loose things to cover it up. It's only really noticeable when you see uncovered limbs and stuff because the bones stick out more, though I suppose a little shows in the face.

The basic medical treatment is probably the same from fairly developed world to fairly developed world. But the social issues surrounding the rest of your questions seem largely up to you. What's the norm in your society? I hope I gave you some kind of an idea above :)

ETA: Welcome to the board!
Thanks! I've been lurking for a while, especially in this forum because I find the questions so varied and interesting. My friend got creeped out after I had an argument with him then somehow ended up on the topic "How To Kill Someone With Science" haha. I hope I can find something I'm qualified to help with here too :D

GeorgeK
09-12-2012, 05:19 AM
Hi, so my teenage MC has depression and hasn't been sleeping well or eating properly over a period of a few weeks, gradually getting worse. He was skinny to start with so the weight loss is pretty severe considering he was already underweight. Eventually this and the lack of sleep get to him and he just collapses, in public. (I'm guessing this is a plausible thing to happen, although if someone could explain to me exactly why/how it does, I'd appreciate it.)

Anyway so someone he knows calls an ambulance because, uh, generally people don't just collapse and he also looks pretty bad anyway. How many people (EMTs?) would be in the ambulance, and what would they do when they got to him? I assume he'd have to go to hospital, what would be the general course of events for him? Would they put him in hospital garments before everything, during, after or not at all? What's the policy on letting friends in during this kind of stuff (one of them was the one that called the ambulance)? I assume due to the malnutrition an IV drip would be involved at some point, when would they put it in? Would there be doctors involved? Would said doctors (or whoever's dealing with all this) be able to tell his friends what happened (i.e. malnutrition and exhaustion) or is that breaking the patient's confidentiality? What would they do if they found signs of self-harm on his body?

Also would this be considered fairly serious, him collapsing and all that?

More context: this doesn't take place in the US, or anywhere really although I suppose it's rather Western. I'm not worried about insurance things. The hospital is pretty close by, and the whole place is kind of a utopic university town slash boarding school. He doesn't have a parent or next-of-kin handy.

If you haven't gotten completely sick of my medical questions, here's some more for another scene ;)

This is actually before the aforementioned scene. If my MC were to be picked up by a large robot hand which slowly starts crushing him, but is rescued before anything too terrible happens, what kind of damage would you expect? I was thinking bruised ribs at the very least. He's not very well built, about 5'0" (yes I know extremely short) and ectomorphic.

Whatever injuries he gets, how would an EMT treat him? How would an EMT even figure out that he has bruised ribs or whatever? I'm aware that people with bruised/fractured/broken ribs tend to breathe shallower, is that enough of a sign? Or do they need to examine him? Do you think he'd start going into shock? (I tried reading up about shock but I couldn't figure out if it was only when you had massive trauma or what.) Also as soon as he's on the ground/out of the hand's clutches he sits in the fetal position and for some reason doesn't want to move or speak. Non-medical shock? I don't know. How would an EMT deal with him being uncooperative?

If someone actually answers all of my ridiculous questions, then they are simply amazing.

Here in America, what the EMT's would do with an actually unconscious patient is strap them to a backboard and put an IV in and give them fluids, oxygen, probably some narcan. They might give IV glucose depending upon whether the jurisdiction would allow them to check a glucose level. What they would definitely not do is feed them anything. There are too many variables that bystanders could not answer safely particularly if there are bruises. They have to consider an occult cervical fracture as a possibility or a subdural. An actually unconscious patient can not be trusted for a proper history even if they revive with fluid. Between allergies and potential need for surgery they must be maintained NPO. They're a scoop and run. Plan on it taking a few hours in the ER to clear the cervical spine and wait for the battery of other tests and for family to be notified.

Now it's a different scenario if your patient is just feeling faint but conversant

jclarkdawe
09-12-2012, 05:33 AM
Now it's a different scenario if your patient is just feeling faint but conversant

Why specifics are so wonderful.

I viewed the patient as being faint but conversant. Unconscious and unresponsive and George is exactly right, backboard and race to the hospital.

Best of luck,

Jim Clark-Dawe

Zashi
09-12-2012, 08:00 AM
@jclarkdawe

For some reason I'd never considered that people could think it could be because of drugs. I don't think my MC looks like the type (yeah, I know there isn't really a "type"). He's still pretty young (14-ish) and looks even younger.

Thanks for the "low blood sugar and dehydration" thing, but wouldn't the lack of sleep contribute at all? Insomnia, low quality sleep when he does manage to drift off, etc.


I assume he'd have to go to hospital, what would be the general course of events for him? Not necessarily. Candy bar and some water could perform miracles here.
Okay, he has to go to the hospital for plot reasons. Is dehydration the only reason an IV is put in? I thought it was used when people were deficient in nutrients. Would the IV still be administered at the scene? Admittedly, I just really want an IV involved because it makes everything seem much more serious XD

When would the mental health consultation take place? Would they let his friends see him before it, maybe if a nurse or someone stayed in the room? What kind of things do they ask/look for in a consultation?


Also would this be considered fairly serious, him collapsing and all that? Probably not, but it depends upon how screwed up are his vitals, including his blood work.
What kind of screwed up could they be? Also this is set in a kinda technologically advanced place (think the trope 15 Minutes Into The Future if you've ever gone on TV tropes) so assume there's access to all the latest in medicine and things like blood work are done very quickly (how long do they take normally?).


I doubt he'd pick the fetal position, but it's possible. Fetal position tends to stretch the ribcage. Try sitting in a fetal position and you can feel what I mean. More likely with bruised/cracked ribs, he'll be lying on his back, trying to breathe. Non-medical shock? Depends upon where he hurts. Position of a person is relative to where the person hurts. You try to find a position where the body hurts the least.
He's weird (well it's more complicated than that but eh) so even if laying on his back hurt the least he wouldn't choose to because he'd feel exposed. What about sitting cross-legged and hunching over? Do people with bruised/fractured/cracked ribs do that, or ever hold their sides?


How would an EMT deal with him being uncooperative? Depends upon the circumstances. If he's uncooperative and he's of legal age and he doesn't look like he's dying, I'd probably get him to sign off on refusing treatment and go home.
He's not of legal age haha. About 14, as I said above. Also pretty sure they're obligated to do something due to being connected to the school, who is responsible for the students.

And naw, you're amazing, even if you don't have a life :P

@Goblynmarket

What kind of nasty things have you seen? I don't know if this would be considered long term, but basically he just doesn't eat properly over a period of a few weeks because the depression causes a lowered appetite and some other factors. Because of the whole "boarding school" kind of situation he has to go out in public and be around other people if he wants to get something to eat and since he's trying to avoid pretty much all human contact, this isn't exactly an incentive to eat regularly. I was thinking he could have also caught some kind of flu which would normally be very mild but because of his weakened immune system would make him feel nauseous (not quite throw-up nauseous but "why would I want to eat anything right now bleh" kind of thing), and that could maybe also contribute to him collapsing later on. Then yet another reason for not wanting to eat is a kind of self-harm/depression-related one, a kind of "you don't even deserve food so put up with this, you don't have a reason to complain" attitude. I'm not sure how long this kind of thing would have to last until malnutrition set in. He's not getting anywhere close to the recommended caloric intake every day.


One of the first things they would do would be set a neck brace. Any fall, I'm assuming there is some type of fall involved in the collapse even it is just out of a chair, has the possibility of a c-spine injury.
Oh that sounds dramatic! (Writers love drama haha.) He was starting to walk off after being confronted about how terrible he looks and was all "Leave me alone". I imagine he'd kind of stagger first, then do the knees-then-faceplant kind of fall. Plausible? I was thinking that getting up suddenly and walking off would exacerbate the problem, and that's kind of what tipped him over the edge.


Paramedics in my experience will sometimes let you ride in the front seat to the hospital with them, but I doubt they would tell a friend of the mc much.
Okay, I think I'll just leave them behind. Would they be told something like "You can go to the hospital and wait if you want" or something else entirely?


From there it depends on what they think caused the collapse. The likelihood that a doctor was involved would increase with the worse the condition your mc is in. It could just be an IV, but I kind of doubt it unless the mc has a history of collapsing because of low blood sugar or dehydration. Signs of malnutrition and exhaustion are pretty hard to miss. It would take a pretty oblivious doctor not to notice.
I'm kind of confused about this. He hasn't seen a doctor before now, so this is the first time he's getting any kind of treatment. He doesn't have a history. Are you saying in that case, an IV wouldn't be enough? What would?



A little last bit to help with your research into shock, remember that there are more than just one kind, and they have different signs. Compensatory shock, elevated pulse and breathing, is the body trying to speed circulation in result to blood loss, non-compensatory shock is when the body can no longer pump enough blood to sustain itself. The transition from one to the other can be quick or slow depending on the trauma and treatment.
Okay, so compensatory shock is like, you've been stabbed, bleeding out, body is trying to make the most of what you've got. Is non-compensatory shock when it doesn't even have enough blood to do that? I think I'm just going to step away from the shock diagnosis, I don't think I understand it well enough haha.


Psychological trauma can also cause shock, which I am guessing is your 'non medical' shock. I don't have any expirence with this but you could look at PTSD.
Yeah, I've been obsessed with mental illness for a while (yet didn't go into psychology at uni :\ my random hobbies) and part of his reluctance to let the EMT examine him is that the injuries are almost the same as some he got from being beaten up (kicked hard repeatedly in the ribs) about a year prior, and he didn't get any proper treatment back then and just put up with the pain and looked up how to deal with it on the internet. He's fairly lucky he didn't have any complications, and from what I understand there's not too much you can do with broken/whatever'd ribs except wait for them to heal.


Good luck!
Thanks! :D You too!

GeorgeK


Here in America, what the EMT's would do with an actually unconscious patient is strap them to a backboard and put an IV in and give them fluids, oxygen, probably some narcan.
Oh wow this is getting even more dramatic. What's narcan? Also Goblynmarket mentioned a neck brace, how does that relate to getting strapped to a backboard? Would they both be necessary?


They might give IV glucose depending upon whether the jurisdiction would allow them to check a glucose level.
Assume that it would. How does one check a glucose level?


What they would definitely not do is feed them anything.
You're talking about refeeding syndrome, right?


There are too many variables that bystanders could not answer safely particularly if there are bruises. They have to consider an occult cervical fracture as a possibility or a subdural.
You mean like how he fell? I don't think he'd have bruises if he fell on grass, and it wasn't a plank suddenly keels over kind of fall. Would spinal injury be that likely? Would they still consider it even if he has no bruises and is on grass?


An actually unconscious patient can not be trusted for a proper history even if they revive with fluid.
Assume they have his history, it was probably necessary for parents to give it to them and the school when they're sent off to live there.


Between allergies and potential need for surgery they must be maintained NPO. They're a scoop and run.
Given what I've told you, is that still the case? And what's a scoop and run? Haha.


Plan on it taking a few hours in the ER to clear the cervical spine and wait for the battery of other tests and for family to be notified.
They have state-of-the-art technology that speeds tests up (handwave hand wave) would he still need to stay in ER that long? (Also that sudden realisation I have no idea what ER is like except vague memories of House and Grey's Anatomy, which obviously cannot be relied upon. In a perfect world, would all patients have a room? Even in ER? Wow I must sound like an idiot.)


Now it's a different scenario if your patient is just feeling faint but conversant.
And now I'm torn. I want him to be unconscious, but don't really want any of these spinal injury tests.

Thank you all for your wonderful in-depth expert answers! :D I had no idea there were so many variables.

GeorgeK
09-12-2012, 01:24 PM
GeorgeK


Oh wow this is getting even more dramatic. What's narcan?

It's a narcotic reversal agent, so if someone has OD'd on narcotics you can reverse it and get them breathing on their own again. It also has some usefulness in unconsciousness due to brain bleeds, but that's more anecdotal so not all places will allow paramedics to give it. However typically the paramedics have already decided what hospital they are taking the patient to and are already on the phone with an ER physician
An IV is a necessity because you don't know when the patient will crash (shock) and then getting an IV in is much less easy. All patients (except psych patients) have IV's in so that you have IV acces for fluids and meds


Also Goblynmarket mentioned a neck brace, how does that relate to getting strapped to a backboard? Would they both be necessary?

Yes, both, always



Assume that it would. How does one check a glucose level?


blood either by Fingerstick or venipuncture


You're talking about refeeding syndrome, right?
No, Paramedics do not ever start refeeding an unconscious patient either by mouth or IV. It's way too dangerous with too many variables




You mean like how he fell? I don't think he'd have bruises if he fell on grass, and it wasn't a plank suddenly keels over kind of fall. Would spinal injury be that likely? Would they still consider it even if he has no bruises and is on grass?

The witnessed fall is not necessarily the only injury. He could have been in a fight last night and have a slowly bleeding subdural or a fractured odontoid process, so yes, backboard AND rigid neckbrace and about half a roll of duct tape holding him into both



Assume they have his history,

They would almost never assume that they have the full history unless the patient was living with a medical professional and that person was there on the scene.


it was probably necessary for parents to give it to them and the school when they're sent off to live there.

That's past history, not history of present illness.


Given what I've told you, is that still the case? And what's a scoop and run? Haha.
It means that their main purpose is to get the patient as safely and quickly to the hospital as they can.




They have state-of-the-art technology that speeds tests up (handwave hand wave) would he still need to stay in ER that long?
Yes, because they are not going to just let him leave. They need an adult to take him out


(Also that sudden realisation I have no idea what ER is like except vague memories of House and Grey's Anatomy,

Forget everything from TV Soap Operas. They are not reality. They are almost always wrong


which obviously cannot be relied upon. In a perfect world, would all patients have a room? Even in ER? Wow I must sound like an idiot.)



It depends on the finances of the local hospital. The ER could be anything from private rooms with solid walls and doors (but with closed caption cameras) to open wards


And now I'm torn. I want him to be unconscious, but don't really want any of these spinal injury tests.
Then you need incomptetent Paramedics and or an incompetent physician on duty in the ER. (Incompetent here just means willing to not go by the book.)



Thank you all for your wonderful in-depth expert answers! :D I had no idea there were so many variables.

In the ER, after a thorough assessment, they will find self inflicted bruises and find out that the patient has not been eating due to psychiatric problems and then would decide what risk he is to himself and others. They might release him to a guardian, they might put him in a mandatory psych unit even before a guardian can be contacted

BTW, his clothes will have been cut to ribbons because that's the only way to examine a patient duct taped to a backboard, is to cut their clothes off

asroc
09-12-2012, 01:31 PM
I’ve had plenty of patients that were exhausted and forgot to eat and drink, especially college students around finals time. They do collapse and maybe lose consciousness briefly, but they don’t remain completely unresponsive. You give them some fluids and fruit juice and tell them to take it easy and get some rest.

But if the character stays unresponsive, something else is wrong that can be potentially very serious. So he’s going to spend some quality time on that backboard. No way around it. He can also count on being intubated.

A neck brace or cervical collar is used to immobilize the neck in case of (suspected) spinal fractures. A backboard immobilizes the spine. They go together. C-collar first, then on the board you go.

Hypoglycemia (low blood sugar) is going to be a likely scenario. You test for it by poking the patient’s finger with a small special needle to get a small drop of blood and putting the blood in a test strip that goes into a little gadget. The gadget tells you the glucose level in the blood. If it’s below a certain number the patient is hypoglycemic. If he’s responsive he can eat or drink something sugary without fat. If he’s unresponsive, D50 (sugar water) via IV or a glucagon shot IM.

IV refers to the method of delivery for meds, not the meds themselves. Starting an IV simply means you establish access to the patient’s vein. You can hook all kinds of stuff up an IV, but an IV started in an ambulance will have a bag of saline or lactated Ringer’s solution hooked up to it and other medications can be injected into this line. Starting an IV is a routine procedure; pretty much every paramedic patient gets one. The medic might take a blood sample before hooking up the saline for the ER.

Narcan (naloxone) is an opiate antagonist; it counteracts opiate drug overdoses like heroin. He shouldn’t be given Narcan unless there are indications of an opiate OD/his vital signs have tanked. People used to be very liberal with it, but we don’t do that anymore.

Whether someone gets to ride along depends to some degree on the willingness of the medic. I personally don’t like it and I don’t allow it unless there’s a good reason. If the person knows about an unresponsive patient’s medical history or has other pertinent info he can ride up front. The only people who can ride in the back are those who would be a calming influence to a freaked-out patient, like a parent for a small kid. Otherwise we’ll tell them where we’re going and they can follow us.

A scoop-and-run means you spend as little time as possible on the scene. Ambulance arrives, medics backboard patient while doing a rapid assessment, ask friends/bystanders for details/medical history (if there’s a friend nearby who knows this I might take him along, otherwise no. I don’t like passengers in my truck, especially teenagers), medics load the patient into the truck and go. Establishing IV access, cardiac monitoring, blood sugar testing and so on all happens during transport.

GeorgeK
09-12-2012, 01:39 PM
He can also count on being intubated.
.
That's certainly a possibility depending on how unresponsive. When he gets to the ER he's also going to get a urinary catheter.

Zashi
09-12-2012, 03:06 PM
Iíve had plenty of patients that were exhausted and forgot to eat and drink, especially college students around finals time. They do collapse and maybe lose consciousness briefly, but they donít remain completely unresponsive. You give them some fluids and fruit juice and tell them to take it easy and get some rest.

But if the character stays unresponsive, something else is wrong that can be potentially very serious. So heís going to spend some quality time on that backboard. No way around it. He can also count on being intubated.
What are some likely things that would make him remain unresponsive? Other than spinal injury. If he's breathing by himself, why would he need to be intubated?


A neck brace or cervical collar is used to immobilize the neck in case of (suspected) spinal fractures. A backboard immobilizes the spine. They go together. C-collar first, then on the board you go.
Hmm, thanks for the clarification.


Hypoglycemia (low blood sugar) is going to be a likely scenario. You test for it by poking the patientís finger with a small special needle to get a small drop of blood and putting the blood in a test strip that goes into a little gadget. The gadget tells you the glucose level in the blood. If itís below a certain number the patient is hypoglycemic. If heís responsive he can eat or drink something sugary without fat. If heís unresponsive, D50 (sugar water) via IV or a glucagon shot IM.
Yeah, I'm pretty sure he'd have hypoglycemia. Since he needs to be unconscious, I'd say administering via an IV would be best.


IV refers to the method of delivery for meds, not the meds themselves. Starting an IV simply means you establish access to the patientís vein. You can hook all kinds of stuff up an IV, but an IV started in an ambulance will have a bag of saline or lactated Ringerís solution hooked up to it and other medications can be injected into this line. Starting an IV is a routine procedure; pretty much every paramedic patient gets one. The medic might take a blood sample before hooking up the saline for the ER.
Do you take a blood sample in the same way as before (finger prick) and use the same or a different gadget? Do you think it's plausible in the future there'll be a device that can extrapolate several things that maybe now you have to do different tests for?


Narcan (naloxone) is an opiate antagonist; it counteracts opiate drug overdoses like heroin. He shouldnít be given Narcan unless there are indications of an opiate OD/his vital signs have tanked. People used to be very liberal with it, but we donít do that anymore.
He's not on drugs, so no Narcan :P
Also "antagonist" and "heroin(e)"... I dunno, am I the only one who looks at that and wonders if a plot could be based on it? Haha.


Whether someone gets to ride along depends to some degree on the willingness of the medic. I personally donít like it and I donít allow it unless thereís a good reason. If the person knows about an unresponsive patientís medical history or has other pertinent info he can ride up front. The only people who can ride in the back are those who would be a calming influence to a freaked-out patient, like a parent for a small kid. Otherwise weíll tell them where weíre going and they can follow us.
It seems like all the EMTs dislike passengers here haha :D . I almost feel like having one of the EMTs remark "Thank GOD no one demanded to ride along this time." As I said, I've decided that his friends can just go to the hospital later.


A scoop-and-run means you spend as little time as possible on the scene. Ambulance arrives, medics backboard patient while doing a rapid assessment, ask friends/bystanders for details/medical history (if thereís a friend nearby who knows this I might take him along, otherwise no. I donít like passengers in my truck, especially teenagers), medics load the patient into the truck and go. Establishing IV access, cardiac monitoring, blood sugar testing and so on all happens during transport.
As I said before, assume they have his medical history available through what's basically advanced iPads. Nothing too special there, he doesn't have any recorded allergies or asthma. I suppose there'd be a mention of that rib-bruising event prior, although I'm not sure they'd consider that at all relevant. Friend would just relate how he got up, started walking away then collapsed and probably mention he's been looking pretty terrible over the last few weeks, but been avoiding them and not speaking to anyone.


When he gets to the ER he's also going to get a urinary catheter.
D: Really? Is there a reason he wouldn't have to? (Or do I just have to stop being so sympathetic and let humiliating things happen to my character?)

GeorgeK
09-12-2012, 03:38 PM
D: Really? Is there a reason he wouldn't have to? (Or do I just have to stop being so sympathetic and let humiliating things happen to my character?)

Not many people can pee strapped down on a backboard. The ER physcians need to monitor urinary output as part of basic assessment. They also need a urine sample to run a toxic screen. When you have an unconscious patient you have to check everything. When you have an unconscious hypoglycemic patient, there is a significant chance that not only are they diabetic, but potentially diabetic long enough to have a diabetic neurogenic bladder which means chronic urinary retention. The fastest way to deal with that is a catheter

Zashi
09-12-2012, 03:45 PM
Not many people can pee strapped down on a backboard. The ER physcians need to monitor urinary output as part of basic assessment. They also need a urine sample to run a toxic screen. When you have an unconscious patient you have to check everything. When you have an unconscious hypoglycemic patient, there is a significant chance that not only are they diabetic, but potentially diabetic long enough to have a diabetic neurogenic bladder which means chronic urinary retention. The fastest way to deal with that is a catheter
I'll be honest, I am getting so confused. I thought the hypoglycemia would stem just from not eating enough over a period of time, not diabetes. Uh, I kind of do not want him to have diabetes. Really, the whole hospital thing is just supposed to show how serious his depression and self-neglect became, and uh, ambulance=drama.

Also I somehow managed to miss your reply before Asroc's.


Paramedics do not ever start refeeding an unconscious patient either by mouth or IV. It's way too dangerous with too many variables
Okay, since I'm not studying medicine I won't ask what the variables are and just never have paramedics do that. But the glucose IV for low blood sugar is okay, right?


The witnessed fall is not necessarily the only injury. He could have been in a fight last night and have a slowly bleeding subdural or a fractured odontoid process, so yes, backboard AND rigid neckbrace and about half a roll of duct tape holding him into both
Oh, he wasn't, but I get that they have to assume that. And duct tape?! Really? Is there anything better to hold a patient in, assuming cost is no object?


They would almost never assume that they have the full history unless the patient was living with a medical professional and that person was there on the scene. | That's past history, not history of present illness.
Oh. Right.


Forget everything from TV Soap Operas. They are not reality. They are almost always wrong
That's why I'm asking you guys! :D Psshh, TV writers Did Not Do The Research. I know how ridiculous it is to be fairly well-versed in something and be put off when a show pretends to know its stuff but really doesn't. Nothing as important as medicine (which would, y'know, be useful to accurately portray so people don't accidentally hurt themselves or others) but I always get annoyed when "artists" are drawing on TV and they're making either shading motions with a pencil or dabbing motions with a brush and the thing they're working on is line art or a painting you wouldn't be dabbing at. Also people speaking Japanese with horrible pronunciation and also getting things wrong in a way you would never realistically get wrong, like mixing an introduction up with "I have a watermelon in my pants" which sounds nothing alike. And I'm not even a psychologist but I get angry every time "multiple personality disorder" comes up and they mangle it horribly, or call a clear-thinking but sadistic killer "psychotic". Um, sorry. Irrelevant rant over.


It depends on the finances of the local hospital. The ER could be anything from private rooms with solid walls and doors (but with closed caption cameras) to open wards
The hospital has a lot of funds, it's state-of-the-art. What would be the ideal kind of setup?


Then you need incomptetent Paramedics and or an incompetent physician on duty in the ER. (Incompetent here just means willing to not go by the book.)
Oh all right, they'll do the tests, I don't want to make anyone look incompetent or negligent. Do they have to do X-rays, what's the minimum to confirm he doesn't have any spinal injuries?


In the ER, after a thorough assessment, they will find self inflicted bruises and find out that the patient has not been eating due to psychiatric problems and then would decide what risk he is to himself and others. They might release him to a guardian, they might put him in a mandatory psych unit even before a guardian can be contacted
Risk to himself maybe, but not to others. I think I asked it before, but how would they determine this? And he only has one guardian at the moment, his mother, but she is not really around. It was actually her visit which broke his last resolve and really sent him spiralling into the abyss. Is there a way they could find this out when asking him questions? I mean, they wouldn't want to hand him over to her, right? He doesn't have any other immediate family he's in contact with either. Would that mean he'd have to stay in the psych ward for awhile?


BTW, his clothes will have been cut to ribbons because that's the only way to examine a patient duct taped to a backboard, is to cut their clothes off
Assuming there is no alternative to duct tape, I don't mind this. :D So... he'd get put in a hospital gown then, right? (People may be getting the impression I am obsessed with hospital clothes. I don't know, they just really sell the "very sick" image if you ask me.)

jclarkdawe
09-12-2012, 04:30 PM
Go to AVPU (http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=0CCYQFjAA&url=http%3A%2F%2Fen.wikipedia.org%2Fwiki%2FAVPU&ei=Cn5QUJ_1N6KV0QGnioCAAQ&usg=AFQjCNHbrrio--nJ3qn9dhYIqI-ojZRC_Q) and Glasgow Coma Scale (http://en.wikipedia.org/wiki/Glasgow_Coma_Scale) and figure out where your patient scores. The difference in treatment between a 3 to a 6 to a 9 to a 12 to a 15 on the Glasgow Coma Scale is massive.

I know where George thinks your patient is on the Glasgow Coma Scale, and I know where I think your patient is on the same scale (and we're on opposite ends), but I don't think you have any idea where your patient is at. Until you do, you're going to get too much information, and much of it confusing.

Best of luck,

Jim Clark-Dawe

Pyekett
09-12-2012, 04:46 PM
An emergency department is going to be focused primarily on one thing: stabilization. Stabilizing the patient so that:

1. the patient is stable but with acute issues that specialists can sort out (including psychiatric or social support specialists, as well as more purely physical medicine specialists), or
2. the patient is stable but has longer term issues that can be turned over to a primary care physician to sort out, or
3. the patient can be verified as stable without any need for followup

That's it. There is little regard for unnecessary drama or supporting a sick image, mainly because the pressures are pretty intense and there isn't time. If somebody passes out from not eating or hydrating well, a lot will happen quickly to make sure he is stable, and then a lot less stuff will happen very slowly. Once stable, the hard work of dealing with psychiatric issues, whether depression, or eating disorder, or something else, or some mix of the former, will begin.

The former is dramatic but over quickly, unless there is another underlying issue. The latter is tedious, often embarrassing or frustrating, and takes a long time to work through. If someone has passed out because of not eating or hydrating well for a long time and is relatively medically stable, all the brouhaha happens in the first hour or so, and then there is the long wait for social services and/or psychiatry. Lots of staring at the ceiling, thumbing through magazines you wonder if somebody has sneezed on, smelling the gaseous output of the person behind the nearby curtain, trying to ignore the television blaring from somewhere (or your neighbor's idiotic ringtone, or the conversation you overhear about how Uncle Earl ain't got no right, he just doesn't know, and why was she there anyway?).

There tends to be a bit of exasperation in emergency departments about mental health issues. It can be a problem. That being said, there are many (and I think the majority) ED workers who remain calm, professional, and helpful even after medical stability is achieved or verified and the more tedious part begins.

As to why diabetes comes up, in the first EMS encounter, none of the workers can assume they have the whole story. Sure, he may have been drinking and passed out (or whatever), but they don't know if he has an underlying problem that was exacerbated by this. Maybe he had diabetes and hid it from people. Who knows?

Generally, serious problems that happen fast get fixed fast: trauma with serious blood loss gets more blood pumped in, for example. But for problems that occur over a long period of time, the body has generally compensated, and so gradual recorrection is the usual path to take. That is, something like a coma from diabetic ketoacidosis isn't dealt with by giving the insulin needed to correct things quickly. It has to be calculated out to correct things back to balance over a matter of days, not minutes or hours. Too fast a correction makes for more problems.

(As you mentioned refeeding syndrome, I suspect you are familiar with this part. That's why refeeding for patients at serious risk of complications from eating disorders takes place slowly on hospital wards, rather than quickly in EDs. Much the same basic issue as with diabetic ketoacidosis, although the details differ.)

So if he is passed out, he gets treated as if he might have a head injury, a cardiovascular problem, a metabolic problem, or all the rest. And once an EKG rules out things like long QT syndrome, and once the initial labwork comes back okay (or with something like low blood sugar that can be relatively easily corrected), and urgent X-Rays of the spine come back normal, and the physical exam shows a quite thin young man with possibly some bruising but no neurologic symptoms and no internal damage ... then comes the ceiling. And the farts, and the half-shredded magazines, and the long minutes while other crises fly around your guy like he's in the dead center calm of the hurricane.

By that time someone would probably have given him a hospital gown to wear, given the fact that an exam on a backboard tends to mean ill things to clothing (as was noted above). This isn't as dramatic a sick image as one might expect, since most people sitting around will be wearing the same thing. Overexposure does not make the heart beat faster with excitement. It just starts to get boring.

Hope your guy gets moved around as best fits the storyelling and doesn't resist the storyteller too much. :)

---

Added: The big question is "is he medically stable?" Someone who hasn't been feeding or hydrating well for a while but who is otherwise healthy (no kidney or heart disease, for example) usually is. Dehydration is the main issue, and that often can be (and is) corrected enough pretty quickly to make the person stable. Eating disorder type issues can lead to heart problems, but they aren't so much Emergency-Department-level-unstable problems as need-to-be-on-a-monitor-in-a-ward level problems, and even that isn't terribly common.

Even concentration camp refugee are generally stable from an ED perspective. Like patients with serious depression or eating disorders, they need a lot--a lot--of help, time, and care, but they generally don't need an ED once they are checked over. That means such a patient gets put in the hurry up & wait section until all the other resources and services can be gathered.

Added part II, from the OP:




Also would this be considered fairly serious, him collapsing and all that?

Depends on who you are talking about. Serious to the Emergency Department staff? Not in the bigger context of emergencies they see, so long as there isn't something underlying like a heart arrythmia to deal with. From an ED staff perspective, their role in this would be pretty straightforward: get him medically stable (and most persons in the situation you describe are, once hydrated if necessary) and turn him over to mental health professionals to sort out the rest.

Serious to people who love and care for him? Sure. He just passed out! He's in an Emergency Department! And they would rightly be panicked and stressed by this, and they would want to make sure he gets taken care of well, if they care about him.

Serious to the mental health professionals who need to sort through things once he is stable? Well, at that point there could likely be reason to have him admitted and looked after more thoroughly. It depends, though, on a number of things: how ill was he, how much room is there at the inn, how good and reliable would the followup be?

You could write it in such a way as to be serious to a mental health professional or not serious. The initial incident would be serious in that it means they have to be careful in the evaluation, but depending on the evaluation, it could lead to anything from a hospital admission to being discharged back to school. It all depends.

Zashi
09-12-2012, 05:04 PM
Go to AVPU (http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=0CCYQFjAA&url=http%3A%2F%2Fen.wikipedia.org%2Fwiki%2FAVPU&ei=Cn5QUJ_1N6KV0QGnioCAAQ&usg=AFQjCNHbrrio--nJ3qn9dhYIqI-ojZRC_Q) and Glasgow Coma Scale (http://en.wikipedia.org/wiki/Glasgow_Coma_Scale) and figure out where your patient scores. The difference in treatment between a 3 to a 6 to a 9 to a 12 to a 15 on the Glasgow Coma Scale is massive.

I know where George thinks your patient is on the Glasgow Coma Scale, and I know where I think your patient is on the same scale (and we're on opposite ends), but I don't think you have any idea where your patient is at. Until you do, you're going to get too much information, and much of it confusing.

Best of luck,

Jim Clark-Dawe

Yeah, you're right, I have no damn idea. Thanks for the links.

AVPU
If they did the pain test on him, he would probably just withdraw from it. Don't know if it would be voluntary or involuntary. If asked things, would probably make an almost inaudible noise or limb twitch as mentioned.

Glasgow Coma Scale
Eye response: He'd definitely open them in response to painful stimuli (don't think they'd stay open for long) and maybe register if someone was speaking to him, but he wouldn't wake up properly.
Verbal response: Probably incomprehensible sounds? But I don't know if that's because he's kinda asleep or what. If it makes him get too severe score and would be weird IRL, then just say he's capable of vague words.
Motor response: As mentioned before, withdrawal from pain (not localised).

I hope this clears things up.

asroc
09-12-2012, 05:16 PM
I'll be honest, I am getting so confused. I thought the hypoglycemia would stem just from not eating enough over a period of time, not diabetes. Uh, I kind of do not want him to have diabetes.

It’s not impossible, but most cases of prolonged unresponsiveness due to hypoglycemia are diabetics who overdid their insulin.


Oh, he wasn't, but I get that they have to assume that. And duct tape?! Really? Is there anything better to hold a patient in, assuming cost is no object?Well, yes, of course. We don't use duct tape. It's a strap system. The end result looks like this (https://www.techsolutions.dhs.gov/PublishingImages/backboardcoverrotatorimage.jpg).


What are some likely things that would make him remain unresponsive? Other than spinal injury. If he's breathing by himself, why would he need to be intubated?

Prolonged unconsciousness indicates something pretty serious that’s likely to affect breathing. Hence intubation.

Other causes could be head/brain injuries, alcohol or drug overdose, diabetic ketoacidosis, decompensated shock or cardiac arrest.


Do you take a blood sample in the same way as before (finger prick) and use the same or a different gadget? Do you think it's plausible in the future there'll be a device that can extrapolate several things that maybe now you have to do different tests for?No, the sample for glucose testing and the other one are two different things. To test the glucose level you only need a tiny drop. The other sample goes in tubes like those (http://upload.wikimedia.org/wikipedia/commons/thumb/6/6f/Blood_test.jpg/220px-Blood_test.jpg), drawn through the IV catheter. You can’t test this sample in the ambulance; it’s for the hospital lab.

I suppose a device like that is in the realm of possibility, though.

A GCS for the character would really help, like jclarkdawe said. How long do you want him to be unconscious?

ETA: Aw, got to write faster and stop exploring the quote function. A GCS of seven is pretty bad.

Pyekett
09-12-2012, 05:29 PM
Zashi, I'm not sure you can get where you are trying to go with your character just by what you have described for the background. This doesn't seem to fit. [Added: that is, it doesn't fit that the first time he runs into a problem (significant enough to be noticable to people) his GCS is 7, purely on the basis of not eating and hydrating well for awhile. The first time he passes out, unless there is more going on, he'd be less bad off, pretty soon stabilized medically, and quickly turfed in the ED to mental health services.]

[Some of what the GCS measures isn't affected by his thought processes, willingness to cooperate, or level of emotional investment in responding to people and the world. It's just basic body physiology not under his control. For the score to be significantly low, his body has to have a serious problem, too. The GCS is designed to help emergency responders judge medical--that is, physical--stability, and it is designed to be minimally affected by thought processes. So even if someone is, say, pissed off and faking a coma, you can assess whether they really need to be intubated.]

That may mean more has to be going on with him, or his situation isn't as dire as the scores you gave him would indicate. There is a mismatch here.

Hope other people can help you figure it out. I am in the process of staying out of things lately, and I'm not doing a very good job of it. Time to turn off AW. Best wishes.

ULTRAGOTHA
09-12-2012, 05:43 PM
I'm going to confuse you more with the social side of things. ;)



Yes, he's a pupil. I assume the school has the right to administer treatment of any sort.

The school wouldn't administer treatment, they'd consent to it. Does he collapse on school grounds? If so, his friends are out of the loop early. One of them should go for an authority figure while another calls 911 (or your equivalent) and stays with the patient. The EMTs are going to want to speak to someone at the school because the school can give consent to procedures. Also someone from the school is going to go to the hospital with the patient to assent to procedures. Someone else at the school will call his parents/guardians.


As for privacy, that would depend on the rules in your universe. HIPAA in the US is fairly strict--to the point that spouses cannot get medical information on each other unless they've signed a release form. Friends of the patient? No way. Okay, thanks. So what would the doctor say to someone if they asked what happened? Something like "When he wakes up he can decide whether or not he wants to tell you"?

Unless you have a very open society and/or campus I can't see any of his friends going to the hospital with him. They probably would be able to visit after he's out of the ER and in the general ward. If the hospital keeps him. But it sounds like, from what you've said is wrong with him, that the hospital won't keep him. They'll send him back to school at the end of the day and then his friends can just ask him then. But if you're basing this on HIPAA privacy laws, the only people the hospital will give status updates to is the person from the school and the parents.

The friends could ask someone at the school about him, but I can't think that a) anyone at the school would know his status very soon (unless the person at the hospital was keeping them up to date in real time) and b) they'd tell his friends anything other than "he'll be fine" or "we don't know yet". Schools also maintain privacy.


As for helping him dress, etc, that really depends on you. Friends don't generally do that in US hospitals now, but it used to be that family and friends not only could provide basic care, but also brought in food. So what is your society like? Oh, I kinda meant if the nurses had to change what he was wearing to something more suitable, like a hospital gown. The hospital is pretty good in that it would provide all care and food.

At some point, when all the procedures have been completed and your MC is ready to be transferred to a room, a nurse would help him into a hospital gown. Not until then. In this case, though, I don't think he's ill enough to stay in hospital so probably someone from the school would bring in some clothes for him to change into before he goes back to school. At that point, his friends might get back in the loop.


If he is going to the bording school, what did the teachers notice and what did they do about it when he started losing so much weight? I think he just tried to avoid contact with pretty much everyone and wore loose things to cover it up. It's only really noticeable when you see uncovered limbs and stuff because the bones stick out more, though I suppose a little shows in the face.

Sounds like oversight of the students is kind of loose. You might try to find someone who's been to the kind of bording school you have in mind to find out the best way for the staff overseeing meals and his "housemaster" to miss that he's lost so much weight.

Although, really, and the medical people can correct me, he doesn't have to lose that much weight to have a fainting spell with low blood sugar. Even a day or so of not eating and some activity would do it. Or it would with me and I'm not even hypoglycemic. BUT it doesn't knock you out for a long time. He'd be responsive(ish) and avoid the back board. If you want him to be unconscious through the whole thing, I would think there ought to be something else wrong with him. But I am not a medical maven.


The basic medical treatment is probably the same from fairly developed world to fairly developed world. But the social issues surrounding the rest of your questions seem largely up to you. What's the norm in your society? I hope I gave you some kind of an idea above :)

It sounds like the norms of your society are the same as the US? If so, have fun with your research!!

Zashi
09-12-2012, 05:44 PM
ETA: Aw, got to write faster and stop exploring the quote function. A GCS of seven is pretty bad.

Oh. Maybe I should make it a bit better. I don't really want it to be something as severe as the brain injuries/ODs/cardiac arrest. What if he's just so tired and exhausted and not-having-energy that he just kinda falls asleep after the initial faint? Or is that then too not-serious? (Some brilliant wordsmithing going on here, folks.) I don't want him to be in a coma. Maybe they can try to wake him up but he just keeps falling asleep again, and if they perform one of those pain-check things they'd notice how skeletal he was and suspect something like anorexia. He's not, but he's basically showing the same signs, although not the more terrible long-term ones that I've heard of (weakening of heart muscle, osteoporosis, etc.).

@Pyekett
I have no idea how, but I managed to completely miss your first comment. It was very helpful though, for getting an idea of the run of events for someone admitted to ER.


Zashi, I'm not sure you can get where you are trying to go with your character just by what you have described for the background. This doesn't seem to fit.

That may mean more has to be going on with him, or his situation isn't as dire as the scores you gave him would indicate. There is a mismatch here.
Yeah, I think I just wanted the drama of collapsing and unconsciousness without thinking too hard about what would make that happen.

Pyekett
09-12-2012, 05:56 PM
Yeah, I think I just wanted the drama of collapsing and unconsciousness without thinking too hard about what would make that happen.

You can definitely get that, for sure. It's just that ED evaluation and stabilization would be over quickly, and then if they picked up on mental health issues, things would be less dramatic while he waits, and waits, and waits, and potentially gets admitted for longer term management of depression or eating disorder issues (if serious enough).

The initial bit could be a fair whizz-bang, though. :)

ULTRAGOTHA
09-12-2012, 05:58 PM
The problem seems to be that you want him to be unconscious for a long time but not seriously ill.

A person can't be unconscious for a long time (and by that I mean many, many minutes, not many hours) and not have somethign seriously wrong unless he's been drugged.

So, which do you want more for your plot? Unconscious (in which case there's something else wrong with him) or hypoglycemic and dehydrated (in which case he's not unconscious and is groggy and somewhat responsive).

Do you want him to go to hospital? Do you want him to stay in hospital? Why do you want him unconscious? Does your plot require it?

Start with what you want for the plot and then fit the medical problem to match it.

ETA: Not typing fast enough!

Also, do you know about rep points? The EMTs on this thread deserve some!

Zashi
09-12-2012, 06:29 PM
I'm going to confuse you more with the social side of things.
I gotta admit, I was really intimidated when I saw the size of this reply XD



The school wouldn't administer treatment, they'd consent to it. Does he collapse on school grounds? If so, his friends are out of the loop early. One of them should go for an authority figure while another calls 911 (or your equivalent) and stays with the patient. The EMTs are going to want to speak to someone at the school because the school can give consent to procedures. Also someone from the school is going to go to the hospital with the patient to assent to procedures. Someone else at the school will call his parents/guardians.
It's kind of hard to explain, but the location this takes place in everything is connected and integrated. Think Apple but with an isolated society, but it takes place in the real world (i.e. the students come there from "normal" societies like the USA, England, etc.). So while obviously they're "separate" they're basically owned by the same "company". I think the consent would be automatic, if that makes sense. One of his friends does call the emergency services, that's how they get there. His parent/guardian is unavailable and they just go ahead.




Unless you have a very open society and/or campus I can't see any of his friends going to the hospital with him. They probably would be able to visit after he's out of the ER and in the general ward. If the hospital keeps him. But it sounds like, from what you've said is wrong with him, that the hospital won't keep him. They'll send him back to school at the end of the day and then his friends can just ask him then. But if you're basing this on HIPAA privacy laws, the only people the hospital will give status updates to is the person from the school and the parents.

The friends could ask someone at the school about him, but I can't think that a) anyone at the school would know his status very soon (unless the person at the hospital was keeping them up to date in real time) and b) they'd tell his friends anything other than "he'll be fine" or "we don't know yet". Schools also maintain privacy.
He's gonna need to stay there for a little while, not be sent back home at the end of the day. Assume the hospital is cool and allows unrelated visitors, would they just wait until he was awake and ask if he wanted to see them? Goddammit I just want my touching hospital scene, haha.




At some point, when all the procedures have been completed and your MC is ready to be transferred to a room, a nurse would help him into a hospital gown. Not until then. In this case, though, I don't think he's ill enough to stay in hospital so probably someone from the school would bring in some clothes for him to change into before he goes back to school. At that point, his friends might get back in the loop.
As I said, he's staying there for awhile. If he's okay with dressing himself, do they still give him a gown or would he be better off in something like pajamas?




Sounds like oversight of the students is kind of loose. You might try to find someone who's been to the kind of bording school you have in mind to find out the best way for the staff overseeing meals and his "housemaster" to miss that he's lost so much weight.
I should have been more specific, I really only used "boarding school" because I couldn't be bothered explaining the situation properly. Every student has their own little room (lucky, huh) and has a card or chip embedded in their computer-like device that they can scan at multiple places to get their meals. Usually he would have been red-flagged for not doing this enough, but for conspiracy-like reasons it was made sure that no one interfered. It's scifi. Basically.


Although, really, and the medical people can correct me, he doesn't have to lose that much weight to have a fainting spell with low blood sugar. Even a day or so of not eating and some activity would do it. Or it would with me and I'm not even hypoglycemic. BUT it doesn't knock you out for a long time. He'd be responsive(ish) and avoid the back board. If you want him to be unconscious through the whole thing, I would think there ought to be something else wrong with him. But I am not a medical maven.
Yeah, I guess he doesn't have to be unconscious the whole time. I just wanted the dramatic collapse and the panic of his friend who is all "HOLY SHIT WHAT DO I WHY ARE Y'ALL STANDING AROUND HELP ME" and then hospital awkwardness as he gets re-healthified and they're all "so you need to go see a counsellor now".




It sounds like the norms of your society are the same as the US? If so, have fun with your research!!
Uh I guess? They're pretty Western, but remember that continent that's also a country and the tiny island that pretty much took over the world at some stage are Western too! XP



You can definitely get that, for sure. It's just that ED evaluation and stabilization would be over quickly, and then if they picked up on mental health issues, things would be less dramatic while he waits, and waits, and waits, and potentially gets admitted for longer term management of depression or eating disorder issues (if serious enough).

The initial bit could be a fair whizz-bang, though. :)
That's pretty much exactly what I want haha. Whizz-bang dramaticness then awkward recovery.



The problem seems to be that you want him to be unconscious for a long time but not seriously ill.

A person can't be unconscious for a long time (and by that I mean many, many minutes, not many hours) and not have somethign seriously wrong unless he's been drugged.

So, which do you want more for your plot? Unconscious (in which case there's something else wrong with him) or hypoglycemic and dehydrated (in which case he's not unconscious and is groggy and somewhat responsive).
I don't really want there to be anything else wrong with him than what I've stated (not eating so no energy, insomnia so exhausted, maybe flu) so unless there's something I'm missing I guess it has to be the latter and he's gonna be groggy. Does anyone know of any (not too serious) anorexia patients and if they were kinda like this?


Do you want him to go to hospital? Do you want him to stay in hospital? Why do you want him unconscious? Does your plot require it?

Start with what you want for the plot and then fit the medical problem to match it.
I definitely want him to go to hospital, and stay there as they're fixing him up so he's not so underweight and making sure he's not suicidal or anything. I guess he doesn't have to be like coma-unconscious, it just needs to be that he doesn't wake properly when his friend is kinda like "Hey! Get up!".



ETA: Not typing fast enough!

Also, do you know about rep points? The EMTs on this thread deserve some!
I think I tried to give one before? That justice scale thing on the right? I'll definitely do it sometime tomorrow, but right now it's almost 1am here and I have university tomorrow and I just spent all day being extremely thrilled that cool internet strangers were talking to me and obsessively refreshing the page instead of doing things that are actually due. So, um, night! See ya tomorrow, or whenever it'll be in your time zone :D

GeorgeK
09-12-2012, 06:35 PM
Ok, I think I know what you want for your scenario. The kid is chronically malnurished due to anorexia from depression. He collapses from mild hypoglycemia in the face of moderate malnutrition. When paramedics show up, he's catatonic.

It's layers of physical and emotional disease.
Due to the confusion of signs and symptoms
Paramedics: IV, Backboard, C-Collar, transport 15 minutes at the scene plus transport time, no intubation, but a nervous paramedic waiting by with an ET tube in hand during route

ER: Strip, exam, labs, catheter, Head and torso CT and spine films
within 1-2 hours they realize that most of his problems are emotional and they consult psychiatry to come down. The psychiatrist uses the rewards of getting rid of the backboard and C-collar and catheter as rewards to get him to start to talk

Pyekett
09-12-2012, 06:50 PM
Ok, I think I know what you want for your scenario. The kid is chronically malnurished due to anorexia from depression. He collapses from mild hypoglycemia in the face of moderate malnutrition. When paramedics show up, he's catatonic.

It's layers of physical and emotional disease.
Due to the confusion of signs and symptoms
Paramedics: IV, Backboard, C-Collar, transport 15 minutes at the scene plus transport time, no intubation, but a nervous paramedic waiting by with an ET tube in hand during route

ER: Strip, exam, labs, catheter, Head and torso CT and spine films
within 1-2 hours they realize that most of his problems are emotional and they consult psychiatry to come down. The psychiatrist uses the rewards of getting rid of the backboard and C-collar and catheter as rewards to get him to start to talk

Beautiful.

And one last clarification on my above posts, because I don't want to be misread: one can have an eating disorder and be seriously (even dangerously) unhealthy but still look fine. Due to a variety of choices and disordered behaviors, one could even be of normal weight (or overweight) and have serious electrolyte disturbances leading to seizures, heart arrythmias, even death ... if not treated.

But the sort of issues you get into with eating disorders, malnutrition, and dehydration can be picked up quickly in an ED and stabilized quickly. Fixing the bigger picture, though takes a lot more work.

If there is someone here who has a friend with an eating disorder or malnutrition through depression, then they can indeed be very sick and not look ill at all. These are serious illnesses and serious problems. It's just that if someone in that state is evaluated appropriately in Emergency, it can be picked up and dealt with before the case is turned over for mental health evaluation.

For the purposes of this story, that means "not serious," because we are talking about a place set up to take care of people with major traumas and other immediately life-threatening issues. It doesn't mean that if someone is engaging in risky behaviors but looks okay to you, they don't need help.

Emergency departments are also set up to deal with people who are confused, withdrawn, manipulative, frightened, unconscious, semi-conscious, under the influence, wishing they were under the influence, forgetful, distracted, etc. It is a place to get things stabilized quickly, and that means keeping people safe who are in all sorts of complicated circumstances.

GeorgeK
09-12-2012, 06:57 PM
Beautiful.

And one last clarification on my above posts, because I don't want to be misread: one can have an eating disorder and be seriously (even dangerously) unhealthy but still look fine. Due to a variety of choices and disordered behaviors, one could even be of normal weight (or overweight) and have serious electrolyte disturbances leading to seizures, heart arrythmias, even death ... if not treated.

But the sort of issues you get into with eating disorders, malnutrition, and dehydration can be picked up quickly in an ED and stabilized quickly. Fixing the bigger picture, though takes a lot more work.

If there is someone here who has a friend with an eating disorder or malnutrition through depression, then they can indeed be very sick and not look ill at all. These are serious illnesses and serious problems. It's just that if someone in that state is evaluated appropriately in Emergency, it can be picked up and dealt with before the case is turned over for mental health evaluation.

For the purposes of this story, that means "not serious," because we are talking about a place set up to take care of people with major traumas and other immediately life-threatening issues. It doesn't mean that if someone is engaging in risky behaviors but looks okay to you, they don't need help.

Emergency departments are also set up to deal with people who are confused, withdrawn, manipulative, frightened, unconscious, semi-conscious, under the influence, wishing they were under the influence, forgetful, distracted, etc. It is a place to get things stabilized quickly, and that means keeping people safe who are in all sorts of complicated circumstances.
agreed

ULTRAGOTHA
09-12-2012, 07:31 PM
I think the consent would be automatic, if that makes sense. One of his friends does call the emergency services, that's how they get there. His parent/guardian is unavailable and they just go ahead.

If you've got a set-up where the island is all "owned" by one "company" and everyone on it is part of that "company" then I can certainly see that no further permissions would be needed by the hospital.



He's gonna need to stay there for a little while, not be sent back home at the end of the day. Assume the hospital is cool and allows unrelated visitors, would they just wait until he was awake and ask if he wanted to see them? Goddammit I just want my touching hospital scene, haha.

Ha! Yes, after he's transferred to his room, assuming the hospital allows unacompanied underage visitors, they could show up during visiting hours and see him. Or whatever rules you have in place in your company town.



As I said, he's staying there for awhile. If he's okay with dressing himself, do they still give him a gown or would he be better off in something like pajamas?

Hospital gowns are for ease of access to the patient by medical staff. Assuming they still need to deal with IVs and exams, etc. It would make perfect sense for him to be in a hospital gown.


As for privacy, it sounds like that's the purview of the Author. What privacy rules does your "company" town have in place? How easy is it for the kids to hack around them? But, really, it might just be easier for the friends to ask school staff. Given your set up, it might be perfectly reasonable for the staff to answer their questions. "Joey is fine. He's going to stay in hospital for a bit. You can go see him during visiting hours after class." That sort of thing.



I think I tried to give one before? That justice scale thing on the right?

Yes, it's the scales on the left. Click on that icon for the post you want to rep someone for. The EMTs in this thread have been awesome.

jclarkdawe
09-12-2012, 09:15 PM
I'll agree that George's approach is very plausible, but with the following caveat -- I expect the patient to show signs in other scenes of a psych problem.

Strapping is used with backboards, although sometimes you will use duct tape. If the situation is serious, or the patient is uncooperative, the patient is strapped down so tight that the backboard can be flipped upside down, with the patient on the bottom, and the patient won't move. Go down to your local rescue squad or fire department and ask if you can volunteer as a victim to see what a backboard is really like.

Definitely after a few hours strapped to a backboard, your patient is going to become very cooperative.

Best of luck,

Jim Clark-Dawe

Goblynmarket
09-13-2012, 12:09 AM
Wow this thread exploded. There isn't much I can add, that hasn't been said better. But I have a bit about recognizing eating disorders, it might help the friend notice something is up.

Bulima Nervosa has several physical signs, tears in the lining of the throat that bled, a lot of the time there are scratches on the knuckles or the fingers. One sign that I saw a lot was slight bruising or burst cappliaries around the eyes. My guess was that it was caused by painful or repeated purging. Also keep in mind these are signs of oral purging. I imagine there signs of laxative purging, but I have no expirence recognizing them.

Anorexia Nervosa, which seems closer to what you are describing, isn't simply someone looking too skinny. A lot of the time, with either bulimia or anorexia, the sufferer looks to be a 'normal' weight, even overweight. What it comes down to is long term starvation. The teeth get loose, the stomach can start to distend. The hair falls out. The body is eating itself, there is really no end the amount of bad that can come from it.

Losing hair and teeth is admittedly on the far end of the spectrum, but several kids I knew have long term medical problems from it. Heart problems, digestive problems, dental problems.

It comes down to how long your MC has been suffering with this. He probably wouldn't have a heart failure after a week, but confusion, anger, apathy are all likely.

One thing I heard a lot, but never saw, was a wonky heartbeat. I use the word wonky because I really don't understand the medical reasons for it, but here goes. Sometimes, it is possible to see the heartbeat in a very thin person that has not eaten for several days. The stomach moves as the heart beats. Like I said, I've never seen it, the occasions where the outside observer would be watching someone's stomach are few. But if the friend spends a lot of time with the MC, that may happen.

To finish this post, which is making me sad to remember things, is an expirence that is similar to your MC. The person was young, an suffered from depression, eating disorders and was prone to anxiety attacks. About once a month, typically durning a relapse and they had begun fasting/binging/purging again, something would trigger an attack and thier heart would go into arythmia and they would pass out, usually hitting thier head on something.

For your MC's friend, it is worth keeping in mind, that if you don't know what is going on, it is f'ing terrifying to see. It takes a truly level-headed person to not panic. The closer you know the person, the harder it becomes to act rashly. That could be a big moment for the friend.

.02$ plus whatever change it's worth.

Zashi
09-13-2012, 05:24 PM
Ok, I think I know what you want for your scenario. The kid is chronically malnurished due to anorexia from depression. He collapses from mild hypoglycemia in the face of moderate malnutrition. When paramedics show up, he's catatonic.
Sounds good :) My ignorance is showing, but what kind of catatonia would that be? Is it just a fancy way of saying "unconscious until hypoglycemia is addressed"?


It's layers of physical and emotional disease.
Due to the confusion of signs and symptoms
Paramedics: IV, Backboard, C-Collar, transport 15 minutes at the scene plus transport time, no intubation, but a nervous paramedic waiting by with an ET tube in hand during route
Yep :) So they're basically just being careful.


ER: Strip, exam, labs, catheter, Head and torso CT and spine films
within 1-2 hours they realize that most of his problems are emotional and they consult psychiatry to come down. The psychiatrist uses the rewards of getting rid of the backboard and C-collar and catheter as rewards to get him to start to talk
Sounds good. Though I wonder if he would be allowed to see his friend before the psychiatry consultant sees him. Even with those tempting rewards he's going to be ridiculously difficult to talk to, I bet he'd just agree to talk and then not answer questions properly. That's why I had to have his friend visit to talk to him because he'd eventually open up a little due to Plot Reasons, one of which is telling him she is his friend when he figured he had none (and really hadn't for YEARS) and never would.




And one last clarification on my above posts, because I don't want to be misread: one can have an eating disorder and be seriously (even dangerously) unhealthy but still look fine. Due to a variety of choices and disordered behaviors, one could even be of normal weight (or overweight) and have serious electrolyte disturbances leading to seizures, heart arrythmias, even death ... if not treated.
Yes, I was basically aware of this already. People with EDs often do not always look like the skeletal figures they use to raise awareness and "shock" the general populace. However, as I said, he was already skinny to begin with and I believe people with depression tend to lose weight (or sometimes gain it). I don't think my MC has anorexia (and since he's not binging or purging, not bulimia) because there is no "control" side to it, no obsessing over calories or trying to get to a certain number. Apologies to Goblynmarket who seemed to get the impression he had it based on what I said. It's basically just self-neglect and a form of self-harm. I was being a bit lazy when I said "anorexia-like symptoms", since I basically excluded the mental side. *loses amateur psychology card*


But the sort of issues you get into with eating disorders, malnutrition, and dehydration can be picked up quickly in an ED and stabilized quickly. Fixing the bigger picture, though takes a lot more work.

If there is someone here who has a friend with an eating disorder or malnutrition through depression, then they can indeed be very sick and not look ill at all. These are serious illnesses and serious problems. It's just that if someone in that state is evaluated appropriately in Emergency, it can be picked up and dealt with before the case is turned over for mental health evaluation.

For the purposes of this story, that means "not serious," because we are talking about a place set up to take care of people with major traumas and other immediately life-threatening issues. It doesn't mean that if someone is engaging in risky behaviors but looks okay to you, they don't need help.

Emergency departments are also set up to deal with people who are confused, withdrawn, manipulative, frightened, unconscious, semi-conscious, under the influence, wishing they were under the influence, forgetful, distracted, etc. It is a place to get things stabilized quickly, and that means keeping people safe who are in all sorts of complicated circumstances.
I get what you're saying. Mental illness and their effects are obviously serious issues, but in emergency departments when they're mainly focussed on fixing the physical side if it's not imminently life-threatening then it's "not serious". But you still pay attention to people exhibiting problematic behaviour, even if they look "normal". Admittedly, since I plan on turning what I'm writing into a graphic novel/webcomic, I have to have a visual side and that's partly why I'm making it fairly obvious. And I do plan on having a LOT of follow-through, nothing annoys me more when a character with a mental illness gets completely "better" by having an epiphany or seeing a therapist once, especially when it's something like depression or Social Anxiety Disorder. And my character has both of those, pretty much, with maybe a dash of PTSD from years of bullying and emotional abuse at home. So yeah, that really doesn't just go away. But the hospital scene marks the turning point of things finally starting to get just a little better. (Of course then more terrible stuff happens but I'm sadistic so yeah XD) I just wanted to address that because I get the feeling people are worried I threw depression in as a cheap plot point and am not going to deal with it properly. jclarkdawe, believe me, he shows so many signs I am going to be incredibly disappointed if no reader picks up on it and is just all "why is he moping about". I will violently slam my head against the wall repeatedly if that happens.

Also I gave every post on this a rep and comment, I don't know if you can see them or where they even come up, but uh, I clicked on the scales and did everything and a message popped up confirming it. Thanks everyone!

GeorgeK
09-13-2012, 06:59 PM
Sounds good :) My ignorance is showing, but what kind of catatonia would that be? Is it just a fancy way of saying "unconscious until hypoglycemia is addressed"?


No, the catatonia is psychiatric withdrawl from external stimuli. It has nothing to do with the hypoglycemia itself.



Yep :) So they're basically just being careful.


Sounds good. Though I wonder if he would be allowed to see his friend before the psychiatry consultant sees him.


If he's catatonic, he's not going to ask to see his friend. His friend might show up asking to see him, and if it's after the ER Dept have realized that the patient is in no immediate danger they'd normally say, "sure, just don't untie him but talking is fine." Visitors are sort of a free set of extra eyes watching people so the nurses and doctors can catch up on their notes. They'd be in the room with them just to keep an eye out but generally visitors are ok after the initial evaluation is done and the patient is considered stable. At that point the staff would also interview the friend to try to get an idea of what's been going on.

Zashi
09-14-2012, 05:39 PM
No, the catatonia is psychiatric withdrawl from external stimuli. It has nothing to do with the hypoglycemia itself.
Wait, so what would have caused it then? *confused*



If he's catatonic, he's not going to ask to see his friend. His friend might show up asking to see him, and if it's after the ER Dept have realized that the patient is in no immediate danger they'd normally say, "sure, just don't untie him but talking is fine." Visitors are sort of a free set of extra eyes watching people so the nurses and doctors can catch up on their notes. They'd be in the room with them just to keep an eye out but generally visitors are ok after the initial evaluation is done and the patient is considered stable. At that point the staff would also interview the friend to try to get an idea of what's been going on.
I'll list what I think would be the sequence of events:

He collapses, friend calls ambulance
Ambulance shows up, he's put on a backboard, then given an IV by one EMT as the other talks to his friend (or would the driver talk to her? Is it 2 EMTs plus a driver, does the driver do anything?)
As they're driving to the hospital they check his glucose level and start giving him... glucose, I guess? Would they have time to recognise and treat dehydration? That's just another fluid in the IV, right? If not I guess that'd be one of the first things they'd do in the ED.
Arrive in the Emergency department, he gets stabilised (admittedly I'm still a bit iffy on how) as they quickly run tests (X-rays, EKG, labwork) and determine nothing he doesn't have anything serious like a spinal injury or brain haemorrhage, it's just exhaustion, dehydration and malnutrition, pretty much. Extremely weird question: what kind of clothing damage would there be? As in, I'm going to have to draw this at some stage, are there specific places they rip? Also because they're only going to find the signs of self-harm if they look in a particular place, otherwise I guess whoever changes him is going to notice it and report it.
His friend turns up about when they realise he's in no immediate danger, since he doesn't need anything urgent he gets transferred to a room/ward, unstrapped from the backboard and changed into a gown because of the clothing damage. The room is supervised by a nurse and his friend comes in and waits. (Also, I assume he still has the IV in?) She's told right now that he's just sleeping. I figure even if he were stabilised medically he'd still be exhausted and want to sleep. Nurse recommends friend come back the next day, friend refuses and stubbornly insists on waiting until he wakes up, which would probably normally violate visitation hours but I don't care this time because plot, characterisation and Rule of Heartwarming.
Many hours later MC wakes up. He and friend have pivotal character development scene (would the supervising nurse be okay with waiting outside/away for a little while, or would they have to be right there at all times?). Friend leaves after a while.
Psych consultation.
He's left for a few days, probably no longer on an IV but they're gradually getting him back to eating normally.
When he's almost ready to leave they tell him he's going to have to see a counsellor/therapist at least once a week, they've instructed his teachers of what's happened, will have extra time for assignments blah blah.
Then therapy and adventure, yeah.


Are there any issues with that kind of chain of events?

jclarkdawe
09-14-2012, 06:21 PM
Wait, so what would have caused it then? *confused* Wikipedia is your friend -- Catatoni (http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=0CCIQFjAA&url=http%3A%2F%2Fen.wikipedia.org%2Fwiki%2FCataton ia&ei=sjtTUNfGB8jbqgHH14GQCQ&usg=AFQjCNFgg5p88Y-oaUSwY0YBVTzmDkE1Tg)


I'll list what I think would be the sequence of events:

He collapses, friend calls ambulance
Ambulance shows up, he's put on a backboard, then given an IV by one EMT as the other talks to his friend (or would the driver talk to her? Is it 2 EMTs plus a driver, does the driver do anything?) Talking to friend consists of "Do you know what happened?" Beyond that, I don't care about the friend. He'd also go on a heart monitor, and a strip showing his EKG will be printed out. Blood pressure and pulse would be recorded. He'd be put on O2. Blood sugar would be tested. Go down to your local rescue and offer to be the victim. They'll run this scenario on you for training.
As they're driving to the hospital they check his glucose level and start giving him... glucose, I guess? Would they have time to recognise and treat dehydration? Dehydration is diagnosed in the field by the 'pinch test.' You pinch some skin into a tent, then watch how fast the tent disappears. If you know some elderly, you can try this on them for comparison. Most elderly have some level of dehydration. That's just another fluid in the IV, right? No. It's the fluid that is the IV. If not I guess that'd be one of the first things they'd do in the ED.
Arrive in the Emergency department, he gets stabilised (admittedly I'm still a bit iffy on how) as they quickly run tests (X-rays, EKG, labwork) and determine nothing he doesn't have anything serious like a spinal injury or brain haemorrhage, it's just exhaustion, dehydration and malnutrition, pretty much. Extremely weird question: what kind of clothing damage would there be? Clothing damage is done usually by the EMTs first. We remove everything we need to in order to see what's going on. Nothing better then a biker with a new leather coat. Snip, snip, snip. As in, I'm going to have to draw this at some stage, are there specific places they rip? Also because they're only going to find the signs of self-harm if they look in a particular place, otherwise I guess whoever changes him is going to notice it and report it.

Are there any issues with that kind of chain of events?

Best of luck,

Jim Clark-Dawe

GeorgeK
09-14-2012, 10:10 PM
Wait, so what would have caused it then? *confused*


His depression. He's so fed up he just witdrawls into his mind.




I'll list what I think would be the sequence of events:

He collapses, friend calls ambulance
Ambulance shows up, he's put on a backboard, then given an IV by one EMT as the other talks to his friend (or would the driver talk to her? Is it 2 EMTs plus a driver, does the driver do anything?)Whatever there, the driver will do as much as is needed according to their educational qualifications. They might only drive, they might check vitals and put in IV's.


As they're driving to the hospital they check his glucose level and start giving him... glucose, I guess?
In isotonic fluid with either glucose in it or added to it. D5 (5% glucose) Normal Saline would be reasonable.


Would they have time to recognise and treat dehydration?start treatment, but not complete it and yes that's IV fluid, which they will continue in the ER


That's just another fluid in the IV, right? If not I guess that'd be one of the first things they'd do in the ED.
Arrive in the Emergency department, he gets stabilised (admittedly I'm still a bit iffy on how) as they quickly run tests (X-rays, EKG, labwork) and determine nothing he doesn't have anything serious like a spinal injury or brain haemorrhage, it's just exhaustion, dehydration and malnutrition, pretty much. Extremely weird question: what kind of clothing damage would there be? As in, I'm going to have to draw this at some stage, are there specific places they rip? Also because they're only going to find the signs of self-harm if they look in a particular place, otherwise I guess whoever changes him is going to notice it and report it.They use bandage scissors and litteraly cut the clothes off people. You don't rip them because that creates force against the body and you never know if there's some foreign object partially penetrating an unseen part of the body that will be dislodged or forced deeper if one, rips. The clothes will be in ribbons


His friend turns up about when they realise he's in no immediate danger, since he doesn't need anything urgent he gets transferred to a room/ward, unstrapped from the backboard and changed into a gown because of the clothing damage. The room is supervised by a nurse and his friend comes in and waits. (Also, I assume he still has the IV in?)
IV in until fluids are repleated and he's ready to be transferred to a psych floor


She's told right now that he's just sleeping. I figure even if he were stabilised medically he'd still be exhausted and want to sleep. Nurse recommends friend come back the next day, friend refuses and stubbornly insists on waiting until he wakes up, which would probably normally violate visitation hours but I don't care this time because plot, characterisation and Rule of Heartwarming.Visiting hours are more of guidelines. Visitors who don't seem like assholes and don't make noise are often, "missed," when it comes time to say that visitors have left. It wouldn't even be unusual for the nurse to get the visitor a blanket and pillow while they waited.


Many hours later MC wakes up. He and friend have pivotal character development scene (would the supervising nurse be okay with waiting outside/away for a little while, or would they have to be right there at all times?). If the nurse feels the patient is safe, sort of anything goes


Friend leaves after a while.
Psych consultation.
He's left for a few days, probably no longer on an IV but they're gradually getting him back to eating normally.Most likely he won't go to the psych floor until the IV is out, but that would not probably be more than about 24 hours after arriving in the ER


When he's almost ready to leave they tell him he's going to have to see a counsellor/therapist at least once a week, they've instructed his teachers of what's happened, will have extra time for assignments blah blah.
Then therapy and adventure, yeah.

Are there any issues with that kind of chain of events?

asroc
09-14-2012, 11:25 PM
Ambulance shows up, he's put on a backboard, then given an IV by one EMT as the other talks to his friend (or would the driver talk to her? Is it 2 EMTs plus a driver, does the driver do anything?)
As they're driving to the hospital they check his glucose level and start giving him... glucose, I guess? Would they have time to recognise and treat dehydration? That's just another fluid in the IV, right? If not I guess that'd be one of the first things they'd do in the ED.



The IV should be started en route and the fluid given through the IV would be normal saline. Itís a fluid replacement and treats dehydration. If the patient is both unresponsive and actually hypoglycemic (in our protocol thatís a blood glucose level of 70 or below and this combination is almost never seen in non-diabetic people) he receives whatís called D50, a mixture of 50% water, 50% dextrose (same thing as glucose in this context). It comes prepackaged and is administered IV push, which means itís injected through the IV catheter with a syringe while the saline is running. They may administer thiamine before the D50.

As for how many EMTs, that can vary, especially if the responding service is a volunteer outfit, but if itís a professional service, like what youíd find in cities, you get two people per truck, both EMTs. One drives, one treats the patient in the back. For this sequence of events at least one of them has to be a paramedic.

Zashi
09-15-2012, 09:08 PM
Talking to friend consists of "Do you know what happened?" Beyond that, I don't care about the friend. He'd also go on a heart monitor, and a strip showing his EKG will be printed out. Blood pressure and pulse would be recorded. He'd be put on O2. Blood sugar would be tested. Go down to your local rescue and offer to be the victim. They'll run this scenario on you for training.
So assuming only two people, say a paramedic with an EMT as the driver, they both quickly strap him to the backboard. As they're doing so and loading him into the ambulance/van they ask his friend what happened. IV gets inserted by paramedic, EMT starts driving to the hospital. En route the heart monitor, EKG etc. is hooked up. O2 means he's given a mask connected to oxygen, right? Blood pressure+pulse recorded and blood sugar tested all while travelling to hospital. (Or would they not be able to get all that done in that time? Approximately how long would it take? They're really not that far from the hospital.)


In isotonic fluid with either glucose in it or added to it. D5 (5% glucose) Normal Saline would be reasonable.
This is going to sound like the weirdest question, I tried googling it but it kept saying things about "half normal saline", but is that just a default bag they hook up? Or do they hook up saline with nothing else in it first, check blood sugar, then inject the D5 somewhere? Or do they just swap the bag out with one labelled (and containing) D5 Normal Saline?

start treatment, but not complete it and yes that's IV fluid, which they will continue in the ER

The IV should be started en route and the fluid given through the IV would be normal saline. It’s a fluid replacement and treats dehydration. If the patient is both unresponsive and actually hypoglycemic (in our protocol that’s a blood glucose level of 70 or below and this combination is almost never seen in non-diabetic people) he receives what’s called D50, a mixture of 50% water, 50% dextrose (same thing as glucose in this context). It comes prepackaged and is administered IV push, which means it’s injected through the IV catheter with a syringe while the saline is running. They may administer thiamine before the D50.
Okay, so saline treats dehydration, gotcha. But uh you've now said D50 and before it was D5, I get that it's because you're assuming hypoglycaemia. Since you've said it's almost never seen in non-diabetic people and I feel like going the "special snowflake" route in this regard is a little stupid just so I can use the word "hypoglycaemic" in a diagnosis, I'll probably just stick the much milder D5. Or should I compromise and go D10 or D20 or something? #likeiknowanything

They use bandage scissors and litteraly cut the clothes off people. You don't rip them because that creates force against the body and you never know if there's some foreign object partially penetrating an unseen part of the body that will be dislodged or forced deeper if one, rips. The clothes will be in ribbons
I researched this (okay, pretty much just googled "EMT cut clothes off") and this link of EMTs talking about when to cut clothes off (http://www.emtlife.com/showthread.php?t=29955) was pretty interesting. Because I get if they have to cut his shirt to put an IV in and get his blood pressure, but if there's no indication of physical trauma on his legs, would they still be trying to cut the pants off him? Also I'm going to assume major clothes-destroying happens in the privacy of the back of the ambulance during transit. Hopefully.

IV in until fluids are repleated and he's ready to be transferred to a psych floor

Most likely he won't go to the psych floor until the IV is out, but that would not probably be more than about 24 hours after arriving in the ER
So say IV in still while he's sleeping and during talk with friend. Sometime the next day it's removed, but he's still hooked up to heart monitors and stuff so when he's eating/drinking orally they make sure nothing bad happens. Psych consultant comes around, leaves, awkward sitting around for a couple of days. It just occurred to me, how does one get transferred to the psych floor? Are there any specific minimum requirements? I mean, if they figure he's not a danger to anyone else but "just" has major depression, does he still qualify? Is the point of the psych floor just to start therapy while they're being supervised/contained? How would they deem someone to be ready to leave?

Visiting hours are more of guidelines. Visitors who don't seem like assholes and don't make noise are often, "missed," when it comes time to say that visitors have left. It wouldn't even be unusual for the nurse to get the visitor a blanket and pillow while they waited.
Excellent :D Pretty much exactly what I need for that scene, haha.

If the nurse feels the patient is safe, sort of anything goes
Safe? Like from himself, or from the friend? I guess I can just make the nurse feel he's safe because plot, anyway, it's needed.

I feel it bears repeating that all of you are amazing and wonderful and ridiculously patient with me and my not understanding what probably seems like kindergarten stuff to you :)

asroc
09-16-2012, 05:41 AM
So assuming only two people, say a paramedic with an EMT as the driver, they both quickly strap him to the backboard. As they're doing so and loading him into the ambulance/van they ask his friend what happened. IV gets inserted by paramedic, EMT starts driving to the hospital. En route the heart monitor, EKG etc. is hooked up. O2 means he's given a mask connected to oxygen, right? Blood pressure+pulse recorded and blood sugar tested all while travelling to hospital. (Or would they not be able to get all that done in that time? Approximately how long would it take? They're really not that far from the hospital.)

You can get that done within a few minutes. The cardiac monitor keeps track of blood pressure, pulse and EKG for you.


This is going to sound like the weirdest question, I tried googling it but it kept saying things about "half normal saline", but is that just a default bag they hook up? Or do they hook up saline with nothing else in it first, check blood sugar, then inject the D5 somewhere? Or do they just swap the bag out with one labelled (and containing) D5 Normal Saline?
Half-normal saline is water with 0.45% NaCl. It's not usually carried by EMS. The default bag is normal saline, water with 0.9% NaCl. D50 would be injected into the injection port in the IV tubing or catheter. D5 isn't used to treat hypoglycemia in the field.


Okay, so saline treats dehydration, gotcha. But uh you've now said D50 and before it was D5, I get that it's because you're assuming hypoglycaemia. Since you've said it's almost never seen in non-diabetic people and I feel like going the "special snowflake" route in this regard is a little stupid just so I can use the word "hypoglycaemic" in a diagnosis, I'll probably just stick the much milder D5. Or should I compromise and go D10 or D20 or something? #likeiknowanything
I've always said D50. D5 is only used to mix with a couple of meds and many services don't carry it at all.
D10 is okay to use, though. It's often used for hypoglycemic infants and some services use it for everyone. Around here it's against protocol at the moment, although I wouldn't mind switching. Pushing D50 isn't easy.

Re: cutting clothing, some EMTs really like to shred stuff, but I only cut off what's definitely necessary and I don't see the necessity of cutting MC's pants. I do it in the truck if at all possible and if I have to do it on the side of the road I try to have a sheet ready to cover the patient up. I may be crabby but not mean.

jclarkdawe
09-16-2012, 06:14 AM
You can get that done within a few minutes. The cardiac monitor keeps track of blood pressure, pulse and EKG for you.

And you do as much as you can either before loading or before you start driving. You can do a lot of this while you're rolling, but it's a lot harder and mistakes are easier.

Best of luck,

Jim Clark-Dawe

GeorgeK
09-16-2012, 02:29 PM
Generally the cutting off of clothes is done in the ER rather than in the field. If a patient needs a backboard, the paramedics need the clothes as handles. Trauma patients are slippery due to blood, vomit, gasoline and grime all over them and slippery patients are hard to secure safely on a backboard. In a non autowreck non-bloody situation like the OP, there is little need for the paramedics to disrobe the patient as any injuries are obviously internal. In the ER they need to do a much more thorough exam.

D5 1/2 normal saline is a maintenence fluid. To rehydrate someone or to maintain blood pressure you need isotonic fluids namely normal saline or lactated ringers solution. Generally the paramedics don't use ringers because of the potassium in it. Since they often don't know the patients' history including medications and there isn't an easy test for serum potassium in the field, they usually don't use it. Too much potassium is fatal.

Safe as in safe from self, from friend, from little grey aliens whatever

Hypoglycemia does not require diabetes. There are many reasons for hypoglycemia. It can be from not eating for a relatively prolonged time, or caused by a variety of medicines. Someone who is clinically hypoglycemic might look like they've had a stroke or comatose or might look catatonic, they might be very disoriented. A shot of sugar can treat it acutely. D50 means 50% glucose (dextrose). D5 means 5%. D5 will be in large IV bags. D50 will be in ampules that the paramedic or nurse will draw up in a syringe and then inject through the IV line. In patients of unknown glucose metabolism and in the acute phase of an injury it's better to err on the slightly high side for glucose. You can always use insulin later if it's too high. That's why IV fluid is usually D5. For maintence fluids in someone without metabolic problems regarding glucose and not on medicines likely to be an issue adding sugar to IV fluid is unnecessary and can be even counterproductive in some patients.

Zashi
09-18-2012, 06:17 PM
(Sorry for the somewhat belated response)

Thanks everyone! I think I have a pretty clear idea of how things are going to run now, and hopefully won't make anyone who knows anything about ambulances and hospitals shake their heads at glaring inaccuracies when they look at my stuff. You're all awesome :D