Concussions and Hospital Treatment Thereof

Yes...

There are varying opinions but if he had a seizure they'd want to keep him. They might even put in an intracranial pressure monitor.

Something else to consider is health insurance. My experience comes from when I was 17 and had a pretty severe traumatic brain injury due to a car accident (in a coma for 11 days, hospital for 21 days, rehab for several weeks), so it may not be totally applicable to your situation, but hopefully this will give you some ideas.

Since I was unconscious, obviously I had to be kept in a hospital, and the ambulance took me to a large teaching hospital nearby. This wasn't one of the "approved" hospitals under my insurance plan, and they told my parents quite bluntly that as soon as I was stable enough to be moved to one of their approved hospitals, I would be. ("stable" in this case meant either waking up from the coma, or being in the coma for 4 weeks which would be classified as "persistent vegetative state".)

Through a rather divine coincidence, I woke up from the coma two days before Thanksgiving, and none of the "approved" hospitals were willing to take a new patient so soon before a holiday. By the the time they were willing to take a new patient, I had improved enough to go home.

Also- obviously I couldn't give a report to the police immediately after the accident, since I was unconscious and not in good health. But even today (twelve and a half years later), I have absolutely no memory of the accident. None. Nada. Yay amnesia!

When I was in the ER, I was given a CT scan. As I understand it, that is the standard way they diagnose brain injuries (though the doctors on this forum are welcome to correct me). I also had LOTS of other x-rays due to various broken bones and suspected broken bones.

I'm not a doctor but as I understand it, a mild to moderate traumatic brain injury would cause unconsciousness for between 30 minutes and 24 hours. So you can fill in the blanks - have him unconscious for three or four hours - and I think that would easily result in a 2-3 day stay in the hospital.

You can also give him a very mild concussion (minimal or no unconsciousness) as well as a severely broken bone that might require surgery. That should give you 24 hours easily, and you could say they want to keep him a little longer due to a "less than optimal reaction to anesthesia".

On top of that, the timing of your accident can affect it. If the accident happens late on a Friday or Saturday night, and he needs surgery, they may not be able to get a full surgical team together until 24 or 48 hours after the surgery.

Just some thoughts that I hope will be useful.

As writers, I think we specialize in overcomplicating stuff.

I am SURE that they use general anesthesia for broken-bone-surgeries at least sometimes. I used to volunteer at a hospital (wayyyy back when I was in junior high), and there were at least a few kids who had to have surgeries to set broken bones. Sometimes they'd have to stay overnight, which kind of goes back to what I said earlier about the timing of accident. This hospital where I volunteered was a smallish hospital that virtually never dealt with serious traumas. (Most of their business came from the nearby nursing homes.) Unlike the giant teaching hospitals, they didn't have their operating rooms going 24/7, or have every imaginable specialty of doctor on call 24/7. So if a patient came into their ER needing surgery outside business hours, they would either be transferred to a different hospital that could do the surgery ASAP, or they would be stabilized, given painkillers, and sent to a room where they could rest until morning.

Another thought, as far as the amnesia/details of the accident- do you want him to not remember the accident at all, or to remember something that is not correct?

For one thing, a really mild concussion would be a pretty easy thing to add. I don't think it even requires that he loses consciousness, just that he is a little confused or not remembering the accident/not remembering it correctly. ("Officer, I am positive that I was hit by a red car!" when in fact the car was blue.) But also, the brain is a funny thing, and sometimes when you experience a really traumatic event, the brain just does not process it into long term memory. So you may not remember (or not remember very well) when you were diagnosed with a terminal disease, or when your parent/spouse died, or when you were assaulted. (Have you ever heard someone say "The doctor said it was cancer, and everything was a blur after that" or something similar?)

Ooo another thought - for keeping him in the hospital for a few days - could he have some kind of minor abdominal bleeding, which requires abdominal surgery to repair? The one that comes to mind would be a lacerated spleen, although a laceration of the liver might do it too. (Need some of the doctors to chip in here!)

Abdominal surgery would DEFINITELY keep him there for a few days, although it would probably take awhile before he was back to 100%. Also if he's in a lot of pain, his mind might block out the memory of the accident.

I'm not a medical professional, but IMO that sounds reasonable. For "weekend cases" like that, like I said, he'd probably be admitted and given painkillers until they could do the surgery. They'd probably also limit his food intake, since I think you're supposed to have an empty stomach before anesthesia.

I think you can plausibly have him in the hospital 2-3 days without a seizure. Maybe they need to keep his arm really stable (not moving at all) to make sure the bone sets right.

As far as seeing the man that no one else sees - you could even have NO concussion/brain injury. The police tell the docs to look because he's "talking crazy" but there are no brain injury symptoms. Maybe the docs even order a psychiatric consult. But as long as the evidence doesn't support his story (ie they can't find the guy he claims he saw) i don't think he needs a brain injury to make his story questionable.

justbishop said:

Is there a doctor in the house?

I need some quick help on what a realistic series of events would be for a 17 y/o boy in the hospital after a car accident. I need him to have a head injury (so that details he gives about the accident are called into question), and I need him to be kept in the hospital for 2-3 days. I currently have it written as a grade IV concussion, but the info online I'm finding is saying he'd be observed for 8 hours and sent home with instructions to come back immediately if he develops any one of a laundry list of symptoms.

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witha concussion you'll usually get an xray to make sure you haven't fractured anything and then, so long as you aren't sick ior faint or having any other complications, you'll usually be sent home so long as there is someone with you to keep an eye on you.

One of the symptoms necessitating a return trip is seizure. Would he be kept if he had suffered a seizure within that 8 hour observation period? For how long? The stuff I've read tells me they'd do a CT scan to check for surgical lesions if he developed seizure activity. Would that be a rush thing or more of a "we'll keep an eye on you and schedule it for tomorrow" deal?

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It depends.

If he has no history of seizures and no obviousl reason why then they may do a CT scan. but bear in mind that people have seizures for lots of non-brain related instances and usually observance is the preferred 'diagnostic;'

Generally they would keep him in and observe. however, what treament/diagnositc he gets depends on where he is, his history and if he's getting private treatment - for instance, as an 'emergency' case I ha to wait 9 months for an MRI in the UK.

I've had several concussions - one really bad one when I fell off a horse and was dragged behind it for half a mile - I fractured my skull and had a bad concussion, but otherwise I was pretty lucky. I was sick as a dog for days - the nauseous feeling is indescribable. I was xrayed and sent home later that night.

And also, at any point would they give him a sedative if he's not intubated or suffering from an open or depressed skull fracture (or post-surgery)?

Thanks!

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Probably not. A sedative can mask other problems - for instance, the patient might not report a pain etc, however, they MIGHT give a sedative if they take the patient for an MRI - the first time I had an MRI I had a full blown panic attack. they give you a panic button but I couldn't squeeze it hard enough to make it work

Sounds good to me.

One thing I remember from the time of my accident (which I think plays right into your scene) is just being tired all the time. I actually don't remember much from the hospital, but in rehab and the months afterward, going back to school - by the end of the day I'd be totally wiped out. I was sleeping 10ish hours most nights. That all stemmed from the trauma - my body was working hard to repair the injuries, which left very little energy for school and other stuff. Of course my injuries were much more serious, but him not moving much, barely opening his eyes- to me that makes a lot of sense.

justbishop said:

At the moment, the nurse walks into the waiting room and says "He's stable now. Come on, I'll take y'all in." The MC sees him in the hospital bed, looking "so small in the midst of all of the beeping and whirring machinery." When he talks to her, he doesn't move his head/body, just looks at her through the corners of barely opened eyes. At the end of the scene, she touches fingertips to the palm of his "good hand" and he very loosely tightens his grip around them. End of scene.

Any of that sound wrong?

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Yes, sorry. It reads like TV medicine.

The nurse is not going to assure them he's stable now because with minor injuries like that he would never be unstable. "Beeping and whirring machinery" implies Critical Care, where this patient has no reason to be (plus all hospitals I've ever been to turn off all the noises except alarms). Mild concussions and wrist fractures don't need to be monitored beyond someone poking in the room every so often and regular hospital rooms only have machinery if the patient's condition calls for it.

sorry to be late to the party but i would recommend that you look at a site like webmd.com they have lots o information on medical issues. from first aid to life issues.

end o my 2 cents

justbishop said:

Hm. It would definitely be a smallish hospital, and this accident takes place on a Sunday morning. I went ahead and wrote the scene with him having a broken wrist, so I can just have a surgery be scheduled for the following morning. Does that seem right?

The MC was in the car when it happened, does not lose consciousness, and sees the character in question (who was driving) unconscious at the time of the accident. I'm imagining him unconscious for 5 minutes or so. With the broken wrist needing surgery that won't happen until the next day, I'm assuming I can toss out the seizure element? Or would it be good to write in as happening that night or the next day or something so they keep him a second or third night? In my timeline I have him going home on Wednesday afternoon, but I could possibly move that up to Tuesday.
.

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Waiting a day to fix the wrist would be normal if they are concerned about his mental status. Most wrist fractures don't require surgery to fix, but some do. They'd also seriously consider a regional block rather than a general anaesthetic in someone with recent head trauma.