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Zanystarr
04-15-2014, 02:07 AM
I am in need of a head nurse to give me advice for my book. I basically need a description of their day-to-day duties, and also an answer to some specific questions as it pertains to my novel. I'd appreciate any help I can get.

Cath
04-15-2014, 02:27 AM
Please be more specific.

For example:

Is the setting rural or city? In what country? Where does the nurse work? In a hospital? A doctor's surgery? A school? On a film set? What's his or her specialty? Emergency medicine? Geriatric? Cancer care? Etc. etc. etc.

Please detail the specific questions you have here. You might also want to check out the forum guidelines here (http://absolutewrite.com/forums/showthread.php?t=248198).

Zanystarr
04-15-2014, 03:52 AM
The settings is in a small town, Stow, OH. The nurse is head nurse at Summa Akron City Hospital. She's mostly an emergency nurse, but I didn't know that nurses had specialties.I need to know the procedure do when a preteen boy (12 years old) is brought in with a bullet wound to the head, and the complications that would arise in the situation that would still allow him to live. As for the police sergeant, like I said, I just need the general day to day duties and what they are responsible for in a criminal investigation.

sheadakota
04-15-2014, 04:30 AM
she either would or wouldn't be an ER nurse. Yes nurses have specialties. you certainly wouldn't want an OB/GYN nurse taking care of an open heart or a fresh trauma.

Any nurse can be the 'head nurse' we all take turns ( at least where I work) we call it charge nurse. but if you are talking about a nursing supervisor that is totally different- they are nurses in a management position- they do not take care of patients- rather they handle staffing and other problems that involve the running of the hospital.

There is a lot involved in your question that cannot be answered with out more details.

sheadakota
04-15-2014, 04:36 AM
The settings is in a small town, Stow, OH. The nurse is head nurse at Summa Akron City Hospital. She's mostly an emergency nurse, but I didn't know that nurses had specialties.I need to know the procedure do when a preteen boy (12 years old) is brought in with a bullet wound to the head, and the complications that would arise in the situation that would still allow him to live. As for the police sergeant, like I said, I just need the general day to day duties and what they are responsible for in a criminal investigation.

Okay, I work in critical care- adult intensive care- but much of this can pertain to pediatric ICU as well ( anyone under 18 is considered pediatric)

first of all with the scenario you describe- a trauma of that magnitude coming into a small hospital- First- they probably would have never brought him there to begin with- small hospitals are not equip to handle traumas such as the one you described.

BUT if they are the closest hospital then they would bring him there- stabilize the best they can ( not easy) then fly him to the nearest level one trauma center. So if any of that is acceptable to you- then I will address what happens next _ the "head" nurse however would have very little to do with any of this.

Zanystarr
04-15-2014, 06:29 AM
I appreciate the help. Thank you for differentiating between head nurse and charge nurse. As for Summa Akron, it's actually a really big hospital; it's the closest major hospital to Stow/Cuyahoga Falls. The exact situation is this; the boy was shot from about a ten-foot distance, and the bullet was in his skull, but not in his brain. The doctors stabilized him, then performed surgery to remove the bullet before it migrated into the brain. When they started the surgery, they realized it was too late; the bullet had slid into the brain, and they had to search for it. In the book, the kid survived the surgery, with some minor brain swelling, but no neurological damage. I basically need to know if that would be at all possible, even with the slightest of chances.

sheadakota
04-15-2014, 06:40 AM
I appreciate the help. Thank you for differentiating between head nurse and charge nurse. As for Summa Akron, it's actually a really big hospital; it's the closest major hospital to Stow/Cuyahoga Falls. The exact situation is this; the boy was shot from about a ten-foot distance, and the bullet was in his skull, but not in his brain. The doctors stabilized him, then performed surgery to remove the bullet before it migrated into the brain. When they started the surgery, they realized it was too late; the bullet had slid into the brain, and they had to search for it. In the book, the kid survived the surgery, with some minor brain swelling, but no neurological damage. I basically need to know if that would be at all possible, even with the slightest of chances.

unless it's an air pellet gun, there is no way a bullet is going to hit his head without entering his brain. not even with a .22. plus even if a bullet somehow was in his skull, it is never going to slide into his brain- simply is not going to happen- a foreign body lodged in bone does not travel.

second- there is no such thing as 'minor brain swelling' all swelling to the brain is life threatening. all swelling will lead to neurological damage of some sort- some is permanent and some is not. hate to be a wet blanket but your scenario simply is not realistic.

Zanystarr
04-15-2014, 07:18 AM
Thanks for that. I appreciate the honesty because it lets me know that I need to change it. Is there any way that it might enter his brain, but he would still survive?

NeuroGlide
04-15-2014, 07:25 AM
Akron City is a major hospital, but there's a good chance they'ld take the kid to Akron Childrens instead. Both Akron General and Akron City (both owned by Summa Medical Group) have their Neo-natal ICU's run by Childrens. Kids also has a Emergency Room at 5655 Hudson Dr. on the south side of Hudson/north side of Stow. It's a lot closer, but it's not a Trauma Center. All they could do is stabilize and pack for air-ship.

sheadakota
04-15-2014, 07:38 AM
Sure, it could enter his brain and he could survive- low velocity bullet- but the kid is still going to have deficits. depends on where it enters how close he was to the shooter. what type of gun, what type of bullet. Its your story, if you want him to survive, then have him survive. But so you know- recovery for this type of injury is years. depending on the deficits. give me a better idea of what you want the end game to be.

Zanystarr
04-15-2014, 07:52 AM
I want him to be healthy and okay. Like I said, the shooter was about ten feet away. It was a small hand gun, a 3680 hi-point. I just don't know what kind of bullets go with that, but I can google it. If it were a low velocity bullet, how long do you think it would be before he went home, assuming all of the healing went well with no complications?

NeuroGlide
04-15-2014, 07:58 AM
Thanks for that. I appreciate the honesty because it lets me know that I need to change it. Is there any way that it might enter his brain, but he would still survive?

It might be more plausible to have the bullet not enter his brain at all. A bullet is sterile when fired, but it will push skin, hair and cloth into the wound cavity. The bullet impacts and fractures the skull, creating a pathway for bacteria and fungi to enter the brain cavity and infect the meninges.

NeuroGlide
04-15-2014, 08:00 AM
I want him to be healthy and okay. Like I said, the shooter was about ten feet away. It was a small hand gun, a 3680 hi-point. I just don't know what kind of bullets go with that, but I can google it. If it were a low velocity bullet, how long do you think it would be before he went home, assuming all of the healing went well with no complications?

9mm handgun. You'll need another Timmy.

Try a .22LR. Who's the shooter.

Zanystarr
04-15-2014, 08:24 AM
The shooter was a man who kidnapped the boy...the boy escaped on the road while the man was changing a tire (it was his first time Kendall anybody and he wasn't very smart about it) when the boy escaped, the man's first instinct was to shoot him, hoping to kill him so that he wouldn't reveal who had taken him.
1) what do you mean I'll need another Timmy?
2) is that gun (.22LR)more likely to have the boy survive?
3) do you think it's a better idea to have the bullet enter the neck, or is it possible that the bullet would enter the skull and just stay there?
4)if the bullet stayed lodged in the skull, would it absolutely have to be removed through surgery, or would it be safer to just leave it in the skull than to attempt surgery on a 12 year old?

ULTRAGOTHA
04-15-2014, 08:33 AM
10 feet is awfully close. I'd back the shooter up or use a waaaay smaller caliber gun.

You could have the bullet hit the head and fracture the skull but not enter. Sort of slide along one side of the head. That's going to cause a lot of trauma with a long recovery time but not as bad as a bullet actually penetrating the skull.

I think some research into head injuries caused by bullets would help you formulate more specific questions. Look up Representative Gabby Giffords. She was shot in the head in 2011 and is still recovering.

Trebor1415
04-15-2014, 08:42 AM
The shooter was a man who kidnapped the boy...the boy escaped on the road while the man was changing a tire (it was his first time Kendall anybody and he wasn't very smart about it) when the boy escaped, the man's first instinct was to shoot him, hoping to kill him so that he wouldn't reveal who had taken him.
1) what do you mean I'll need another Timmy?
2) is that gun (.22LR)more likely to have the boy survive?
3) do you think it's a better idea to have the bullet enter the neck, or is it possible that the bullet would enter the skull and just stay there?
4)if the bullet stayed lodged in the skull, would it absolutely have to be removed through surgery, or would it be safer to just leave it in the skull than to attempt surgery on a 12 year old?

Google up "James Brady Reagan shooting." Brady was the White House Press Secretary who was shot in the head during the assassination attempt on Pres Reagan in 1982 (I think '82?).

Brady was lucky. The bullet was only a .22 which is the only reason he wound up having any small chance of surviving after truly heroic brain surgery by one of the top brain surgeons in the U.S. His recovery afterwards took months/years and was not complete. He suffered serious brain damage, is confined to a wheelchair, his partial paralysis, speech impediments, memory loss, loss of fine motor skills, and other medical issues. And, to top it all off, he is the "miracle example" of this of injury.

So, in short, if your little Timmy gets shot in the actual BRAIN with any handgun round, expect him to be killed outright, die in surgery, or, at best, be another Jim Brady.

I do have a suggestion: Bullets do funny things and the skull is actually a fairly hard target. It is designed to be armor for the brain, after all. It is definitely possible for the shooter to hit Timmy in the skull and hit at exactly the right angle where the bullet deflects off and doesn't penetrate into the skull or brain. It's not "lodged in the skull" so much as deflected away.

This does actually happen in real life. It's more likely with a smaller caliber, like a .22 or standard pressure .38 Special, but has been known to happen even with 9mm or .45 ACP handgun rounds. Just sometimes the shooting victim gets lucky.

If the bullet deflects off the skull the victim will still have a nasty, bloody, head wound, which will require medical attention, but won't leave any real permament damage, outside of a scar. He'd essentially have the wound cleaned and sutured and be released after some observation.

If you want complications he could suffer a concussion, if not from the gunshot, then from falling after the shock of being shot. (Not literally "knocked off his feet" by the impact so much as losing his balance and falling and hitting his head).

If want major complications you could have the risk of brain bleeding, but that is life threatening and he's going to require surgery and recovery. There's also the chance a skull fragment could "spall" off and penetrate the brain for an even more severe injury.

Personally, I'd give him the "nasty looking" bloody head wound, a headache, and possibly the concussion from falling and stop there. That would require medical attention and possibly hospital admission for the concussion, but wouldn't require an exceptionally long recovery.

ULTRAGOTHA
04-15-2014, 08:43 AM
1) what do you mean I'll need another Timmy?
2) is that gun (.22LR)more likely to have the boy survive?
3) do you think it's a better idea to have the bullet enter the neck, or is it possible that the bullet would enter the skull and just stay there?
4)if the bullet stayed lodged in the skull, would it absolutely have to be removed through surgery, or would it be safer to just leave it in the skull than to attempt surgery on a 12 year old?

NeuroGlide means Timmy (your boy) will die if he's shot in the head at 10 feet with a 9mm.

Yes, much more likely to survive a head shot at 10 feet with a .22.

A bullet entering the neck might be worse. Could be better.

There's no room for anything inside the skull except the brain. If a bullet lodges in the brain it's almost always got to come out.

What do you WANT to have happen? How long do you want your boy to be in hospital? What kind of ongoing medical and neurological problems do you want him to have one, two, three, four or more years down the road?

NeuroGlide
04-15-2014, 08:46 AM
The shooter was a man who kidnapped the boy...the boy escaped on the road while the man was changing a tire (it was his first time Kendall anybody and he wasn't very smart about it) when the boy escaped, the man's first instinct was to shoot him, hoping to kill him so that he wouldn't reveal who had taken him.
1) what do you mean I'll need another Timmy?
2) is that gun (.22LR)more likely to have the boy survive?
3) do you think it's a better idea to have the bullet enter the neck, or is it possible that the bullet would enter the skull and just stay there?
4)if the bullet stayed lodged in the skull, would it absolutely have to be removed through surgery, or would it be safer to just leave it in the skull than to attempt surgery on a 12 year old?

1) Old Dinosaurs TV show. A character on one of their TV shows died each week. His name was Timmy. It (their show) was live action.

2) Yes, 22LR is a varmint round, low power, meant for small animals. nine mm para is a combat round. A skull hit from that and the parents would be looking at a closed casket funeral.

3 & 4) Double check with the medical experts, but a strike along the side of the jaw, ricocheting up into the nasal cavities could give you the injury you want. They might choose to leave it. The fractures this creates would make meningitis possible, especially if he's laying in the dirt for a while.

NeuroGlide
04-15-2014, 08:50 AM
Yes, much more likely to survive a head shot at 10 feet with a 22mm.

You mean caliber, right? Not an autocannon round, right? :D

Zanystarr
04-15-2014, 09:07 AM
This is all super helpful. Thank you guys so much.I believe I'll end up changing it so that it deflects off the skull, they stitch him up, and he ends up with a concussion. I really only want him to be in the hospital for a few days, with very few residual effects besides the scar and some traumatic memories.The boy (his name is Mike) ends up being really close to the main characters because they saved his life.

Trebor1415
04-15-2014, 09:22 AM
This is all super helpful. Thank you guys so much.I believe I'll end up changing it so that it deflects off the skull, they stitch him up, and he ends up with a concussion. I really only want him to be in the hospital for a few days, with very few residual effects besides the scar and some traumatic memories.The boy (his name is Mike) ends up being really close to the main characters because they saved his life.

You should have someone mention how lucky he was that it did deflect off the skull, especially if it's anything larger than a .22. Like I said, it has been known to happen, but it's really lucky for the person shot when it does.

Oh, and it should be a "glancing" hit, off the side of the skull, not a perfect shot right between the eyes or anything.

Zanystarr
04-15-2014, 09:33 AM
Yeah, I will. I'll make it a big deal that he got so lucky, to only come away from it with a concussion. Now, for the .22LR... is that a type of bullet or a type of gun? Or both? (I know absolutely nothing about guns, as you can see).

Trebor1415
04-15-2014, 12:29 PM
Yeah, I will. I'll make it a big deal that he got so lucky, to only come away from it with a concussion. Now, for the .22LR... is that a type of bullet or a type of gun? Or both? (I know absolutely nothing about guns, as you can see).


Oh vey. There is a firearms thread here you should browse. Search under my name and you'll find it as I've posted to it quite a bit. Just browse in general and you'll learn things and answers to questions you don't even know to ask.

Caliber: The caliber of a handgun is the nominal measurement of the diameter of the bullet (projectile) it fires. I say "nominal" measurement because sometimes the caliber designation and the actual precise measurements differ slightly for reasons too complex and obscure to explain here.

".22 LR" is the name of a specific type of ammunition. A .22 LR cartridge is a complete round of ammunition (brass cartridge case, propellent (gunpowder), primer (to set off the propellent) and bullet (the actual projectile) that is 22/100th of an inch in diameter.

That 22/100 of an inch is expressed in decimal as .22. The "LR" stands for "Long Rifle" to identify this as the type of .22 cartridge that is longer than the older .22 Short and .22 Long cartridges. (Don't let the "rifle" part in the name fool you, it is both for rifles and handguns).

The .22 LR cartridge is for small game hunting (rabbits, squirrels, etc) and target shooting. It fires a smaller, lighter bullet, with less recoil than larger caliber ammunition, so it is rather pleasant to shoot.

While it is still dangerous, and potentially lethal, to a human, it is not designed or recommended for self defense. The actual bullet is just too small and too light to RELIABLY penetrate deep enough and do enough damage to a human to stop them.

Don't get me wrong. A .22 LR can still kill you. It is just less likely to do so than a larger, more effective caliber like a .38 Special round or a 9mm round.

However, .22 LR handguns are occassionally used by regular people for self defense if that is all they have available or if they have health problems that make using a larger caliber problematic.

Criminals also sometimes use a .22 LR firearm, mainly because it's what they happen to have. A guy robbing a gas station might have a stolen .22 LR revolver for instance. A "pro" robbing a bank, however, would have something more effective.

So, when we say "He should shoot the victim with a .22." We mean a handgun chambered in that caliber. The actual handgun would be either a pistol (semi-auto) or a revolver and could be described as a pistol or revolver or identified by manufacturer name. (Colt, S&W, Ruger, etc)

You mentioned a Hi Point. I don't believe they make a .22. If it has to be a Hi Point, it would be in one of the calibers they make. I think they make both a 9mm and a .45 ACP. You can check.

Both 9mm and .45 ACP are quite a bit more powerful than a .22 LR. They are both suitable for, and commonly used for, self defense. You character could still be shot with a 9mm or .45 ACP bullet and have it deflect off the skull. It would just be less likely than if he was shot with a .22 LR so it would be much more lucky for him to survive if he's hit with one of those larger calibers.

Zanystarr
04-15-2014, 01:22 PM
Thanks :) If it really is possible for the 9mm to deflect off the skull, then I'll do that; I want it to be as unbelievable and lucky as possible that he survived with no permanent damage. But if I changed it, the gun type would be (for example) Colt .22 or Magnum .22, right?

Trebor1415
04-15-2014, 03:04 PM
Thanks :) If it really is possible for the 9mm to deflect off the skull, then I'll do that; I want it to be as unbelievable and lucky as possible that he survived with no permanent damage. But if I changed it, the gun type would be (for example) Colt .22 or Magnum .22, right?

Colt is a brand name. A "Colt revolver" is like saying a "Ford sedan."

Magnum is NOT a brand name. The term "Magnum" is used in some specific cartridge names to designate that they are more powerful than other cartridges with the same diameter bullet.

For example, the .22 LR cartridge is a common round. The .22 Magnum cartridge has almost the same diameter bullet, but the bullet is heavier, the cartridge case is longer with more propellent, and the bullet moves faster. The designers of the .22 Magnum used "Magnum" in the name to show it was more powerful than the .22 LR.

The first named magnum cartridge was the .357 Magnum. This was based on the .38 Special revolver cartridge with a longer cartridge case so the bullet would travel at a faster velocity. (Same size bullet, btw). They borrowed the term "magnum" that was used to describe extra large champaign bottles to describe this extra long .38 case.

So, don't use the term magnum unless you are specifically refering to the .22 Magnum, .357 Magnum, .44 Magnum or any of the other named Magnum cases I'm forgetting.

And, the useage is ".22 Magnum" not "Magnum .22"

I'd also suggest if you are having him shot with a .22 it be a standard .22 LR and not a .22 Magnum.

Here are some links on bullets bouncing off skulls for reference and info'
http://www.activeresponsetraining.net/head-shots-and-bouncing-bullets

http://www.gunnuts.net/2014/01/24/boom-headshot/

http://articles.orlandosentinel.com/2013-12-13/news/os-bullet-bounced-off-mans-head-20131213_1_bullet-window-wesley-chapel

http://news.google.com/newspapers?nid=950&dat=19611231&id=gUhQAAAAIBAJ&sjid=IVcDAAAAIBAJ&pg=4388,4766368

http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=224x3191

http://message.snopes.com/showthread.php?t=15570

http://books.google.com/books?id=O7GzmPy6uqEC&pg=PA53&lpg=PA53&dq=handgun+%22head+wounds%22+%22wound+ballistics%2 2&source=web&ots=cJ_lCOEq45&sig=fb_MEJh0uUynupkDjpEYpSB_huQ#v=onepage&q=handgun%20%22head%20wounds%22%20%22wound%20balli stics%22&f=false

read the last paragraph of taht one.

sheadakota
04-15-2014, 03:34 PM
Why does he have to be shot in the head? You could have him shot in the chest, and have a much more believable scenario, or the back if he's running away. Lots of blood, the bullet could realistically lodge in the body causing the need for the immediate life saving surgery you want. Little to no deficits depending on where it hits, and far shorter recovery time.

Orianna2000
04-15-2014, 06:24 PM
Someone will probably disagree with this advice, but my suggestion is, if you don't know much about guns and ammo, it's safer to keep things vague and generic, so you don't risk getting the details wrong. Unless you're writing a police or medical report, for example, you don't really need to specify what kind of gun is used, or what caliber it was.

If you do decide to get specific, make sure you get a knowledgeable beta-reader to look the story over. Find someone who knows about guns and ammo, so they can read the scene and find any mistakes. That's what I did when I had to write a scene at a shooting range. I got most of the scene right, but there were a couple of details I got wrong. If I hadn't had a good beta-reader, those mistakes would still be in the novel.

ULTRAGOTHA
04-15-2014, 06:57 PM
You mean caliber, right? Not an autocannon round, right?

Awww come on! It was midnight. I realized what I'd done as soon as I saw the message show up and I fixed it! You're not supposed to be looking at this board at midnight!! I get extra grace time to fix stupid mistakes at midnight, darn it! :P

Zanystarr
04-16-2014, 02:14 AM
Thank you so much :)

Zanystarr
04-16-2014, 02:18 AM
Why does he have to be shot in the head? You could have him shot in the chest, and have a much more believable scenario, or the back if he's running away. Lots of blood, the bullet could realistically lodge in the body causing the need for the immediate life saving surgery you want. Little to no deficits depending on where it hits, and far shorter recovery time.

I want him shot in the head because I want there to be absolutely no doubt that the shooter was trying to kill him. If he was shot in the back, or the chest, then it's possible the shooter could lie in court and say that the gun accidentally went off or something. I want there to be absolutely no doubt of what the shooter was trying to do, but also have the boy be extremely lucky that he survived without permanent damage.

NeuroGlide
04-16-2014, 04:46 AM
Awww come on! It was midnight. I realized what I'd done as soon as I saw the message show up and I fixed it! You're not supposed to be looking at this board at midnight!! I get extra grace time to fix stupid mistakes at midnight, darn it! :P

I gave you a smilely. :D Better?


I want him shot in the head because I want there to be absolutely no doubt that the shooter was trying to kill him. If he was shot in the back, or the chest, then it's possible the shooter could lie in court and say that the gun accidentally went off or something. I want there to be absolutely no doubt of what the shooter was trying to do, but also have the boy be extremely lucky that he survived without permanent damage.

Shooters aim center mass, i.e. middle of the largest part. A head shot on a fleeing target is more luck than skill. And it's standard practice to assume that shooting a target means you want it dead. You want lucky, bullet comes to rest against the aorta, the main blood vessel exiting the heart. I recommend keeping it a .22LR. A 12-year old doesn't have the mass to absorb a 9 mm/.45 ACP.

ULTRAGOTHA
04-16-2014, 05:04 AM
I gave you a smilely. :D Better?

Thank you. That makes it all better. ;)




Shooters aim center mass, i.e. middle of the largest part. A head shot on a fleeing target is more luck than skill. And it's standard practice to assume that shooting a target means you want it dead.

Not to mention it's just as easy to claim the gun went off my mistake with a head wound as with a body wound.

I like your aorta scenario. But if the OP is enamored of a head shot, a graze along one side will be gory and concussiony and lucky enough for what s/he wants me thinks. Though not with a 9mm.

Trebor1415
04-16-2014, 07:17 AM
I want him shot in the head because I want there to be absolutely no doubt that the shooter was trying to kill him. If he was shot in the back, or the chest, then it's possible the shooter could lie in court and say that the gun accidentally went off or something. I want there to be absolutely no doubt of what the shooter was trying to do, but also have the boy be extremely lucky that he survived without permanent damage.

Yeah, I agree that your justification for "needing" it to be a head shot is weak.

If you shoot someone, the cops and prosecutors are going to view it that you intended to do it, and that you intended for the victim to die.

Yes, the shooter could aim for the body and then lie in court and claim it was an accident, but any jury would laugh at that. And, he could make the same lie even if the bullet hit the victim in the head. Again, no one is likely to believe it, but the fact the victim was hit in the head doesn't really "prove" anything.

If you need your character shot in the head, have him shot in the head. But, the reasons you stated that you need him shot in the head don't really make any sense from a story point of view or a real life point of view.

In other words, don't worry about "he could lie" affecting where you have the victim shot. Have the victim shot wherever works best for your story in terms of the medical results you need.