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hauntedwriter
03-30-2016, 02:26 PM
In my story, my main character in a basement. It's a low ceiling, almost crawl space, cramped basement. When he looks up, he sees the beams of the ceiling along with nails protruding out. At the end of the story, he's in the basement, something happens and he turns around. But in doing so, he inadvertently stands. When he stands, he stands up into on the nails. I have him dropping straight down. He starts to feel the blood trickle down and he blacks out.

My question is: what happens next? I've looked online but can't find what would happen. He wakes up in the hospital. I have that. But what types of testing would be done with that type of penetrating injury? Tetanus shot? Just x-rays?

The character doesn't die from this wound but I just would like to know what would be said to him once he wakes up and is fully conscience of where he is and what had happened. What would the doctor say to him, or his wife, about what they (the hospital) did to him?

Thank you for your time!

King Neptune
03-30-2016, 06:10 PM
I take it that the ends of some nails come through the subflooring. Other than have a nasty gash and bleeding for a while, I don't think anything would happen., unless there is a weak spot in his skull. A normal skull would hold up and the nail would not make a hole. In the hospital they might X-ray, if someone thought it went through. Otherwise, they'd shave part of his skull and sew up the gash, if it needed that.

Katharine Tree
03-30-2016, 06:50 PM
Agree with King Neptune that this wouldn't cause the nails to penetrate the skull. The skull is too strong and reflexes are too good.

Once he's in the hospital, though, if he blacked out, he would be held for observation for a period of time--maybe a few hours, maybe, if his insurance is really good, overnight. They might have him in a neck brace for a while, as a precaution (like, no longer than the time he spends in the hospital, unless he really has a neck injury), and they'd definitely evaluate him for a concussion. As King Neptune said, he risks having part of his head shaved to get stitches.

CWatts
03-30-2016, 07:10 PM
Also, it's my understanding that the scalp bleeds profusely- not enough for him to make him pass out (concussion from hitting the beam? or more likely just fainting) but enough to be really alarming for him to see, or for whoever finds him.

Wicked
03-30-2016, 07:55 PM
The skull is pretty tough. I doubt just standing up too fast would do the amount of damage you are hoping for.

When I was twelve, I got thrown off a horse that was running at full gallop. I went head first into a fallen tree, then got up, and walked a half mile toward the sound of my dad's tractor. Pretty sure I was in shock. When I finally found his truck (the tractor was still farther away), I got in, sat there a minute, then reached up to wipe off the "sweat" I felt running down my face.

It was blood. Lots and lots of blood. At that point I screamed loud enough for my dad to hear me over the tractor.

My parents weren't big on doctors, so I didn't go in, but years later I had x-rays for another horse related head injury, and it seems I had chipped and cracked my skull in the original incident.

Incidentally, the second time I had gotten clothes-lined by a tree, and hit the back of my head on the ground. That time I was knocked out for a short period of time, and ended up with a mild concussion, but there was no blood.

ATE: All that said, we knew a lady who slipped on her icy sidewalk, and was DOA by the time they got her to the hospital. There are a lot of factors at play. The type of trauma, location, the force behind it, etc.

The exposed nails would cause shallow punctures. The scalp isn't very thick, so to me, those would be pretty minor injuries. So they would likely flush the wounds, and a tetanus shot for sure. The x-ray would probably just depend on the doctor, but it's plausible when dealing with head injuries. (going by my own experiences as a multiple head wound patient in the ER)

ColoradoGuy
03-30-2016, 10:54 PM
In my story, my main character in a basement. It's a low ceiling, almost crawl space, cramped basement. When he looks up, he sees the beams of the ceiling along with nails protruding out. At the end of the story, he's in the basement, something happens and he turns around. But in doing so, he inadvertently stands. When he stands, he stands up into on the nails. I have him dropping straight down. He starts to feel the blood trickle down and he blacks out.

My question is: what happens next? I've looked online but can't find what would happen. He wakes up in the hospital. I have that. But what types of testing would be done with that type of penetrating injury? Tetanus shot? Just x-rays?

The character doesn't die from this wound but I just would like to know what would be said to him once he wakes up and is fully conscience of where he is and what had happened. What would the doctor say to him, or his wife, about what they (the hospital) did to him?

Thank you for your time!

I'm an ICU doc and head injuries are part of my usual gig. I have a couple of thoughts to answer your questions.

1. I disagree with other folks that such a mechanism of injury can't penetrate the skull. It could, especially if the nail hit the head at right angles. Your scenario has to involve sufficient force to cause a severe concussion because you want loss of consciousness. That much force could drive the nail entirely through the skull. I've actually seen injuries like that.

2. Bleeding from the scalp would be there, but since it would be a puncture and not a gash the bleeding would probably be modest unless he hit a blood vessel. But there certainly could be enough for your scenario. As CWatts points out, the scalp is notorious for bleeding a lot from a laceration.

3. The x-ray study that would be done would be a head CT without IV contrast. What they would do next would depend upon what they found. If there was ongoing bleeding in the brain he would go right to the operating room. Even if there was no active bleeding or large clot he probably would still have his brain explored to irrigate the wound area and remove any debris (bits of hair, bits of nonviable brain, bone fragments, anything else that got in). He would get a tetanus shot if it's been longer than 5 years since his last one as well as IV antibiotics. If he were my patient I'd keep him on IV antibiotics for 7-10 days.

4. You also should think about the location of the puncture. An injury like that to the frontal lobe could easily cause no neurological defect at all. So if you want that outcome hit the frontal lobe nearer to the forehead. An injury to the back of the frontal lobe or the front part of the parietal lobe would probably (but not necessarily) cause some damage to motor or sensory function. The defect would be on the side of the body opposite to the injury, since the nerve fibers cross on their way down. If you want that kind of injury have it on the side of the head above the ear. Any neurological defect would be apparent when he wakes up and would not develop later. If you want an injury that he's likely to recover from completely, drive the nail in maybe 1 cm into the frontal lobe (don't forget to allow for the thickness of the skull). If you want an injury that gives a neurological defect that he later recovers from you could have a scenario in which there is some brain swelling around the area of injury that resolves over the next couple of days.

5. If he wakes up from surgery without a neurological deficit the doctors would say he should be OK ultimately. If he has a deficit the doctors would be more guarded, probably saying "we'll wait and see -- no predictions." If you want some complications in a few days, infection, such as an abscess, would be very plausible.

Hope this helps

WeaselFire
03-31-2016, 12:54 AM
From the "been there, done that" realm...

I managed to hit myself in the forehead with the hammer from a S&W Model 29 in .44 Magnum, "The most powerful handgun in the world" and "It'll blow your head clean off" gun of Dirty Harry fame. Don't try and be cool and bend your elbows when you fire that one. I got seriously dizzy, went back in the house and my aunt screamed and nearly fainted when she saw me. Blood pouring down the side of my face and what looked like a hole in my forehead. From a 14-year-old out back shooting guns.

End result was washing off blood and a bandage. Many years later I had an x-ray for another stupid, self-inflicted injury (if you didn't realize it, I'm male so this is all genetic...) and the doctor asked me about the bone chip sitting under the skin on my forehead. So an injury like you want can happen, but it usually takes a significant amount of force.

The second issue is that nails penetrating the sub-floor, quite common, are rarely long enough to penetrate a skull. It's about 1/4" to 1/2" of nail protruding in most cases. I would find the story more believable if he turned as he rose and stuck a 12p common nail from the joist into his temple. Pierce the jugular and he could have enough blood loss, or if all you need is the unconsciousness, have him whack his neck on something so his carotid gets a decent smack and he goes out from the rise in blood pressure to the brain.

There are a number of ways to write this, depending on your story's needs.

Jeff

King Neptune
03-31-2016, 02:46 AM
My experience with nails is like Jeff's. They don't penetrate far through the floor. There are places where the skull is less than a half inch thick, but having a nail that hit such a spot isn't very likely. It would be easy for a nail to penetrate part way through the skull.

hauntedwriter
03-31-2016, 02:19 PM
Thank you all so much for the information! I really appreciate it all. And some of the things you guys went through... wow. This give me some great info to write the scene and explores what happens next for the character... which is the police waiting for him on an attempted arson charge. It gets worse and worse!

Again, thanks for taking the time to answer my question!