1. Kaynic
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    Kaynic Member

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    Broken Back?

    Discussion in 'Research' started by Kaynic, Oct 5, 2013.

    One of my characters--inhuman, capable of healing himself after injury, though not instantaneously, and not without a great deal of pain--is brutally beaten in hand-to-hand combat with a supernatural entity that damages a lot of internal organs--it's mentioned he pisses blood for a week--and breaks nearly every bone in his body excepting his extremities. Shattered ribs and legs, snapped collarbones, broken shoulder blades, etc. including his back: broken in five places, though the spinal cord is intact. The fact he even survives is counted a miracle. He's looked after by the main character, who's fighting on more than one front and exhausted from constant vigilance. Keep in mind, she's in no position to find any kind of medical care beyond first aid, some medical equipment, and painkillers, nor is she a skilled caretaker, and she has to hole up in a ruin with little comfort besides a stolen cot and piles of matting and blankets, a space heater, and jerry-rigged fridge for medical supplies. My question is, how would the main character go about providing any kind of rudimentary care? Should she simply keep him immobilized, clean open wounds, provide painkillers, and hope to hell he can stay alive? He'd be down for thirty days or so, near death and delusional but slowly recovering, so there's the issue of pressure sores, and she can't really alleviate that for fear of wrenching his spine.
     
    Last edited: Oct 6, 2013
  2. GingerCoffee
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    GingerCoffee Web Surfer Girl Contributor

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    Why complicate things so? "Inhuman capable of healing" or at risk of spinal cord disruption? Which is it?

    Strap him on to some kind of splint so he can at least be rolled from side to side. Look up non-displaced spinal fractures on the Net.
     
  3. Kaynic
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    Kaynic Member

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    He's capable of recovery, sure, but it's not a quick occurrence--though faster than human recovery time--it's incredibly painful, and he can still be injured in the meantime. I figured immobilizing would take care of a lot of issues, but I wasn't sure if she could do anything else besides taking the 'wait and pray' approach.
     
  4. GingerCoffee
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    GingerCoffee Web Surfer Girl Contributor

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    I get the, 'he can recover' part. I don't understand the, 'can he be paralyzed in the meantime' part.

    I'd still go with the temporary splinting of the back (spine).
     
  5. Trish
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    Trish I've been deleted.. again Contributor

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    From a readers perspective, I don't see anything wrong with what you're planning. Since it sounds as though she can't heal him, it's logical that her role would be to protect him until he can heal. The things you listed originally are all reasonable for her to do. He would heal from pressure sores anyway, right? If you don't think she can move him, don't make her move him. It won't matter. Think - if it was real life and she had no idea what to do for him and no way to move him or help him - what would she do? I think you nailed it in the first post. You're over thinking it. :)
     
  6. jazzabel
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    jazzabel Contributing Member Contributor

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    With the broken back, it's difficult to say because in modern medicine we'd scan and decide whether to operate or is bracing enough. If cervical vertebrae are affected, you'd immobilise cervical spine with cervical collar. For lower down, it might need anything from a back brace to a massive cast that would prevent arm and leg movement as well as immobilise the torso. For simplicity sake, of you say the break was uncomplicated (ie, no neurological symptoms indicative of spinal damage, such as numbness, pain or weakness in dermatomes and myotomes (google it, it's quite interesting) and the break was from c7 to T3 for example, then a neck and back brace will suffice. For a human it'd take several months, but a supernatural being can feasibly heal much faster. If you google 'back brace for fractured vertebra' you'll get the general idea of what they look like.

    Limb immobilisation is fairly straightforward, any first aider will know how to deal with that.

    Re. kidney injury (pissing blood) she would have to flush the kidneys, make him drink lots of water. Pain-wise, giving any anti-inflammatories such as aspirin (found in willow bark) would promote bleeding so she'd steer clear of that. For pain relief I'd stick with opiates which she could brew as tea (opium poppy). This will help with broken rib pain also, but here make him have a good cough or two every hour, so he doesn't end up with pneumonia. Kidneys can be good in a week, and if he is a superfast heeler, the rest will heal by the time back is ok.
     
  7. mammamaia
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    mammamaia nit-picker-in-chief Contributor

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    huh?... how can his back [= spine] be broken in five places and still be 'intact'?... or did you mean 5 vertibrae were fractured, but his 'spinal cord/nerve' was not damaged?
     
  8. Kaynic
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    Kaynic Member

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    Sorr
    Sorry, yes: the spinal cord is intact, though bone fragments lodged in the tissue are a risk factor.
     
  9. Kaynic
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    Kaynic Member

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    This all great info, thanks! Cervical vertebrae is unaffected, fortunately for him. He won't be happy about the coughing--broken ribs and clavicles and such--but that's good to know. I'd like this to be as realistic as feasibly possible. You've answered all my major questions.
     
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  10. Kaynic
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    Kaynic Member

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    Ha, yeah. I just needed some medical specifics. Typically I'm pretty good at this, but I've never had to write about this severe a degree of injury before and I'm a stickler for medical details; one of those who thinks both Winchester brothers ought to be in persistent comas after all the brain damage they've experienced.
     
  11. BFGuru
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    The bones of the spine can indeed be broken without disrupting spinal cord activity. I work with spinal cord injuries. In your situation, no damage to the actual nerves, we would brace the patient. They would wear a hard brace in two pieces one for front and one for back. Some are plastic, and if your character has access to thin pieces of plastic, they could warm it and mold it to immobilize your patient. Others are more involved with stringes and velcro and elastics. There is much that happens even if the spinal cord is not damaged.

    The fact that he is peeing blood introduces many issues. One of voiding. Even if there is no tearing of the spinal cord, there is more than likely swelling. This will temporarily present with nerve loss until swelling subsides. Will your character be able to void at all? Are we going to have to drain the bladder and empty the bowels manually until swelling subsides? Who is caring for the patient while he heals as he will not be permitted above a 30 degree sitting angle without being majorly braced (any bone fragments run a huge risk of tearing the spinal cord). He will need to be turned every 2 hours to prevent pressure sores (which will slow down his healing immensly and could become infected killing your patient). Most pressure sores occur on the sacrum, heels and buttocks, but can also frequently occur on the hips of thinner patients.

    When your patient is sitting, someone will need to do what we refer to as weight shifts. Leaning the patient forward or backward to relieve pressure so that again, no pressure sores occur on their buttocks. If the vertebrae are broken in the neck, the neck may be braced depending on where. On the spinous process there is nothing to be done. It also presents little risk to the spinal cord, but it is very painful. You could get away with one area being broken like this, but not all.

    When laying supine for a while blood pressure tends to re-normalize. This may make your patient hypotensive when sitting and they may get dizzy. This is dealt with by using compression stockings and binding the abdomen. Binding will also act as an immobilizer.

    Hope this helps. I feel bad for pissing blood. That alone will be painfully excrutiating.
     
  12. Cogito
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    Cogito Former Mod, Retired Supporter Contributor

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    If he's not human, you can postulate whatever you want.
     

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