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The Character Clinic



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Sat Feb 27, 2016 11:18 am
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TriSARAHtops says...



Thank you!! I was googling scientific reasons behind supposed hauntings and CO poisoning was one that cropped up, so thought it would be worth getting some medical insight on. :) This is really helpful, and definitely food for thought.
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Wed Mar 02, 2016 6:46 pm
Lefty says...



Hey, Stella! I've got another quick question for you.

I've got a character who is hit with a tranquilizer dart in the thigh which knocks them out within 30 seconds to a couple minutes. I was wondering if you knew of any normal sedatives that would make sense for that, since animal tranq's are too strong for humans to handle. Also, how long would this sedative keep them out for and what would be the side-effects after waking up? Thanks!
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Thu Mar 03, 2016 8:30 pm
StellaThomas says...



Hi @LeftyWriter!

So originally I was like "what an easy question" and then realised - no! Because what you're looking for is a general anaesthetic that goes into the muscle and works quickly. Most of what we use in surgery is given intravenously. Propofol, our favourite anaesthetic, has no effect if given into the muscle. Midazolam does, but it takes about ten minutes to take effect. So actually, you've kind of answered your own question in that the best drug I can think of is ketamine - which you might know as "horse tranquillisers" ;). But it's used for humans too - and it's a good one in this setting because it won't stop your character breathing like a lot of anaesthetics do. Its onset of action is about 3-4 minutes after an intramuscular injection, but it can be less! Its duration of action - ie. how long will they be asleep is less than an hour, it really just depends on the dose.

After they wake up, most patients feel a bit groggy and confused after a general anaesthetic. In addition, following a ketamine dose, they might feel nauseous, they might hallucinate and they might have pain where the dart hit them. There's lots of other side effects too that you can look up, but those ones seem the most fun for you to play around with.
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Thu Mar 03, 2016 8:39 pm
Lefty says...



Perfect! That was exactly what I was looking for. Thanks so much, Stella! You rock. ;)
Hear me out, there's so much more to life than what you're feeling now. Someday you'll look back on all these days, and all this pain is gonna be invisible. - Hunter Hayes
  





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Wed May 11, 2016 1:32 pm
queenofscience says...



I need help with two things medican realated.
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Wed May 11, 2016 1:42 pm
queenofscience says...



Im writing a fanasty story and I have a drug called Abixum ( it's a dark liquid medicen) and it helps someone who has cronic nightmears and or someone who is a sleepwalker to have good dreams, literaly, and to go into a deep sleep. ( well, non sleepwalking sleep for someone who is a sleepwalder) I need help with how this medicen works? I'm going to have my teenage character go to a doctor and get percribed this. I need the doctor to explain this to my character and how it works.
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Wed May 11, 2016 1:47 pm
queenofscience says...



Also, I have a hospital dirrector (who is a cat btw.) Would the hospital dirrector be in charage of hireing and fireing? Is it their job to keep tabs on all of their staff???

I have quite a few medical questions.
I am the science and science fiction guru.

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Mon Jul 18, 2016 12:59 pm
JuliasSneezer says...



Good day, Stella (Or Dr. Thomas,)!

Sorry, but I have two questions:

1. My character, (a fourteen year old boy who is pretty healthy and strong) falls off a twenty seven foot drop onto a ground of stone. How would that effect him, medically speaking?

2. In the original draft of my story, he gets a broken leg after this event. It's a broken fibula. Do you know how bad it would hurt to put it in a splint? Would most people scream in pain? I've never gotten any broken bones myself, so I don't exactly know how to approach this.

Many thanks!

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Mon Jul 18, 2016 7:09 pm
StellaThomas says...



Hi @CupcakesForRealMen!

I did a couple of responses on falls on page two of this topic (The Character Clinic) but I'll run through some things for you quickly here. You're making me think about medicine and not just intern-monkeying for the first time since finals!!

Twenty seven feet is pretty high! What matters of course, is what part of his body hit the ground first. If it was his head, that would be pretty bleak. Feet - could result in a broken tibia or fibula - or more likely both, and one leg taking the impact of his fall, however awkward that would look, would probably be the best for him physically. Either a leg or a shoulder taking the impact. It would be likely that he might at least crack some ribs - but remember that the treatment for bruised and broken ribs is almost exactly the same: take some paracetamol and suck it up - unless he breaks enough ribs to give himself flail chest which - well, lets not do that. Of course either with or without broken ribs you have to consider the risk to his internal organs - he might get a bleed on his liver or spleen, or bruised kidneys, which would mean a longer hospital stay and the potential need for surgery if things didn't improve.

As I said to Lightsong in a previous post, pelvic fractures are also worth considering, but your character would be most likely in a wheelchair and then on crutches for a while, whereas with a lower leg fracture they can manoeuvre with crutches/boot - it just depends on how mobile you need them for the sake of the story.

"Medically" speaking, short of bruises and broken bones there's actually not much to say. Just remember that if this is a modern story he'll be in a neck collar until they can Xray him because of the risk of still tearing his spinal cord because they can't rule out a broken neck. Other things - like electrolyte disturbances and other such posh words - would happen as complications (eg. kidney failure secondary to rhabdomyolysis, secondary to compartment syndrome secondary to a fracture but let's not worry about that).

And now... the leg fracture. An open tib-fib fracture in a young male was one of my questions in my finals xD Realistically, he'll probably break both bones - the fibula is kind of small and weedy and he'd have to be hella hella lucky to only break that one tiny kind of useless bone.

We splint bones to hold them in place, which means we only need to do it when the two broken bits don't meet up the way they should anymore - a "displaced" fracture. To get it back into place you have to "reduce" the fracture. This generally means pulling back the foot until the bones click back. It hurts. Like. Hell. BUT - like with a dislocated shoulder, once the fracture has been reduced and it's been put into a splint, all of their pain goes away. In a modern setting, he'd obviously get pain medication so it wouldn't be so bad. Even more likely they'd end up doing surgery on him and sticking a good old plate into those bones. But closed reduction - someone literally pulling his foot back into place - makes for a better scene, and it does still happen if they think that's all that the person needs. Yes, he would scream, but then afterwards things would get better.

Hope that's what you're looking for!

-Stella x
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Mon Jul 18, 2016 8:00 pm
JuliasSneezer says...



Thank you so much! This is SUPER helpful. I really appreciate it. Thanks again!
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Tue Jul 19, 2016 12:48 pm
AnarchyWolf says...



Hello Stella! If it's not too much trouble, I've got a few questions to ask?

Firstly, my character will have seven fingers broken. I imagine that this will be extremely painful, and, because of in-story reasons, he cannot be taken to a hospital. Would a pen or the wooden stick you get from Magnum ice creams be sufficient to keep the fingers straight and heal them properly? Also, would paracetamol do anything at all for the pain?

Secondly, would burns sustained from hot oil (as in, cooking oil) scar for life, and would they affect the ability of the muscle under the burn?

Last of all - can you put a dislocated knee back without medical help? As in, could you just move it around a bit and then slide it back into the knee socket? Could the pain of a dislocated knee cause the sufferer to pass out?

Thanks so much :)

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Wed Aug 03, 2016 2:29 pm
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StellaThomas says...



Hey @AnarchyWolf! I'm so sorry, somehow this got missed!

So your first question. Ow. In terms of sourcing splints, anything strong and straight is perfect, so you're good for that. Usually we try to take the broken finger to a non-broken one but if they're all broken (or, you know, most) then splinting is the way to go.

Paracetamol is a better painkiller than people thing. The fingers will still hurt like hell when they're first broken - they'll need to be reduced (put back in place) and splinted as you say, and that should help with the pain quite a lot, then give them the paracetamol. Remember no more than 4g a day, unless you want them to die a horrible, painful death.

Secondly - yes, especially if it was very hot, and didn't get washed off straight away. In terms of burns, there is first degree - your run of the mill red sore burn, second degree - blistering, painful, and third (and fourth) degree. Third degree is also called "full thickness", when the skin is no longer red but white or charred black, and the full thickness of the skin is burnt. It is often painless because all the nerve endings have been killed (but say around the splash area of the oil there would be first/second degree burns as well which would be painful). Fourth degree is burns below the level of the skin, but I find it unlikely that oil would burn that far down. So in terms of affecting the muscle directly - no. But it's the nerves that matter. If you damage the nerve, the muscle becomes weaker, and as I mentioned above, nerves can get damaged in burns more easily than muscle, so it could become weak (but probably they would eventually regain their power with a lot of physio). As for scars, it depends on the person - I have a scar from a first degree burn on my wrist. It depends on their skin elasticity I guess, and to a lesser extent skin tone - people with very pale skin or very dark skin are probably vaguely more likely to have a visible scar, but I'm not 100% sure.

Lastly - I'm not sure how you want to dislocate the knee, the knee is kind of held together very strongly with ligaments, and it's a hinge joint, so you can't pull it out of the socket. You can partially dislocate your kneecap - this is called a "patellar subluxation" - and, like shoulders (a far more dislocatable joint) it can just pop in by itself with a good shove, though it'll hurt like hell. The knee itself, like the meeting of femur/fibia/tibula would be quite difficult to dislocate without ripping ligaments and needing surgery, so I'd probably avoid that one.

Sorry for the delay in getting back to you!

-Stella x
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Wed Aug 03, 2016 3:53 pm
AnarchyWolf says...



Thanks so much for the reply! (it's totally fine that it got missed) It's so helpful :)

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Sat Aug 06, 2016 4:11 am
Kale says...



Just dropping in to say that cooking oil can absolutely result in fourth-degree burns, depending on the scenario. A scald will probably not result in fourth-degree burns, but if you're, say, deep-frying a turkey and the oil gets so hot it explodes... it's not pretty. You can google pictures of cooking oil burns, and within the first few results, there's a lot of (very graphic) pictures of second- and third-degree splash burns in various stages of healing, as well as a few fourth-degree burns farther in.

As for scarring, I don't scar easily, but I got a third-degree burn two years ago, and the scar from it is still fairly visible, though it is fading. I happen to be very pale, so the scar tissue is darker than the rest of my arm, which makes it look like a birthmark. Considering how much my scar has faded in a year (the burn took several months to fully heal), I expect it will no longer be visible in a few more years.

So, to echo what Stella said, it depends on the person, and even lifelong scars will tend to become less visible over time, especially if the person makes an effort to make the scars fade. Generally though, the longer an injury takes to heal, the more severe the scarring will be.
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Sat Aug 06, 2016 5:44 pm
Rosendorn says...



Okay, reading through this burn discussion— what are some steps a person can take to make scars fade?
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