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Domestic Violence

Blunt Chest Trauma in A Book

07/24/2006

Question:

Hi. I`m writing a book and having a hard time researching the medical aspects. One of my main characters is attacked and beaten pretty badly. She has a compound rib fracture and a fractured skull. I would like to know what would happen to her as soon as she reaches the hospital. What would the treatment be? How long would it take to heal? Would it have been possible for her to drive herself a few blocks back to her house, immediately following the attack? Every search I`ve done for this information has simply told me to seek immediate medical attention, but not what that attention would entail. Any help would be appreciated. Thanks.

Answer:

Yes it would be theoretically possible to drive a short distance say within 10 to 15 minutes time to a hospital.  With respect to her injuries, compound rib fractures are extremely rare.  A compound fracture means that fractured or broken bones are exposed through the skin and the degree of force required to cause that would more likely be seen with a high speed, high impact  crash. Having fractured ribs makes it extremely painful to move at all including and especially breathing. So for both of those reasons driving may be potentially difficult.  A fractured skull in and of itself is not necessarily life threatening.  An underlying injury to the brain would be of more concern, such as edema (swelling) that develops over a few hours, the same as with a sprained ankle.  The other brain injury of concern would be a blood clot (sub dural or epidural hematoma)  these are potentially fatal and often require an emergency operation by a neurosurgeon.  Recovery from fractured bones generally takes 6 to 8 weeks.

 Upon arrival to a hospital she would be seen in the emergency department by an Emergency Medicine physician where she would undergo an initial assessment for life threatening or potentially life threatening injuries ( airway and breathing assessments), resuscitation for shock if present (IV fluids, blood transfusion if necessary), then a secondary assessment for more subtle injuries.  This is a thorough medical history if possible and detailed physical exam.  At this time diagnostic tests such as X-rays (cervical spine, chest and pelvis),ultrasound of the abdomen, CT scan (head and abdomen) would be obtained.  At that point some decision about definitive care would be made, eg involvement of a trauma surgeon, a neurosurgeon, transfer to a trauma center, operation, admission to the hospital possibly intensive care unit or discharge home. 

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Response by:

Kenneth   Davis, Jr, MD, FACS Kenneth Davis, Jr, MD, FACS
Professor of Surgery and Clinical Anesthesia
College of Medicine
University of Cincinnati