Jaycee Woods

In Chapter 4 “The Monster” in my draft for Boudica and The Butcher, Gideon returns injured from the battle at the mill. While Boudica is useless in helping him, she does summon help. Asclepia, the medic from Chapter 1 “Harvest of Blood” comes to assess his wounds.

I knew that I wanted him to have a concussion as that becomes an issue for him in subsequent chapters. Lacking knowledge, I relied on Copilot to assist my research needed for editing the scene.

Question: In the field what symptoms would a medic assess for a concussion in a semi-conscious patient?

In a field setting, a medic would assess several key symptoms to determine if a semi-conscious patient has a concussion. These symptoms include:

Altered level of consciousness: The patient may be dazed, confused, or unable to respond appropriately to questions.

Headache: This is a common symptom and can range from mild to severe.

Slurred speech: The patient’s speech may be slow or difficult to understand.

Delayed response to questions: The patient may take longer than usual to answer questions or may not respond at all.

Memory issues: The patient may have trouble remembering events before or after the injury.

Dazed appearance: The patient may appear stunned or disoriented.

Balance and coordination problems: The patient may have trouble walking or standing steadily.

Nausea or vomiting: These symptoms can sometimes accompany a concussion.

It’s crucial to take immediate action if a concussion is suspected, including removing the individual from any further risk of injury and seeking medical attention as soon as possible.

Question: Describe the visual symptoms Tua displayed of his concussion. Are such always immediate or could they be delayed by adrenaline?

When Tua Tagovailoa suffered a concussion during a game, he displayed several visual symptoms that are common with concussions. These included:

Fencing posture: This is a characteristic position where the arms are extended outward, resembling a fencer’s stance. It’s a sign of severe brain injury.

Blurred vision: He had trouble focusing and his vision was impaired.

Dazed appearance: He appeared confused and disoriented.

Regarding the timing of symptoms, it’s important to note that while some concussion symptoms can be immediate, others can indeed be delayed. Adrenaline can mask symptoms initially, making it seem like everything is fine right after the injury. However, as the adrenaline wears off, symptoms like headaches, dizziness, and cognitive issues can become more pronounced.

Question: In battle conditions, could such symptoms be delayed for an extended period until the patient experienced an adrenaline crash?

Yes, in battle conditions, it’s possible for concussion symptoms to be delayed due to the effects of adrenaline. Adrenaline can mask symptoms initially, making it seem like everything is fine right after the injury. However, as the adrenaline wears off, symptoms such as headaches, dizziness, confusion, and cognitive issues can become more pronounced. This can happen hours or even days after the initial injury.

It’s crucial to monitor anyone who has suffered a head injury closely, even if they seem fine initially, as symptoms can emerge later on.

Question: If an unconscious patient has a head injury, are there any detectable symptoms of a concussion? Must a medic wait for consciousness to assess?

Yes, there are detectable symptoms of a concussion even in an unconscious patient. A medic doesn’t necessarily have to wait for the patient to regain consciousness to assess for a concussion. Some signs to look for include:

Altered level of consciousness: The patient may be drowsy or less responsive.

Slurred speech: If the patient is able to speak, their speech may be slow or difficult to understand.

Delayed response to questions: The patient may take longer than usual to respond or may not respond at all.

Dazed appearance: The patient may appear confused or disoriented.

Memory issues: The patient may have trouble remembering events before or after the injury.

Nausea or vomiting: These symptoms can sometimes accompany a concussion.

It’s crucial to monitor the patient closely and seek immediate medical attention if a concussion is suspected.

Question: What about pupil responsiveness in an unconscious patient with a concussion?

Pupil responsiveness is an important indicator in assessing a concussion, even in an unconscious patient. Here are some key points to consider:

Pupil size: Check if the pupils are of equal size. Unequal pupil size (anisocoria) can indicate a serious brain injury.

Pupil reaction to light: Shine a light into the patient’s eyes and observe if the pupils constrict (get smaller) in response to the light. Delayed or absent reaction can be a sign of brain injury.

Pupil reactivity: Assess how quickly the pupils respond to changes in light. Slower reactivity can indicate a concussion or more severe brain injury.

Monitoring pupil responsiveness can provide crucial information about the patient’s condition and help guide further medical intervention.

Question: Are there any treatments besides rest and monitoring for a concussed patient?

Besides rest and monitoring, there are several treatments that can help a concussed patient recover:

Over-the-counter pain relievers: Medications like acetaminophen (Tylenol) can help alleviate headaches and pain.

Hydration: Drinking plenty of water is important, especially if the patient is experiencing nausea or vomiting, which can lead to dehydration.

Gradual return to activities: It’s crucial to avoid strenuous activities and gradually return to normal activities as symptoms improve.

Physical therapy: For some patients, physical therapy can help with balance and coordination issues.

Cognitive rehabilitation: This can help address memory and concentration problems.

Neck rehabilitation: If there’s associated neck pain or injury, targeted exercises can help.

Neuro-optometric vision rehabilitation: This can help if the patient is experiencing vision problems.

Vestibular rehabilitation: This can help with dizziness and balance issues.

It’s important to follow a healthcare provider’s recommendations and not rush the recovery process. Each patient’s recovery plan may be different based on the severity of the concussion and individual needs.

Question: What ongoing symptoms might the concussed patient have in the days or weeks afterwards?

A concussed patient might experience ongoing symptoms for days or even weeks after the initial injury. These symptoms, often referred to as post-concussion syndrome (PCS), can include:

Headaches: Persistent headaches that can be similar to tension headaches or migraines.

Dizziness: Ongoing dizziness or a feeling of being off-balance.

Cognitive issues: Problems with memory, concentration, and processing information.

Sleep disturbances: Difficulty falling asleep, staying asleep, or experiencing unrefreshing sleep.

Mood changes: Increased irritability, anxiety, or depression.

Sensitivity to light and noise: Increased sensitivity to bright lights and loud sounds.

Fatigue: Persistent tiredness and lack of energy.

Visual disturbances: Blurred vision or difficulty focusing.

These symptoms can vary in intensity and duration from person to person. It’s important for anyone experiencing ongoing symptoms to seek medical advice and follow a tailored recovery plan.

Question: If the concussed patient fails to rest but seeks to maintain a normal schedule but will limited physical activity, are there any additional symptoms or does that simply slow recovery?

If a concussed patient doesn’t rest properly and tries to maintain a normal schedule, even with limited physical activity, it can indeed slow down their recovery and potentially lead to additional symptoms. Some of these symptoms might include:

Persistent headaches: Headaches can become more frequent and intense.

Increased dizziness: Dizziness and balance issues may worsen.

Cognitive difficulties: Problems with memory, concentration, and processing information can become more pronounced.

Fatigue: The patient may feel more tired and less able to cope with daily activities.

Mood changes: There might be increased irritability, anxiety, or depression.

Sensitivity to light and noise: Sensitivity to bright lights and loud sounds can become more severe.

Sleep disturbances: Difficulty falling asleep, staying asleep, or experiencing unrefreshing sleep can persist.

It’s crucial for a concussed patient to follow a healthcare provider’s recommendations for rest and gradually return to normal activities. Pushing through symptoms can lead to prolonged recovery and increased risk of complications.

Question: During the days and weeks after a concussion, what would a doctor’s follow up routine and examination be?

A doctor’s follow-up routine for a concussed patient typically involves several steps to ensure proper recovery and monitor for any complications. Here’s an overview of what the follow-up might include:

Initial Assessment: The doctor will evaluate the patient’s symptoms, medical history, and the circumstances of the injury.

Symptom Monitoring: The patient will be asked to keep a symptom diary, noting the frequency, duration, and intensity of symptoms like headaches, dizziness, and cognitive issues.

Neurological Examination: The doctor will perform a neurological exam to check for any signs of brain injury, including assessing memory, concentration, balance, coordination, and reflexes.

Cognitive Testing: Tests may be conducted to evaluate cognitive functions such as memory, attention, and problem-solving skills.

Imaging Studies: In some cases, imaging studies like CT scans or MRIs may be ordered to rule out more serious brain injuries.

Rest and Gradual Return to Activities: The doctor will provide guidance on rest and a gradual return to normal activities, avoiding activities that could lead to another concussion.

Follow-Up Appointments: Regular follow-up appointments will be scheduled to monitor the patient’s progress and adjust the treatment plan as needed.

Referral to Specialists: If symptoms persist or worsen, the doctor may refer the patient to specialists such as neurologists, neuropsychologists, or physical therapists.

The goal of the follow-up routine is to ensure the patient’s safe and complete recovery while minimizing the risk of long-term complications.

Question: For adding descriptive detail to a fictional story about a soldier concussed in battle, are there any other issues I should consider?

Absolutely, adding depth to your story can make it more engaging and realistic. Here are a few additional aspects to consider:

Environmental Factors: Describe the chaotic environment of the battlefield—explosions, gunfire, and the physical and emotional toll it takes on the soldier.

Immediate Aftermath: Detail the soldier’s immediate reactions—confusion, disorientation, and the struggle to stay conscious.

Sensory Overload: Highlight the sensory overload—ringing in the ears (tinnitus), blurred vision, and the overwhelming noise.

Physical Symptoms: Include physical symptoms like nausea, dizziness, and difficulty standing or walking.

Emotional Impact: Explore the emotional impact—fear, anxiety, and the soldier’s determination to continue despite the injury.

Interactions with Comrades: Show interactions with fellow soldiers—how they react, provide support, or help evacuate the injured soldier.

Medical Response: Describe the medical response—how medics assess and treat the soldier, including checking pupil responsiveness and other vital signs.

Long-Term Effects: Consider the long-term effects—persistent headaches, cognitive issues, and the psychological impact of the injury.

By incorporating these elements, you can create a vivid and compelling portrayal of a soldier’s experience with a concussion in battle.

Question: Added to the concussion, the patient’s left eye is swollen shut. Besides potential blindness long term in that eye, are there other symptoms or medical issues that I should consider?

Besides potential long-term blindness, there are several other symptoms and medical issues to consider if a patient’s left eye is swollen shut due to a concussion:

Pain and discomfort: The patient may experience significant pain and discomfort around the swollen eye.

Blurred or double vision: Vision problems such as blurred or double vision can occur.

Light sensitivity: Increased sensitivity to light (photophobia) is common.

Eye movement issues: Difficulty tracking objects with the eyes or abnormal eye movements can be present.

Droopy eyelid: The eyelid may appear droopy (ptosis).

Misaligned eyes: The eyes may not align properly, leading to issues with depth perception.

Visual field loss: There may be a reduction or loss of the visual field in the affected eye.

Infection risk: Swelling and injury can increase the risk of infection, which needs to be monitored and treated promptly.

It’s important to seek medical attention to address these symptoms and prevent any long-term complications.

Question: The patient had been struck in the face and temple by a human femur that had been used as a club. The femur bone broke on impact with his head. Beyond the concussion and swollen shut eye, are there other medical issues that I should consider for elimination?

Given the severity of the impact, there are several additional medical issues to consider:

Facial fractures: The force of the blow could cause fractures in the facial bones, such as the cheekbone, jaw, or orbital bones around the eye.

Skull fractures: A blow to the temple can result in a skull fracture, which can be serious and require immediate medical attention.

Epidural hematoma: Trauma to the temple can lead to an epidural hematoma, a type of brain bleed that can be life-threatening.

Soft tissue injuries: There could be significant bruising, swelling, and lacerations to the face and head.

Internal bleeding: The impact could cause internal bleeding, which might not be immediately apparent.

Nerve damage: The blow could damage facial nerves, leading to numbness, tingling, or paralysis in parts of the face.

These potential injuries highlight the need for a thorough medical evaluation to rule out or address any serious complications.

Question: How might a medic in the field assess potential for an epidural hematoma?

In a field setting, a medic would assess for potential epidural hematoma by looking for specific signs and symptoms, including:

Altered level of consciousness: A sudden change in alertness or consciousness, especially if the patient was initially lucid after the injury.

Headache: A severe headache that worsens over time.

Nausea and vomiting: These symptoms can accompany a head injury and indicate increased intracranial pressure.

Seizures: Any seizure activity following a head injury should be taken seriously.

Focal neurological deficits: Weakness, numbness, or changes in vision, such as a visual field cut, can indicate a hematoma.

Unequal pupil size: Anisocoria (unequal pupil size) can be a sign of increased intracranial pressure.

Pupillary response: Delayed or absent reaction to light in one or both eyes.

If an epidural hematoma is suspected, it’s crucial to stabilize the patient and arrange for immediate transfer to a medical facility for imaging (such as a CT scan) and further evaluation.

Question: During triage how might a medic treat for a subdural hematoma? What level of priority would triage assign such a patient? What negative symptoms might eliminate an epidural hematoma as a diagnosis?

In triage, a medic would treat a suspected subdural hematoma by:

Ensuring airway, breathing, and circulation (ABCs): Stabilize the patient’s airway, breathing, and circulation.

Administering oxygen: Provide supplemental oxygen to ensure adequate oxygenation.

Monitoring vital signs: Keep a close watch on blood pressure, heart rate, and respiratory rate.

Administering medications: If needed, administer medications to control symptoms like pain, seizures, or nausea.

Preparing for immediate transfer: Arrange for rapid transport to a medical facility for further evaluation and treatment.

Priority Level: A subdural hematoma is considered a high-priority condition due to the risk of rapid deterioration and potential for life-threatening complications. It would be categorized as a Level 1 (Immediate) priority in triage.

Negative Symptoms for Epidural Hematoma: Symptoms that might suggest a subdural hematoma instead of an epidural hematoma include:

Gradual onset of symptoms: Subdural hematomas often have a slower onset compared to the rapid deterioration seen in epidural hematomas.

Symptoms persisting or worsening over hours to days: Unlike epidural hematomas, which can deteriorate quickly, subdural hematomas may show a more gradual progression.

Localized neurological deficits: Subdural hematomas might present with focal neurological signs, such as weakness on one side of the body, that are not typically seen in epidural hematomas.

Question: What is a subdural hematoma in contrast to an epidural hematoma?

A subdural hematoma and an epidural hematoma are both types of intracranial bleeding, but they differ in location and cause:

Subdural Hematoma

Location: Bleeding occurs between the dura mater (the outermost membrane covering the brain) and the arachnoid membrane (a layer beneath the dura mater).

Cause: Often results from rotational or deceleration forces, such as in car accidents or falls. The brain moves within the skull, causing veins to tear.

Symptoms: Can include headache, confusion, drowsiness, and neurological deficits. Symptoms may develop more slowly over hours to days.

Epidural Hematoma

Location: Bleeding occurs between the skull and the dura mater.

Cause: Typically caused by a skull fracture that tears an artery, leading to rapid accumulation of blood.

Symptoms: Symptoms can appear suddenly and include severe headache, loss of consciousness, and focal neurological signs. This condition can be life-threatening and requires emergency treatment.

Both conditions require prompt medical attention, but an epidural hematoma is generally more urgent due to the risk of rapid deterioration.

Question: What treatment would a medic provide for an epidural hematoma?

For an epidural hematoma, immediate medical intervention is crucial due to the risk of rapid deterioration. Here are the key steps a medic might take:

Stabilize the patient: Ensure the patient’s airway, breathing, and circulation (ABCs) are stable.

Administer oxygen: Provide supplemental oxygen to maintain adequate oxygenation.

Monitor vital signs: Keep a close watch on blood pressure, heart rate, and respiratory rate.

Administer medications: If needed, administer medications to control symptoms like pain, seizures, or nausea.

Prepare for immediate transfer: Arrange for rapid transport to a medical facility for further evaluation and treatment.

Surgical intervention: The definitive treatment for an epidural hematoma is usually surgical evacuation of the hematoma to reduce pressure on the brain. This typically involves a procedure called a craniotomy, where part of the skull is temporarily removed to access and remove the accumulated blood.

Close observation: In some cases, if the hematoma is small and the patient is stable, close clinical observation with possible delayed evacuation might be considered. However, this approach requires very close monitoring due to the risk of rapid expansion.

Question: What symptoms would eliminate either an epidural or subdural hematoma as a diagnosis?

Certain symptoms can help rule out either an epidural or subdural hematoma:

Symptoms that might rule out an Epidural Hematoma:

Gradual onset of symptoms: Epidural hematomas typically present with rapid onset of symptoms. A gradual worsening of symptoms over hours or days is less characteristic of an epidural hematoma.

Absence of focal neurological signs: Epidural hematomas often cause focal neurological signs like weakness on one side of the body. If these signs are absent, it might suggest another type of injury.

Normal pupil response: An epidural hematoma can cause unequal pupil size due to increased intracranial pressure. Normal pupil response might suggest a different diagnosis.

Symptoms that might rule out a Subdural Hematoma:

Sudden onset of severe symptoms: Subdural hematomas usually have a more gradual onset. A sudden, severe headache or loss of consciousness might suggest another type of injury.

Absence of confusion or drowsiness: Subdural hematomas often cause confusion, drowsiness, or altered mental status. If these symptoms are absent, it might indicate a different condition.

Normal imaging results: If a CT scan or MRI does not show any bleeding, it can rule out both subdural and epidural hematomas.

It’s important to note that these symptoms are not definitive on their own and should be evaluated in the context of a full medical assessment. Always seek professional medical advice for accurate diagnosis and treatment.

Question: What instructions would a doctor give to a family member for monitoring a concussed patient?

A doctor would provide the following instructions to a family member for monitoring a concussed patient:

Ensure Rest: The patient should rest and avoid activities that require concentration and mental strain, such as reading, using electronic devices, and watching TV.

Monitor Symptoms: Keep a close watch on symptoms like headaches, dizziness, nausea, confusion, and changes in behavior. Note any new or worsening symptoms.

Check Regularly: Check on the patient every 1-2 hours, especially during sleep, to monitor their condition. Look for changes in skin color, breathing, and level of consciousness.

Avoid Strenuous Activities: The patient should avoid physical activities, sports, and heavy lifting until cleared by a healthcare provider.

Hydration: Encourage the patient to drink clear fluids like water, sports drinks, and fruit juice. Avoid caffeine, alcohol, and milk products.

Pain Management: Use over-the-counter pain relievers like acetaminophen (Tylenol) for headaches. Avoid anti-inflammatory medications like ibuprofen or aspirin.

Seek Medical Attention: If symptoms worsen or new symptoms develop, seek immediate medical attention. Be aware of danger signs like severe headache, vomiting, seizures, and unequal pupil size.

These instructions help ensure the patient’s safety and support their recovery.

Question: If the concussed patient is a military commander whose tent is near the infirmary, would admitting the patient for monitoring be essential or could issues of morale (hiding the severity of the patient’s condition) take precedent?

In a situation like this, balancing the health of the military commander with morale considerations is tricky. Ideally, the safety and well-being of the patient should take precedence. Concussions can have serious and unpredictable complications that necessitate close monitoring. Admitting the commander to the infirmary ensures they receive the necessary medical care and timely intervention if their condition deteriorates.

However, military contexts sometimes require discretion for maintaining morale. In such cases, a compromise might involve discreetly monitoring the commander within their tent, while ensuring they have immediate access to medical care if needed. This way, the severity of the condition is managed while keeping the commander’s presence visible to their troops.

It’s a fine balance, but patient safety should always be the priority.

Question: So, the medic wanting to admit the patient and the concussed commander refusing could add drama to the scene?

Absolutely. Picture this: the medic, fiercely insisting on admission, knowing the risks. Meanwhile, the commander, fueled by duty and pride, refuses, believing their presence is vital. The tension heightens as they clash—one advocating for safety, the other for morale. This conflict encapsulates the harsh realities of leadership and responsibility in extreme circumstances. Powerful stuff!