Expert: Dr Ian Jackson - please note UK based - 8/30/2008

Question
i do not know whether you might be able to help me out. I am writing a novel in which my MC is involoved in an RTA. He sustains seveal broken ribs (3 or which are broken in 2 places) also he has servere bleeding onto his lungs. he is drifting in an out of consciousness, obviously the EMT's have brought him in. i need to do a scene in Truma room as a new character is introduced there. i have a couple of questions 1) what would the truma team do to stabilise his condition. 2) what medication is he likely to recieve ( i have a conversation to do so need some tech stuff) 3) is he likely to go to ITC afterwards and if so how long would stay and 4) what would they watch for.

sorry if you are not right person, could not find any A & E doctors or nurses on this sight.

I have e-mailed many A & E depts but most do not answer, those that are usualy to busy (understandably)

if you could help that would be great

Answer
Trauma team would put him through ATLS protocol which involves the ABCDE method of ensuring nothing is missed. Most details about this are kept under wraps by the people who run the courses for this technique of trauma management but you can find details at http://en.wikipedia.org/wiki/Advanced_Trauma_Life_Support
Given the trauma described he would have a flail chest (where same ribs are broken in two different places and would be at risk of lung collapse (pneumothorax) or the even more life threatening tension pneumothroax.
To stabilise condition they would be likely to have IV access, chest drain, pain relief, but if his conscious level is bad and his chest bad they may decide to intubate and ventilate him.
Drugs would range from pain killers such as morphine to full anaesthetic drugs to ventilate him. Not certain what they would use for this in the States, in UK would be propofol or ketamine to put him to sleep then suxamethonium to paralyse him so an endotracheal tube could be inserted. This would be done as a "rapid sequence induction" and would be tricky unless they knew his neck had not been damaged in the accident.
Sorry but this could go so many different ways that it is impossible for me to cover all eventualities - plus I too have busy schedule. You really need to think the direction you would like to take your character and then sit down and talk with a friendly medic.
Best of luck
Dr Ian Jackson