Knocked unconcious on a pirate ship

[sunsalute]

Can I pick a medical brain about how you'd care for someone that was knocked unconcious with a blow to the head? If there's experience with how it feels and how to describe waking up, that would also be super amazing. I know it's super dangerous and requires a hospital visit but this is fic-land and historical and they're on a pirate ship so we're ignoring that small tidbit.

Setting: I'm not going to lie, this is pretty vague. Whatever Pirates of the Carribbean is, ish? On a ship belonging to a relatively well-respected naval officer who's just picked up someone with an 'or alive' bounty. As little crew as they can get away with.

The Knockening: poor Character is headbutted into unconciousness. They stay unconcious long enough to be moved to another ship.

The questions:
-how long can they stay unconcious before breaking suspension of disbelief
-how would someone used to dragging unconcious bodies around check up on Character as they wake up
-how does it feel to wake up after such a blow
-assuming no lasting damage, what temporary damage can Character expect?

Thank you so much!

Comments

[pallas_rose]

MY TIME HAS COME! :D

In the real world and my personal experience, unless there is concurrent substance abuse (e.g. they're not roaring drunk), the loss of consciousness for a concussion is pretty short, on the order of minutes. However, after they wake up, concussion victims can be perseverative (asking same question over and over again) and with short term memory loss (don't remember asking that same question before, nor your previous response) for minutes to hours. However, I am constantly reading fiction with people knocked out for hours with no sequelae, so I think most people would be willing to suspend their disbelief for an hour or so.

With a more severe TBI (traumatic brain injury), where there is actual bleeding in the brain and the victim has a persistent depressed level of consciousness, they may never recover fully, and if they do, it may take weeks to months to years.

Someone used to people with concussions would be resigned but patient with the very annoying repetitive questions of the concussed, explaining what happened and where the patient was and what was happening over and over again. If they were also experienced with moderate-severe TBIs (even in old timey land!) the things they would likely check to see if the patient was deteriorating (e.g. bleeding getting worse, brain getting compressed) would be: symmetry, reactiveness to light and size of pupils, patient's ability to talk and be coherent, and ability to move all their extremities on command (raise your right arm; squeeze your left hand). Depending on the medical tradition you're using, a doctor might use trepanning (cutting into the skull; we would now use the term Burr hole in the modern era) to relieve pressure from bleeding on the brain if there are lateralizing signs (eg, an asymmetry in the physical exam). They would be planning to do this immediately and urgently if the exam changed, to prevent herniation of the brain and death. They'd do it with a hand drill after cutting an incision into the scalp.

As for how it feels: I have had patients with concussions who lost consciousness have no headache and others have terrible headaches, so both are possible. Concussion symptoms often include nausea, vomiting, dizziness, and photophobia (light hurts your eyes). If they don't remember the blow or the preceding events or immediate aftermath, they may never remember it in the future.

Similar answer for the cases with no lasting damage (meaning a minor concussion; mod-severe concussions can have the above symptoms and more for days to weeks).

Often people with concussions from being struck with an object have a laceration to their scalp where they were hit that bleeds like stink and needs washing out and sewing up. Even on the forehead, the scalp can split like that, and can bleed briskly! Even if no actual laceration, you can get a real goose-egg of a hematoma or a skull fracture. That said, the bone under the forehead is some of the strongest bone in the body, so not likely in your scenario, especially if they don't have any lasting symptoms.

Does that help? Anything I can clarify more? SO thrilled to be able to use my knowledge to help fic or fannish writers :)

[source: I am a trauma surgeon]

[acelightning73]

When I was a kid, I'd see all these movie and TV adventures where someone got punched in the head and fell down, and by the next commercial break he was on his feet and chasing after whoever punched him. I knew from my own experiences that being hit in the head isn't like that.Every time it happened to me, it left me dazed and disoriented, with a lot of pain where I was hit and, I'd eventually throw up. Not like Heroic Private Detective who just got whammed in the medulla oblongata with a large revolver.

[lyorn]

Not a medical brain, but the scariest thing I ever experienced:

I had a motorbike accident when I was 17 and must have hit my head badly when some car (not going fast) drove into my right side (probably) while I was not going fast (quite sure). I was wearing a helmet.

That was around half past five in the evening, in December, so it was dark.

I remember an endless night chopped into pieces, a strange place I could make no sense of, people around me I did not recognize, me always asking "what happened", "where am I", yet never receiving an answer.

Later I learned that one of the people had been my mother, and that my questions must have been answered dozens of times. Another was my best friend who I did recognize and who could calm me down a bit. I remember nothing of that.

I awoke around nine in the morning and recognized that I was in the local hospital which I knew well enough, and that it was winter outside. Someone had said something about an accident, and after I had checked that I was physically OK, I mostly worried about my motorbike. When I tried to remember anything, I found that in my last easily accessed memories it was summer. I had some skin scraped off my knuckles, a bruise on my chin, and was otherwise OK enough. I took me about three days to piece my memory back together, but I happened on forgotten details for weeks, and I never remembered the accident.

So:

To my best guess, I was up (and agitated as hell) probably shortly after they got me into the hospital which was 500 metres from the accident site. Maybe even in the ambulance? Consciousness is not either/or. It has degrees.

But I was completely out of it for more than 12 hours. Even if you allow for most of them to have been sleep, it took the staff at least 30 minutes to find my mother and get her there, and my best friend arrived later than her.

I did not even have much of a headache, and my eyes were just fine. (I had a concussion when I was eight and I had trouble reading for about half a day because the letters seemed broken.) I was confused and worried but very relieved that I was physically OK.

I might have been nauseous and lost my supper. That had also happened the first time I had a concussion, where I did not lose consciousness, awareness or memory.

Five days after the accident they let me out of the hospital. Two weeks after I was still easily exhausted and fatigued. One month after I was quite well again, also mentally: I was preparing for final exams (in math, chemistry and geography) and passed the exams two months after the accident.

No lasting damage, except for some months in my life which have always been a bit vague in my memory.

[acelightning73]

I agreee about the helmet

I dated a guy who had a motorcycle, and who was teaching me how to drive it. There was a highway cloverleaf which wrapped around a very low hill, and people used to drive up it on motorcyles and bicicles to get a little bit of a "jump", and my boyfriend did that, and the bike landed on its side. I was wearing a helmet, which prevented me from having my face scraped off in a patch of gravel, and my ankle landed on the exhaust pipe which gave me a nasty-looking burn. But I kept trying to drive that bike, which was too tall for me - my feet didn't touch the ground when I straddled the seat.

And my son worked in a hospital as a volunteer, and also as an EMT, and motorcyles are referred to by ER personnel as "donorcyles".

[abracanabra]

From personal experience in being a dumb-ass, if they get a hard hit to the front of the head, one likely medium-term damage effect is raccoon eyes bruising and swelling that will take a couple of weeks to go down (but takes about 24 hours to fully develop). Painful and VERY noticeable.

Welfare check might include checking to see if the pupils dilate appropriately, if they match in size, if they remember what happened, if there are any squishy spots in the skull, if there's clear fluid or blood coming from the nose or ears.


Wakeup might be--hey, I'm awake! ...why does everything hurt and why are things sort of blurry? Why can't I remember what happened? (A few minutes to an hour of memory loss prior is likely.)