TRAUMA 101
C. J. Lyons, MD
No one is immune to danger....
www.cjlyons.net
RWA, 7/06

INTRODUCTION:

Who the heck is CJ Lyons and what the heck does she have to teach us about writing and medicine?  Well, here's the "official version":

Award winning author CJ Lyons has lived most of her life on the edge.  Trained in Pediatric Emergency Medicine, she has assisted police and prosecutors with cases involving child abuse, rape, homicide and Munchausen by Proxy.  She has worked in numerous trauma centers, on the Navajo reservation, as a crisis counselor, victim advocate, as well as a flight physician for Life Flight and Stat Medevac. 

Winner of the Golden Gateway and a Golden Heart Finalist in Romantic Suspense, CJ is a member of Mystery Writers of America, International Thriller Writers, Romance Writers of America, Sisters in Crime and Kiss of Death.  Her work has appeared in CrimeSpree, Romantic Times, and Spinetinger.  She has presented workshops for the Mystery Writers of America, Romantic Times and many RWA chapters.  Her medical suspense series debuts from Berkley in early 2008.  Learn more about CJ at her website: 

About Trauma 101.  There's no way I can cover everything in this one hour workshop, so I invite you to check out the articles in my newsletter, Lyons’ Tales,  as well as my longer online workshops which cover everything from pre-hospital care to gunshot wounds, fractures, head injuries, mass casualty and disasters, emergency child birth, etc.  But this workshop should get you started with some real life terminology and a look and feel of actual equipment to aid in your depictions of medical scenarios. 

ABC's of Trauma Talk 

"51yoWM c/c of CP, SOB, DOE with PMH sig for MI, s/p CABG x4, NKDA, BP240/120, RR32, HR144, SO2 96% on 5L NC.  SL nitro x 3, IV at KVO, MS 2 mg, EKG reads NSR, ETA 5"

How'd you like to pick up your phone and hear that on the other end?  Usually spoken by someone who doesn't take a breath until the end and whose voice is in danger of being drowned out by the whoop of a siren and honking horns.

Just like writers have their own lingo (how many times have you mentioned GMC to a non-writer and they think you're shopping for a car?), so does the medical world.  In fact, it often seems that the medical professionals pride themselves on speaking an archaic lost language that no one understands outside their world. Part of this is because of the need to communicate a multitude of details as fast as possible, as in the above EMS communication.  Part is a leftover from our paternalistic heritage when it was felt best to leave the patient in the dark and the doctoring left to those who knew what they were doing.  And part just because it's so damn cool–like being in a fraternity or sorority and knowing all the secret codes to get in to the keggers for free!

Below please find a nowhere-near-all-inclusive list of some common terms.  Please feel free to chime in with any from your own experiences or region (these reflect my experiences in the Northeast, South and Midwest).

The translation to the above is at the end of the handout!  

Airway=trachea and mouth (oropharynx)

ABG= arterial blood gas, painful procedure where a needle is stuck into an artery, usually the radial (pulse at your wrist) or femoral (pulse in your groin) and oxygenated blood is obtained and analyzed for oxygen, carbon dioxide, bicarbonate and pH

ALS#1=Advanced Cardiac Life Support (also ACLS), meaning someone has training in advanced techniques (physician, medic or nurse) and the equipment to do more than basic life support.  Also designation for ambulance or medic unit with paramedics and advanced equipment as in: "I need an ALS rig to transport."

ALS#2=alternate light source, the black light used to identify potential semen during rape exams, this same light can also be used to detect cornea abrasions, the presence of anti-freeze in urine and a host of other things as well

Asystole=flatline, no heart rate or pulse detectable, very little treatment for this (as in, there ain't no cure for death).  Using defibrillation (shocking the patient with electricity) doesn't work, unless you can treat the underlying cause (hemorrhage, shock, electrolyte imbalance, etc) and keep the blood circulating through CPR, this is pretty much fatal.

Arrhythmia=dysrhythmia, or abnormal heart beat, most of these respond to medications such as epinephrine and also electricity (defibrillation)

Box, Bus=ambulance

Bag, BVM=bag valve mask, used to be called "ambu-bag".  There are two types of these bags, ones that stay inflated even if not hooked up to oxygen (this type is most often used in ER and by medics on the street) and "anesthesia" bags that require pressure driven oxygen source to inflate them.

Bagging=forcing air into a patient by squeezing a BVM attached to the patient either through a tightly fitting mask over their face and nose or attached to a tube going into the trachea

Cabbage#1= aka gork, someone who's heart has been successfully resuscitated but their brain is damaged irreversibly

Cabbage#2=coronary artery by-pass and graft, the most common type of open heart surgery to bypass clogged arteries, as in triple bypass if three arteries are clogged, quadruple if four, etc

Code=full arrest, patient without respirations and/or heartbeat, or a patient unstable and crashing quickly, also Codeteam, a prearranged team of medical providers who carry beepers and respond to codes.  Most hospitals no longer use "code blue" as this has grown too recognizable, instead they often have their own overhead paging secret word.  Common ones are: Code 99 or Condition ABC

Code Brown=patient with explosive diarrhea that requires cleaning, usually refers to a job assigned to the medical student with lowest seniority, also sometimes refers to medical students and residents known for ass-kissing as in "he's such a code brown"

Code Black=mass casualty, disaster alert most commonly

Code Red=fire

CPR=cardiopulmonary resuscitation, usually specifically refers to chest compressions

Crotch shot=intramuscular dose of ceftriaxone, used to treat sexually transmitted diseases

Cyanosis: blue tinge to mucus membranes (lips, mouth) or body indicating severe lack of oxygen

Dem Dudes=world famous and very well traveled perpetrators of any crime, mischief or mayhem that a patient was involved in.  As in the oft-repeated refrain: I was just standing there, minding my own business, when dem dudes done come and jumped me. 

Donorcycle=motorcycle rider not wearing a helmet

Dyspnea=short of breath

ED=emergency department (this is what real docs and nurses use, not ER)

EMS=emergency medical services

Epinephrine=adrenalin, high potency drug that simulates body's own adrenalin and makes the heart race (a good thing when it's not beating at all!)

GOMER=get out of my ER!  Term of endearment for frequent flyers, usually of the elderly, hypochondriac or repeatedly intoxicated persuasion

GCS=Glasgow Coma Scale, ranges from 3-15, 15 is normal, 3 is what a brick would be assigned, anything less than 8 usually means the patient is so bad off that they'll be intubated and totally unresponsive

GSW=gun shot wound

Internship=first year of residency,  you've graduated from medical school, have an MD after your name but have no earthly clue what to do with it yet

Intubated=having an endotracheal tube placed through the vocal cords and into the trachea by using a laryngoscope to visualize the cords

LOC=level of consciousness, usually associated with someone not with it as in: he's got an altered loc, or merely, he's altered

Nasal cannula= oxygen tubing with two small prongs to be placed inside the nose to deliver the oxygen, this is measured in liters/minute of oxygen

Pulse ox=method of obtaining oxygen level in the blood (oxygen saturation or sat) by placing a lighted probe that looks like a bandaid or a plastic clamp over a finger, toe or earlobe, considered the "fifth" vital sign along with pulse, respirations, temperature and blood pressure

Rape kit= cardboard box of prepackaged envelopes, combs, drapes, swabs, slides used to collect evidence, the box is sealed, signed by the collector and their witness and usually given directly to the police or locked in a vault (with a supervisor signing the chain of custody) until the police can arrive to pick it up.  

SA=sexual assault

SCAN=suspected child abuse and neglect

Scoop and run=first responders realizing that a patient is so critical that there is little they can do on the scene, instead they only perform a rapid primary survey and take off for the hospital, performing the secondary survey en route.  Sometimes also used when minimally trained responders panic and bring a patient in without performing any interventions, as in a police officer rushing a GSW victim in the back of their car or the like

Scutmonkey or scutpuppy=terms of endearment for the lowest person on the medical food chain available to do scut work (all the mundane, boring or gross little things like charting, chasing down labs or disimpacting constipated old geezers, yes this is done by hand and a very long glove!) 

TA=traffic accident, used more commonly now than MVA (motor vehicle accident) by police but both are used by medical personnel

T-bone=type of TA where the cars impact in the shape of a T, one ramming into the side of the other

Treat and Street=emptying out the ER as fast as possible during busy times, usually by assigning one or two providers to a "fast track" where they quickly see the less urgent patients

Triage=process of sorting patients from most severe to least, used in the field, especially with multiple casualties, as well as in the ER.  In mass casualty responses, patients are actually given a tag that is color coded.  Black tag=dead or good as dead, Red tag=first priority, critical but can be saved with available resources, Yellow tag=second priority, can wait but not too long, Green tag=walking wounded

"51yoWM c/c of CP, SOB, DOE with PMH sig for MI, s/p CABG x4, NKDA, BP240/120, RR32, HR144, SO2 96% on 5L NC.  SL nitro x 3, IV at KVO, MS 2 mg, EKG reads NSR, ETA 5"

Translation: fifty one year old white male with a chief complaint of chest pain, shortness of breath and dyspnea on exertion.  His past medical history is significant for a myocardial infarction requiring a quadruple coronary artery by-pass and grafting.  He has no known drug allergies.  His blood pressure is 240 over 120, respiratory rate is 32, heart rate is 144, oxygen saturation on five liters of oxygen given via nasal cannula is 96%.  We've given him three doses of sublingual nitroglycerin, begun an intravenous line running minimal fluids and given him 2 milligrams of morphine.  His electrocardiogram is normal sinus rhythm and we'll be arriving at your facility in five minutes. 

See what I mean about using our lingo saving time!

Hope this gives you all an appreciation and taste of trauma and how to incorporate it into your writing.  I am of course available for consultation (time permitting) and also answer medical questions in my newsletter, LYONS' TALES --it's free and there's always a contest going on!   Go to  to sign up.  If you or your organization are interested in one of my longer workshops, don't hesitate to contact me at 

Thanks for reading!
CJ
No one is immune to danger