And since you asked... ....would you be able to give me an idea of what the doctor would say to the family following surgery regarding the gunshot wound, falling into a coma, and recovery expectations and such?
I haven't actually done my surgery rotation yet, but I can give you a pretty good account of what would go on.
First of all, hitting their head on something (such as a table edge) on the way down would probably work - especially if they hit it with enough force to fracture the skull.
Regarding the GSW (gun shot wound) and surgery - the surgeon would come out and tell the family 1. how the patient was doing NOW (the most important thing is to let the family know that the patient survived surgery and is alive), but then make sure that the family understands that the patient has not yet regained consciousness, and that we don't know when the patient will regain consciousness. The patient would go from surgery to post-op recovery (or SICU - intensive care), actually we'll probably put them in SICU for the moment because of the head injury.
The patient would be assessed for coma, initially when they came in to the ER and then once they were transferred to the SICU - the Rancho Los Amigos and the Glascow Coma Scale are the 2 main forms of assessment for head injury and level of coma. Tell the family that the patient is currently in a coma resulting from the head injury. You need to do a CT scan to determine the extent of the injury and the amount of swelling in the brain - looking for fractures, hematomas, bleeding, etc... That will better allow you to assess the the injury and then you'll have more information for them. A CT scan may have been done in the ER, or it may not have depending on the extent of the shoulder wound and how fast they were transferred to surgery. A CT should definitely be done after surgery to determine the extent of the injury. They would also do follow-up CTs once every 24 hours for at least the first 72 hours to follow the amount of swelling/bleeding in the brain.
Let the family know that you'll be doing the CTs and that you'll be able to tell them more after you've examined the patient a few hours post-op and after the CT, but also let them know that head injuries are unpredictable and you won't be able to make them any promises about when the patient will recover or how well they will recover from the head injury.
I hope that's helpful, I'm writing this kind of hurried on my lunch break at the hospital - I'll come back later and make sure that it was coherent and that I didn't forget anything too important.
Jill (who doesn't mind being abused for medical knowledge in the name of fic)
