gunshot wound

Two hours might be a bit long but if he's in really good physical shape he could probably do it. Humans are surprisingly resilient when they need to be. We didn't survive millions of years of evolution by being wimps.

Shock is very unpredictable. There are cases of people involved in car accidents with absolutely no injuries who died of shock and there are cases of people who sawed off their own legs and crawled twenty miles through the woods to safety (yes this really happened).

It really depends on what caliber of rifle was used, and what type of round (i.e. Ball round, hollow point, armor piercing, etc.). If this isn't specified, is it an assault rifle, hunting rifle, or something else?

If none of these are specified, and it was just "a rifle" at "long range," then I'd agree with Drachen. If the guy is in relatively good shape, he could conceivably move around for quite some time before shock might set in. If he's trained in survival, shock might not set in at all. For a flesh wound, back on his feet in 36 hours is not unrealistic, though obviously he would not be 100%.

jeseymour said:

Hi folks

Yet another gunshot thread. I'm hoping this is just enough different to warrant its own place. My MC is shot from a distance, with a rifle. The bullet hits his left upper arm. I've written it as a shallow wound, through and through, without hitting the bone or the joint. I see it as a furrow of open flesh, with lots of bleeding. "Just a flesh wound" in other words. However, I know he's going to be a hurting puppy. I just want him to get someplace safe before he collapses and goes into shock and all that other stuff that goes with this. So - can he have two hours? One on a train (holding on with his good arm to the ladder on a boxcar,) and one stumbling along on foot. At that point he finds a culvert to hide in. It's the middle of the night, in August, no rain, in upstate New York. Is this realistic? I can shorten the time if absolutely needed. I figured he's running on adrenaline, until he gets somewhere that looks relatively safe, when he will collapse.

Second question - no doctors, no hospital. Simple first aid, wrapping with pressure. Realistic? Can he be back on his feet in 36 hours or so? Not running around, but limping along? He will have some water and a couple of tuna sandwiches in that time.

Any of this sound plausible? Thanks in advance for any input.

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He'll need stitches if it's an open furrow. So he will have to sew himself up. ERs are snippy about people with gunshot wounds. They ask all kinds of embarrassing questions. So he'll need a first aid kit with sutures or a medical stapler. There's also a medical grade superglue that could be used.

As for him on his feet in 36 hours with a flesh wound to the upper arm, I'd say that's reasonable. It'll hurt like hell and he'll have to be careful to not tear the stitches out.

Stan

I agree with every one else. I saw a lot of GSWs in the military. Some of the boys coming in didn't ever go into shock at all, especially with shallow wounds. Most of the time the shock is from blood loss. Though the trauma of it all can def. cause you to go into shock. But I think 2 hours isn't unreasonable.

In my newest WIP, I have a girl who's been Conditioned from the age of 3 to handle stuff like this. Never goes into shock from almost the exact same kind of wound. You should be perfectly fine.

If your guy is wearing cotton, wool or linen clothing (natural fibers, or at least mostly natural fibers if it's a poly blend, the cloth will likely clot into the wound and reduce bleeding. Of course every time the cloth moves it will dislodge the clot. Also if it's a furrow, it's a graze, not a through and through. Depending upon location and depth it could be anything from a nuisance to life threatening. Depending upon the length, he may not even need stitches, and if he did he could always lie to the ER. A graze from far enough that there's no obvious powder residue might not look that different from a variety of other injuries. "No, really, I got snagged on a bolt on the fire escape when my girlfriend's dad came home early."

A through and through is going to be more difficult to explain.

jeseymour said:

Hmmm. The way I've got it, he just gets to wrap it up. Every time he changes the dressing it bleeds again. He doesn't clot well, he's got a bad liver. Stitches would really complicate things. He will end up in the ER after a few days, (shot early Thursday morning, hospital Sunday afternoon) where he will get those stitches. In the meantime the wound will have been repeatedly opened up by activity. He's a mess by Sunday, still walking around, but barely. So it needs stitches, but he can't have them.

I have written in the pain aspect. He walks around with his left hand stuck in a belt loop or the fingers twined in his shirt, to keep from moving the arm.

He is a tough guy, (ex-Marine) and he is pretty fit. Can we live without the stitches?

Thanks!

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Sure. But as GeorgeK says, there'll be fibers in the wound. That will guarantee an infection if not treated immediately.

BTW there are no ex or former Marines. Once a Marine, always a Marine. They're sorta sensitive about that.

Stan

jeseymour said:

Hmmm. The way I've got it, he just gets to wrap it up. Every time he changes the dressing it bleeds again. He doesn't clot well, he's got a bad liver. Stitches would really complicate things. He will end up in the ER after a few days, (shot early Thursday morning, hospital Sunday afternoon) where he will get those stitches. In the meantime the wound will have been repeatedly opened up by activity. He's a mess by Sunday, still walking around, but barely. So it needs stitches, but he can't have them.

I have written in the pain aspect. He walks around with his left hand stuck in a belt loop or the fingers twined in his shirt, to keep from moving the arm.

He is a tough guy, (ex-Marine) and he is pretty fit. Can we live without the stitches?

Thanks!

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If it's 3 days later, it's too late to stitch him up in the ER, particularly if he's chronically ill. Also since the liver makes a good chunk of the clotting factors, he probably will have an oozy wound. By now it's a dirty wound and should just continue with the dressing changes unless it's still bleeding significantly in which case he'd go to the OR for debridement and a combination of cautery and oversewing of the deep bleeder. They'd also want to address in some fashion, the bad liver (probably schedule an appointment with an Internist, or consult one in house if they want to keep him for a few days. People with bad livers don't heal well, so if you want him to stay in the hospital, it'd be reasonable). The skin might be very loosely closed at that point (stitches about an inch or more apart to allow infection to drain)

Stanmiller said:

BTW there are no ex or former Marines. Once a Marine, always a Marine. They're sorta sensitive about that.

Stan

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except if dishonorably discharge (or so I'm told)

jeseymour said:

He is a tough guy, (ex-Marine) and he is pretty fit.

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I got called on this when I made the same mistake. An ex-Marine is someone with a dishonorable discharge, a major insult. Otherwise, he is a former Marine, or a Marine not actively serving. Or just a Marine.

Best of luck,

Jim Clark-Dawe

jeseymour said:

Hmmm. The way I've got it, he just gets to wrap it up. Every time he changes the dressing it bleeds again. He doesn't clot well, he's got a bad liver. Stitches would really complicate things. He will end up in the ER after a few days, (shot early Thursday morning, hospital Sunday afternoon) where he will get those stitches. In the meantime the wound will have been repeatedly opened up by activity. He's a mess by Sunday, still walking around, but barely. So it needs stitches, but he can't have them.

I have written in the pain aspect. He walks around with his left hand stuck in a belt loop or the fingers twined in his shirt, to keep from moving the arm.

He is a tough guy, (ex-Marine) and he is pretty fit. Can we live without the stitches?

Thanks!

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Joy! FORMER Marine... FORMER. No such thing as "ex", unless he seriously dishonoured the Corps.

Also, I'm no expert but I believe if certain wounds aren't stitched within a certain time frame you can't stitch them up (infection). Check with AW's resident docs. I think Terazima (sp) is one and there's another (name escapes me right now). ETA: What GeorgeK said!!

Stanmiller said:

Sure. But as GeorgeK says, there'll be fibers in the wound. That will guarantee an infection if not treated immediately.

BTW there are no ex or former Marines. Once a Marine, always a Marine. They're sorta sensitive about that.

Stan

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jeseymour said:

At the time of this book, he's been out of the Marines for 30 years. Would I call him a Marine? To me, that implies active service.

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I Once said ex-marine while in a camp of them. Seriously 30 marines.

I was quickly educated on why there are no ex-marines. Except for the dishonorable discharge exception noted above.

My arms still hurt when I think about it. And come to think of it, who's idea was it to have a bunch of marines run a boy scout camp?

(It was actually one of the better run camps I've ever been too. And despite them making it on the fly with just what they could get on a flat bed, had good facilities as well. Marines are awesome.)

Nivarion said:

... Marines are awesome.

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I would have to agree with that!

Second question - no doctors, no hospital. Simple first aid, wrapping with pressure. Realistic?

If he promptly applies pressure to the wound, and then a good bandage (a t-shirt will do) , he won't lose enough blood to send him into shock. I've seen some horrendous snowboard gashes (like filleting the entire thigh top to bottom!) and the patient did not go into shock because their buddies did a fast pressure bandage.

He has quite a while before he has to worry about infection - 48 hours or so.

Pain ... if you have things that have to be done, he can ignore it. He'll be a bit slower than usual, and his arm isn't going to work real well, but he can manage it.

I work in the firearm carrying industry. We carry tampons just in case. Best on-the-spot first aid for a gunshot wound. Just jam it in and do not pull it out until you have medical assistance. If it keeps bleeding, jam another in. Slows down shock because it plugs the bleeding. Best on-the-run treatment.

Most of it's been said, but I'll chime in as well.

Shock should be looked at as a tool of the writer. Yes, it's very real. But it's also extremely unpredictable. I've seen it take immediately, I've seen it never take at all (until anesthesia was applied to remove the round).

Stiches are good, but not necessarily necessary. Small rifle rounds can leave wound trails not much wider than the bullet. In some of these cases butterfly bandages, staples, or superglue can hold him together without infection.

The "3 days later" part is your biggest problem. That will require either a good amount of pain-management or just a tough SOB and limited ranges of motion. But, hey, it's your story...

With a wound like that, he can have two hours, or he can have forever, if he's healthy. People do NOT automatically go into shock unless they lose a LOT of blood, and sometimes not even then. I've seen gunshot wounds far worse than you describe, and the person went for nearly two weeks without treatment. He was well on the way to being healed before a medic ever saw him.

Caliber doesn't matter all that much, either, if it's just a furrow.

The real danger is infection, not shock. Bullets tend to be dirty, and so does unsterilized bandages.

But the bad liver? That could kill him.

I'm going to nitpick a bit on the train thing. That's not exactly easy to do with two hands, let alone one and feeling weak from a GSW.

See http://www.northbankfred.com/blue.html for a great description of trainhopping.

a few things to note: shock isn't a given; it's going to burn at first (bullets feel hot inside you), then, based on the healing process, it's going to make his affected extremity stiff, then, as time goes by, it's going to itch; depending on the amount of blood loss, he will get cold, and possibly tired/confused/lethargic; contingent on the amount of time that goes by without treating it and the loss of blood, it's also going to smell - first of blood (metallic), then of something akin to a wastebasket in an ER (the scent of rot would come after three days, after infection incurred necrosis).

if his bones or joints were untouched by the bullet, keep in mind that hydrostatic shock (the displacement of fluid in the cells, which is what causes the most damage in gunshot wounds) could still have caused those bones and joints harm.

I had four bullet wounds to the leg and foot. Except for self-administered first-aid, they went untreated and without meds for at least two hours. I have no significant issues with most helpful posts here, especially none with the following, except a minor tweak or two due to subjectivity or special circumstances.

siouxnyc said:

a few things to note: shock isn't a given; it's going to burn at first (bullets feel hot inside you), then, based on the healing process, it's going to make his affected extremity stiff, then, as time goes by, it's going to itch; depending on the amount of blood loss, he will get cold, and possibly tired/confused/lethargic

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I had little or no systemic shock, probably due to only having about the same amount of blood loss as donating a pint to the Red Cross. There was no burning or any other initial pain. The only sensation I remember was a tingle from foot to thigh. I was told that affect may have been the result of local trauma, a different sort of shock than the systemic variety. Pain didn't hit for the better part of an hour. Then it was a dull ache at rest with my leg elevated and sharp stabs of pain on the move, as is Joy's character. Yes, at rest, I wanted to just lie there and go to sleep. At the two-hour mark, pain was intense until I got meds.

siouxnyc said:

if his bones or joints were untouched by the bullet, keep in mind that hydrostatic shock (the displacement of fluid in the cells, which is what causes the most damage in gunshot wounds) could still have caused those bones and joints harm.

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Here's where my experience may not help. My bullet wounds were from .30 Carbine, more the class of pistol rounds than high-power rifle. Especially in full-metal jacket, .30 Carbine bullets are pretty much hole drillers with much less hydrostatic shock effects.

However, Joy's rifle bullet was fired at a distance. Even with rifle bullets, the greater the distance, the lesser damage produced within the wound channel. What I'm saying is Joy's rifle wound can be at such a distance as to also make a hole-drilling wound. I've seen such on big game hit past 300 yards.