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KMorris
11-22-2008, 06:39 AM
In a certain part of my story, a character is in the car accident and most of the injuries involve deep gashes and a large amount of blood loss but NO damage/rupture of major arteries. One is a head injury, and the other is a long gash vertically up a forearm.

My questions:

1.) How long would the hospital stay be, especially if the blood loss resulted in symptoms of minor shock and unconsciousness?

2.) Would the patient be hooked up to an IV or anything that would prevent him/her of getting out of bed without have to drag something along with him/her?

Elaine Margarett
11-22-2008, 04:11 PM
I've had a blood transfusion. I would imagine that would be the treatment for your character as well. Yes, he's be hooked up to an IV drip. I forget how long it took to receive a pint of blood, but it was at least two or three hours. I wouldn't think your character would be mobile while suffering from severe blood loss.

Maybe someone with medical experience will chime in~

sheadakota
11-22-2008, 07:40 PM
I guess that would depend on what your definition of severe would be. In a hospital setting a head lac and a deep laceration on the arm without artery involvement probably would not result in the type of blood loss you are looking for. Head wounds do bleed profusely and you can lose a lot of blood, but if the transport time from accident to hospital was swift and assuming EMS was on scene pre- hospital to treat it, You most likely would not end up with severe blood loss- My definition of severe blood loss would be enough to send the person into hypovolemic shock- venous bleeding if controlled would not do this. Now a splenic or liver lac/fracture were blood is constantly oozing or activley bleeding, then yes- your patient would require multiple transfusions of blood- depending on how shocky your patient is depends on how fast they infuse- very shock they would fly in through something called an introducer delevered by a level one rapid infuser- one unit or liter of fluid can infuse in mere minutes.

Your pateint would be in bed and not very with it usually - they may be flat in bed if blood pressure is low. No ambulation and he would be on a m on a monitor and most likey in an acute care setting.
Hope this helps a little.

RJK
11-22-2008, 07:46 PM
Severe blood loss? Have you ever donated blood? you give one pint and you're light headed. Your character would be weak as a kitten. If he tried to stand up he'd fall down. You'd need to replenish most of the lost blood, then he'd still have to deal with the head injury, how bad is that?

Assuming no complications from the head injury, and large lascerations don't prevent him from walking, he'd be out of the hospital in 24 - 36 hours, but he'd be connected to IV all during that period.

Barb D
11-22-2008, 08:01 PM
My dad was recently in a very bad accident. He had a traumatic brain injury, but no major blood loss. He was in Shock Trauma (a specialized trauma hospital in Baltimore) for a week, and in a rehab hospital on a brain injury ward for 2 weeks. For those 3 weeks he was restrained in his bed or chair. This was EXTREMELY frustrating to him, because he didn't remember the accident or understand what was happening to him or why he was being restrained. As many times as we would explain things to him, he wouldn't remember. This is apparently very common with brain injuries.

Once he got home after that 3 weeks he began connecting with reality, and now almost 6 weeks after the accident he's been cleared to drive again and to go back to work in December.

The doctors told us that if he'd been younger (he's 72) he would not have been responsive. The brain shrinks as you age, which gave his brain more room to swell within his skull.

HeronW
11-22-2008, 09:21 PM
Depending on the rate of the flow, a unit of blood transfused can take 1-2 hours. Shock depends on different factors: psychological, physical, and emotional. Often adrenaline can carry a person through a high stress situation over coming blood loss and pain.

A person of 150 lbs has roughly 8 pints of blood. I've volunteered at a blood blank and seen big guys near pass out where small women are just fine after donations. Much of the post-donation feeling depends on the donor's blood pressure, and fluid and caloric consumption before donation.

Used to be if you weighed less than 90lbs they wouldn't let you donate.

An arm gash can be problematic: if the major blood vessels are missed, the nerves may not be, the muscles certainly aren't and you'd have weeks of physical therapy to undo the damage to the hand, to regain fine motor skills, and strength.

Calixus
01-10-2009, 08:48 AM
I have to agree with the others here. The injuries you describe would not create the type of blood loss you are speaking of. Now if the MC has been on any type of anticoagulant, that could be a different story. But most times, even if they are, there would still have to be a fairly large vessel involved to cause serious blood loss. There would have to be significant loss of pressure to cause shock symptoms but as someone pointed out that big guys can pass out with loss of just a couple hundred mls of blood loss. If the person is an athlete, they have a lower heart rate and blood pressure at rest than non-athletes (heart rates can be in the forties and BP can be in the 80/40 ranges), but their hearts are bigger, pump stronger in stress situations so would do better with blood loss. I honestly do not know how to reconcile the two for you. As for how long, it would depend on severety of injurys and if the MC is unconscious due to the concussion or the blood loss. Most likely they will be held overnight for observation to make sure there were no hidden injuries such as a leaking spleen (which could account for invisible blood loss) or small tear in the liver.

emandem
01-10-2009, 09:48 AM
He'd be in the hospital 1-2 days, generally no longer than that unless there is internal bleeding. Yes, he'd be hooked to the IV the whole time. After getting IV fluids and possibly a blood transfusion (which would take a couple of hours), they'd probably just monitor his vital signs, level of consciousness, and then re-check his hematocrit the next day before sending him out. Oh, and they would CT his head if he lost consciousness at any point and if there was any doubt as to whether he'd hit his head or not.

jclarkdawe
01-10-2009, 05:50 PM
With your injuries, I doubt that you'd get the blood loss you're looking for. I had a motorcycle accident where the patient was wearing shorts and nothing else (New Hampshire does not require helmet). Road rash on 95% of his body. Massive amount of pain (lots of morphine on top of the alcohol he started with -- still screaming). Left blood smeared over most of the county, it seemed like.

Probably lost about 2 units. His system had not hit crash mode yet. Still had enough volume for his heart to work.

Basically what happens when you start losing blood is your system starts to compensate. Blood flow lessens to the skin and legs, stomach, and other less needed systems. Blood pressure would start to increase despite loss of volume. (The numbers might not change, but the heart is working harder.) Patient would probably be responsive to verbal stimuli.

Then all of a sudden the volume drops below the critical point. Blood pressure drops to something like 50/0. Patient collapses, as well as blood vessels.

My guess is to produce the results you want, a vein or two need to be cut (arteries tend to shut themselves down) or have some internal bleeding.

Basic treatment is stop leaks and refill. In the field, we'd start with at least one large bore IV and possibly two. Oxygen would also be administered in massive amounts (increase the efficiency of the blood). Hospital would start with blood transfusions.

Once the diastolic pressure hits zero, the patient is going to start seeing internal organs suffering damage. Kidneys are a big problem. My guess is a patient in that sort of situation would be in the hospital for several days.

Blood loss is classified. From Wikipedia:

Class I Hemorrhage involves up to 15% of blood volume. There is typically no change in vital signs and fluid resuscitation is not usually necessary.
Class II Hemorrhage involves 15-30% of total blood volume. A patient is often tachycardic (rapid heart beat) with a narrowing of the difference between the systolic and diastolic blood pressures. The body attempts to compensate with peripheral vasoconstriction. Skin may start to look pale and be cool to the touch. The patient might start acting differently. Volume resuscitation with crystalloids (Saline solution (http://en.wikipedia.org/wiki/Saline_%28medicine%29) or Lactated Ringer's solution (http://en.wikipedia.org/wiki/Lactated_Ringer%27s_solution)) is all that is typically required. Blood transfusion is not typically required.
Class III Hemorrhage involves loss of 30-40% of circulating blood volume. The patient's blood pressure (http://en.wikipedia.org/wiki/Blood_pressure) drops, the heart rate increases, peripheral perfusion, such as capillary refill worsens, and the mental status worsens. Fluid resuscitation with crystalloid and blood transfusion (http://en.wikipedia.org/wiki/Blood_transfusion) are usually necessary.
Class IV Hemorrhage involves loss of >40% of circulating blood volume. The limit of the body's compensation is reached and aggressive resuscitation is required to prevent death.You're talking a class III or IV loss. On average, a woman has 10 pints and a man 12 pints of blood. So for a class III loss, you're looking at 3 to 4 pints (depending upon size of patient). To see how much this is, take three pints of water. Add lots of red food coloring. Go outside and throw on ground. Bet it's a lot more than you thought it was going to be.

If you really want to make this look good, have friend lie down and then throw over them. Make sure it's red enough.

Best of luck,

Jim Clark-Dawe
Former EMT/Captain volunteer Fire Department