Gunshot wound through right lung (new question in post #6)

357 hollowpoint to the chest and abdomen...probably time to call a mortician.

But yeah, assuming 4 saving throws in a row of 20 AND an experienced trauma crew used to dealing with GSW's, then they'd probably staple off a wedge of the lung. There may be someone somewhere who'd attempt a thoracoscopy but usually in these kind of situations time is of the essense and it's easier to control bleeders with a finger than with a sponge through a scope. Depending on the exact situation they might even crack the chest in the ER, pack off the bleeding because you can ventilate someone using just one lung and if the chest wound is open, it won't become a tension pnemothorax. Then open the belly in the OR, fix that stuff, then explore the chest formally in the OR.

Long term breathing difficulties depend a lot upon underlying lung disease, smoking, life style etc. A young healthy non-smoker who is not a manual laborer might not have a lot of complaints. A marathoner or bike racer will likely retire from competetition unless they are like Lance Armstrong.

Just as a sort of interesting aside, although my injury was not a gunshot wound, I did suffer severe lung trauma, including a collapsed lung, just over twenty years ago (22 years ago this month) when a horse stepped on my chest. Internal bleeding, needed two units of blood, 6 ribs broken in 9 places, I think. Anyway, the point I'm getting to, in 1999 or so I started coughing up blood. Just a little here and there, I ignored it for a while, then made the mistake of mentioning it to my doctor. Ended up in surgery in 2001 where they discovered that the big mass in my lung was a fungus. Aspergillus, to be exact. The fungus moved in because of the damage to my lung. They actually treated me with a powerful fungicide and I'm okay now, but that might be an interesting twist for your character, to have him start coughing up blood a few years down the road. I do have reduced lung capacity, and reduced use of my right arm. Plus I can't stand up straight.

Kalsan said:

Hi,

In the story I'm currently working on, my MC has been shot through the right lung from behind with a .357 using a hollow-point bullet. The exit wound is just below the collarbone and what I'm looking for is what surgical procedure would be more likely: thoracotomy or thoracoscopy?

The lung has, obviously, collapsed; so would I be correct in assuming they'd staple off the damaged section of the top lobe in order to reinflate it? How would this affect lung capacity in the future?

He's also been hit in the left abdomen so lying him on his side for surgery doesn't seem like a good idea.

Thanks.

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With a .357 hollowpoint, and that trajectory, he's going to have a exit wound you can stuff a softball into "below his collarbone" and be gushing blood from a number of mangled arteries and veins, and have splinters of bones hanging out. (judging by what they can do to a full-grown black bear with a reasonably close straight shot through the chest ... and humans are smaller)

What sort of first responder team is going to keep him from bleeding to death or dying from lung collapse in the first few minutes?

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Adding: the hollowpoint bullet will fragment into shrapnel on impact, making hamburger out of his lungs.

ooh this is fascinating and timely! So if you were shot with say a 22 and didn't bleed out, could they do anything for you laproscopically? Or would they just go in an fix the lung through the wound, sew you up, re-inflate it and be done?

How long would that take to heal?

It's also four years old.

Kalsan said:

I should probably have pointed out that it was the chest wound only that was caused by the 357; the abdominal shot is a much smaller caliber so, hopefully, I won't need an undertaker just yet. Thanks for the assistance though; it's much appreciated.

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As the poster above, Tsu Dho Nimh, said, the chest wound with a .357 hollow point would pulverize his lungs, sever multiple arteries, and he would die within minutes (same as if someone sliced open his carotid or jugular arteries by slitting his throat). He would not survive this wound.

Perhaps use a different type of bullet, a normal full metal jacket. And maybe change the caliber (also using full metal jacket rounds). Even a 9mm though the chest would give him a chance of not dying if it wasn't close range. I'd go with a smaller caliber though, like a .22 handgun.

The original post is four years old. The story is either long finished by now or abandoned.

There's a new question relevant to the thread, happy to let it stand.

I know, I was wanting the info for my own story! LOL

Laparoscopy deals with the abdomen. If you are using a scope in the chest it will be a thoracoscopy, a mediastinoscopy, or a broncoscopy. BTW it is unlikely that any of those would be used in a trauma situation.