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Swordswoman
11-26-2010, 08:45 PM
I'd be very grateful for any medical advice to help me write this situation.

19th century and the Battle of the Alma. I have two wounded soldiers in an entire field of wounded soldiers, one of whom has been shot in the lung. I don't need to know specific treatment (the poor guy's going to die long before that stage) but I wonder if anyone can tell me:

1. What symptoms would show to the utterly untrained observer - eg does the cliched 'blood-flecked foam' on the lips have any basis in reality? He has a little hole in his back, of course (duh!), but is there anything other than that which could tell his companion where the bullet is? Would it be at all like pulmonary edema, eg would his face be pale and sweaty, and very gradually get the bluish tinge? Any coughing in the later stages?

2. Is there anything his companion could do to make him more comfortable? He has no medical knowledge, but I'd rather he didn't do something stupid that a trained reader would recognize as making things worse. Eg -
At present he props the guy up, but would he be better lying him down? At present he gives him a sip of water, but is that dangerous?
At present he moves him slightly into the open where he's got a chance of being seen by the 'bandsmen' with the stretchers, but would that be fatal?
At present he tries to dress the wound, but would he be better not mauling the guy about at all?

3. What symptoms would the injured guy feel? Pain from the wound itself, of course, but would (for instance) his breathing be bubbling and painful? I've had pneumonia and pleurisy, so if it's at all similar I can do this bit myself!

4. Is it credible for him to speak a little, or would that be impossible? I'm imagining only in short sentences, but I'd like him to manage those if he can.

5. Is it credible for him to die in about 3-4 hours? I'd like him to if he can.

The musket ball can be lodged deeply in the lung, it can have just chipped it, it can be wherever we want it to be and we'll never find out where it was.

I'm so sorry, this is a lot of questions in one. If anyone can give a minute to help out a complete ignoramus I'd be very grateful.

Louise

Drachen Jager
11-26-2010, 09:26 PM
http://en.wikipedia.org/wiki/Pneumothorax

http://www.tpub.com/content/armyintelligence/IS0877/IS08770081.htm

Swordswoman
11-26-2010, 09:49 PM
Thanks for taking the time to respond, Drachen Jager, and indeed for the links. The Army Intelligence one looks particularly useful for the future. There's more knowledge there than a 19th century soldier would have, but I get from this that it's a good idea to try and seal the wound - ie the rough dressing. My poor soldier won't have cellophane, foil, or anything airtight, but at least this suggests he's not being stupid in trying to cover it.

I'm fairly well up on pneumothorax, but unfortunately it's not clear how much of this would apply to a single gunshot wound, or indeed how it would be treated in the field - eg where the options of needle decompression etc are simply not available.

This is why I'm finding it so tricky researching this myself. Most medical sites rely on modern knowledge and science, and the prognoses are based on a patient in hospital rather than one stuck in a field! I've been working through the memoirs of a medical surgeon in the Crimea at this time, but even he doesn't describe what a man looks/sounds like when he's been shot through the lung, or how long he'd be likely to live... Very irritating of him!

ETA - Ooh, I've just followed more page-links from the Army Intelligence site, and see it gives me advice on positioning and visible symptoms as well! Brilliant, thank you - that's really helpful.

Drachen Jager
11-26-2010, 09:52 PM
Proper current first aid says not to cover it entirely but that's a development made in the '80s.

From what I remember from my first aid training, you lay the person on his side, injured lung down. Put a square of plastic over the wound, tape three sides air-tight leaving the lower side open so it can act as a valve where blood will go out as the injured party breathes out but will hold air as he breathes in.

Swordswoman
11-26-2010, 10:01 PM
Yes, that's what the Army site says too. It really is a great resource, that site - thank you so much for finding it.

My chap won't be able to tape or seal anything, nor would he credibly have the knowledge to lie the man with the injured lung downwards, but the site says if the patient's more comfortable sitting up then that's also good, so I'll stick with the propping up option.

It looks as if it's perfectly possible for the patient to speak, so I'm okay with that one. It also seems the visible/audible symptoms are exactly the same as plmonary edema, so I can go with the pale, sweating, turning blue etc etc too.

Really all I need now is to know if it's safe to drink, and whether it's credible for him to die in a rough 3-4 hour timescale.

Again - thank you so much. You've really, really helped.:)

Louise

Drachen Jager
11-26-2010, 11:21 PM
Oh yeah, he could live for a few hours depending on the severity of the wounds. I know with most internal injuries you're not supposed to give water but I don't think it would matter with a lung. In any case they wouldn't know that in your time line. Normal procedure is just to give a moistened cloth so they don't get much liquid but get the illusion of having something to drink.

Before he dies he'd be gasping for breath, sucking harder and harder with longer pauses between breaths, that stage might last for as much as fifteen minutes to a half hour.

Swordswoman
11-27-2010, 12:41 AM
That's great, Drachen Jager. Horrid - but great.

Now all I have to do is write the thing...

Thank you very much for taking the time and trouble to help me - and for providing a resource that could be very useful for future scenarios too.

Louise