Fantasy: Blood loss and cauterization of a wound?

Supposedly, American Indians used fire (or coals) to cauterize wounds, then used some sort of salve on the wound.

I assume this isn't a deep puncture wound.

I'm sure some of the medical folks can give you better details, but I suspect you're referring to a chest wound that does not involve a punctured lung, or compromised artery - otherwise traveling any distance would be moot.

It's not just the loss of blood volume, but the lack of pressure that will be problematic and lead to unconsciousness. Direct pressure on the wound would slow bleeding, but traveling is still an issue. I think your (magic) cauterization idea has merit, but it might have to occur before your character attempts any strenuous activity.

First of all, cauterization of wounds is generally a bad idea. I'm going to quote a post I made in another thread here several months ago:

JayMan said:

No! I don't know who told you this, but cauterization (something that Hollywood is quite fond of) is very rarely a good idea in the field. Surgical cauterization is one thing, but taking hot objects out in the wilderness and branding an open wound is generally a very bad idea. At best, you'll stop the bleeding but cause second and third degree burns, destroy a lot of good tissue, and drastically increase the chance of wound infection.

You would not only be wounded, but also burned. It might be a last resort, something to do when there's absolutely no other option, but cauterization should not be a go-to move.

Click to expand...

However, in your case, the wound is probably bad enough to warrant cauterization if the bleeding hasn't stopped. According to this medical text I found (http://books.google.com/books?id=cs6O3QIwrKcC&lpg=PA306&ots=mbIqfSf_MJ&dq=30-40%25%20blood%20loss%20of%20consciousness&pg=PA306#v=onepage&q=30-40%25%20blood%20loss%20of%20consciousness&f=false, pg 306), a 30-40% loss in blood volume (the average person has about six liters of blood) results in altered mental status, being anxious or confused. After 40% "restlessness," "agitation," and "listlessness" set in and the victim may be confused and lethargic. At 50% blood loss, there is "loss of consciousness, pulse, and blood pressure"--essentially, the victim is going to die at that point.

So in your case, I think it would be better to, instead of the character losing consciousness, just being really out of it--mumbling, unable to walk, disoriented, incoherently responsive to pain or verbal stimulus, etc. because if he's full-on unconscious (defined as being totally unresponsive), that means he's probably lost too much blood to survive without immediate and thorough medical intervention.

Cauterizing would probably stop the bleeding, but would also open him up to the possibility of infections and other consequences (since cauterization is essentially killing a whole lot of tissue, and this is a big, open wound to boot.)

I've been an EMT, but not a doctor, so take all my words with a nice big cup of salt. But if I were you, I'd have the character lose enough blood to make him incoherent/disoriented/uncoordinated--have the other character attempt to apply direct pressure to the wound to stop the bleeding (though I'm not sure how he'd carry him and apply pressure), then cauterize the wound at the rendezvous point, keeping in mind that cauterization comes with its own set of messy risks, though given the circumstances may be the best bet if the bleeding doesn't show signs of stopping.

ETA: Like ironmikezero said above, the loss of blood pressure is what will cause the unconsciousness and changes in mental status, for the most part. Again, I'm not a professional or an expert but I don't believe the pain of cauterization would be enough to wake him (though it's fiction and you're allowed to take creative liberties!), and he certainly would not be in any condition to travel for weeks at the least, months more likely.

Ain't gonna work

Glorium said:

All right, so here's the scenario.

I have a character who gets a rather large wound on his chest and he's leakin' like a sieve. He travels with another character to a rendezvous point, unexpectedly, but when they arrive, he's lost too much blood and he passes out.

The first question would be, how much blood does someone have to lose before they pass out?

So, after he passes out, the people around try to tend to him, but unfortunately, they can't seem to stop the bleeding. Another character steps up and volunteers to cauterize the wound using magick - he can blow fire from his mouth.

So this is a double question.

Would the fire even work to stop the bleeding and save his life for the moment? Also, if he was passed out, would the heat of the fire on his skin wake him up?

Mind you, this is magickal fire, so it can be directed to a certain place with relative ease.

Click to expand...

So you want a chest wound that won't respond to pressure, but will respond to cautery? Then you are probably involving the subclavian artery and in order for the cautery to work you are going to have to cook the artery which will drop the lung on that side and make the entire arm on that side necrose. The good news is that the character won't have to worry about infection becuase he'll be dead before that. Unless the subplot is showing how little your magician knows about anatomy or medicine, I suggest applying pressure and letting Hollywood blunders remain in the past.

Sorry if that sounds terse. It's not intended to be mean, just informative.

Ok, I calmed down a little and theoretically you could have a severed intercostal artery for which, focused cautery would be the thing to do assuming you had no way to oversew the bleeder. You might get by with the equivalent of a few seconds of a blow torch resulting in a burn the size of a small chicken egg. It would hurt like heck and might get infected, but if you wash it and dress it 3 times a day and the dude is healthy, well fed and able to rest, would have a reasonable chance of healing. As to passing out or forcing someone awake, it could do either.

As has been poined out, the cauterization isn't a good idea. If you want the charctr to survive, but you want him unconscious for a time, then keep in mind that it is low blood pressure, rather than actualy blood loss that cause unconsciousness. So you might move the wound to an arm and have a major artery cut. That would cause blood loss, and it probably would respond to pressure. On the other hand, if you want to cauterize something, then have him lose a hand in the fight; but in that case the cauterization would have to be almost immediate, or the character would die.

Okay, first off, I have to wonder. He has a massive hole in his chest, correct? So how did such a wound managed to miss his lungs or his heart? How about the major arteries and veins that are in that area? Let's not even worry about having time to bleed to death. If you hit one of the those things, you're going to be gone in a matter of minutes.

Secondly, he's bleeding like crazy and he can still manage to ride a horse? What about shock? If he's losing blood, at a rapid rate, it doesn't take long for the person to get lightheaded. And if someone was bleeding that heavy, it's stupid to move them, because they're going to bleed even more heavily.

So how long does it take? Not that long if he's losing blood from the chest, especially if it managed to nick a major artery.

Finally, cauterization...on the chest? It's not the skin that needs to be cauterized or healed...it's the arteries. And cauterizing the arteries...is not a good idea, unless of course, you want the person to stop getting blood flow and die. Also, I don't know how you would cauterize something without striking the heart or lung or etc.

Sorry to sound terse, but the scenario is implausible. As Snick suggested, you should move the placement of the wound. And perhaps find a different method to heal other than cauterization.