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theninjkaymarie
07-31-2012, 07:53 AM
So I have a character that is stabbed five times with a dagger. Th dagger is from early seventeenth century Europe and is about five or six inches long. While the dagger is old, the story takes place in 2009 and he is found about five minutes after he is injured. He is nineteen years old, 5'8, quite scrawny but physically healthy. The paramedics take about ten minute to arrive after he is found. Two stab wounds are in his left lung, one was deflected by a rib, one hit the upper large intestine, and the last one was in the right ventricle of his heart, and the knife was left in this entry point. The only stab wound that is deep is the one in his heart, and the others are at maximum about three inches. The heart wound is the length of the blade. The two people who found him were told by the person on the phone to place him on his side so that he was in recovery position to aide with breathing. I have several questions abut his prognosis.

1. Would it be realistic for his throat to be filled with blood so that he has difficulty breathing when the two people find him?

2. If he hasn't been breathing and is clinically dead for two minutes before the paramedics revive him, what complications such as brain damage and other organ failures could result?

3. Is it realistic that he could even survive this stabbing?

4. What kind of surgeries or procedures would the doctors follow to save him, and without any further complications, how long would he be in surgery and how log would it be before he gains consciousness?

5. What treatments and medications would he have to go through afterwards while in the hospital, and how long would they keep him there barring infection from the intestinal stab wound?

6. After release from the hospital, what sort of follow up treatments and restrictions would he endure, and how long before he is able to do normal activities other than things such as heavy lifting and hard physical exercise?

7. If he has a history of bipolar disorder and attempted suicide and all of the evidence points to suicide though it was a homicide, would they keep him longer for psychological evaluation, or would they even go so far a to institutionalize him?

Also, I have looked through multiple threads and the most I could figure out was that he'd probably survive with fast care, that there was a risk for infection, and I'm guessing maybe ten days for the hospital stay? I'm really not sure about the last part. Sorry I have so many questions and this post is so long.

theninjkaymarie
07-31-2012, 07:56 AM
Oh, and all he is wearing is jeans and a thin v-neck undershirt.

boron
07-31-2012, 11:13 AM
1. The throat filled with blood (from the injured lung wing) making breathing difficulty, yes, realistic; but also little to no blood possible. A lot of blood in the throat could result in choking to death, but the blood is usually reflexively coughed up.

2. Two minutes without breathing does not necessary cause any permanent damage to the brain or any other organ at all. Five minutes would be a completely different story. The person could lose consciousness from fear or from the loss of substantial amount of blood. Unconscious person may breath normally...The wounds you described by themselves do not necessary cause unconsciousness. The paramedics (probably with a doctor) would start with resuscitation (ABC) if necessary and give intravenous infusion or blood transfusion and oxygen by a mask.

3. I believe he could survive - the knife kept intact would, at least partly, keep the heart wound closed and one healthy lung wing would supply enough oxygen.

4. Surgery: Heart surgery, lung surgery and abdominal surgery to repair the wounds. My guess about surgery time: 3-4 hours. He would be technically conscious when the effect of anesthetics would wear off - within the minutes of the end of surgery, but they would also likely give him some strong sedatives, so he could be in a deep sleep for quite some hours thereafter. A stabbed lung wing remains collapsed after surgery - here (http://www.mayoclinic.com/health/pneumothorax/DS00943/DSECTION=treatments-and-drugs) is a short description how they expand it.

5. Hospital medications: Intravenous infusion with appropriate fluid, nutrients, antibiotics, anticoagulants, narcotics and then weaker painkillers - few days at least. Oxygen via a face mask. He would be probably not eating anything by mouth the first day after surgery. 10 days in hospital sound realistic, but someone other should tell...

6. At home: painkillers to deal with postoperative pain (http://www.cts.usc.edu/hpg-painmanagementandmedicationafterheartsurgery.html) .

7. In some countries, after suicide attempt, it is obligatory by law to stay in certain institution for some time.

Pallas Athene
07-31-2012, 11:29 AM
As a caveat: my experience comes from being a navy corpsman, so I can answer your questions about the emergency care end of things, but once he gets into the hospital/aftercare my knowledge gives out.

1. He'd be likely to have bright, frothy blood in his throat from the lung injuries, but the difficulty breathing would be more from the pneumo/hemothorax- air or blood in the pleural cavity, which would cause a collapsed lung.

2. Brain injuries from lack of oxygen vary depending on the location and severity of tissue death. We're talking anything from minor memory loss to having to relearn how to walk and talk, to being dependent on caregivers for the rest of his life. A two minutes without oxygen though, any brain injury is likely to be minor. During CPR though, there is some oxygen getting to the brain and organs. It isn't much, but what the American Heart Association has found is that the blood stays oxygenated enough during CPR that the main focus now is on effective compressions.

You mention that the bystanders are directed to roll the patient on his side to help him breathe, but I very highly doubt this would happen with a stab wound to the heart. In a situation like that the damage done if that knife shifts is too great to risk moving him.

3. This depends. How fast do bystanders get there? Do any of them have experience with first aid of any sort? Do they know not to remove the knife from the heart? With the knife left in it's possible, but not very likely, he'd survive.

The lung wounds are serious, but not as much as the knife in the heart.

The wound to the intestines is minor compared to the others. The major concern there is infection.

4. Other than a needle decompression for the collapsed lung, I really don't know.

5. He'd be on high doses of antibiotics, but again I'm not sure other than this. Hospital stays vary on how the patient responds to treatment, but with a hole in the heart I'd think ten days is probably an underestimate.

As for six and seven, I don't know.

theninjkaymarie
07-31-2012, 12:30 PM
Thank you! Yes, the person on the other end of 911tells them not to move the knife. I guess I will try to find a little more information on laws and stuff for how long his hospital stay is, but you two have been a lot of help.

ilovetoreadnwrite
04-10-2014, 04:27 AM
Your question actually helped answer a bunch of my questions. But I was just curious, what if, unlike your case, the knife is not left inside the body? How would that alter the situation and the consequences?

Also, I would appreciate it if anyone who would know the answer to my question (http://absolutewrite.com/forums/showthread.php?t=288409&highlight=multiple+stab+wounds) could answer to it there.... Thank you!

Cath
04-10-2014, 05:45 AM
Folks here are good at reading and contributing to all the threads, ilovetoreadnwrite, so no need to link to it. :)

DTW_dtw
04-15-2014, 01:50 AM
So I have a character that is stabbed five times with a dagger. ... The paramedics take about ten minute to arrive after he is found. Two stab wounds are in his left lung, one was deflected by a rib, one hit the upper large intestine, and the last one was in the right ventricle of his heart, and the knife was left in this entry point.

3. Is it realistic that he could even survive this stabbing?

4. What kind of surgeries or procedures would the doctors follow to save him, and without any further complications, how long would he be in surgery and how log would it be before he gains consciousness?


I'm a low level medical student. One of my instructors in particular is a surgical tech who's assisted in a couple hundred surgeries. She's had her hands in people and a ring-side seat for everything. She loves to tell gory stories. Here's what strikes me about this as a big problem.

The rib hit and the intestine hit aren't going to be an immediate problem (except for pain) unless the blade manages to create massive blood loss by opening an artery or vein. The intestinal stab, especially if it opens the intestine, will create a very large issue with sepsis and septic shock that could kill the guy within a day or two unless treated.

The lung hits are a more immediate problem, but only somewhat so. A person can survive on one lung. If the lung hits don't create significant blood loss, the guy would still be 'okay'. In a lot of pain, and not up to any serious amount of exertion, but basically 'okay'. Shouldn't be a stretch for him to last long enough for paramedics to get him to a hospital.

The huge problem is with the heart hit. Long story short, the heart has four chambers. The ventricles are the lower chambers. The right ventricle feeds blood to the lungs where it's oxygenated, and the left feeds the body via the aorta. Putting aside the significant likelihood of any damage to the heart (especially via a sharp weapon) severing any of a NUMBER of major blood vessels (the aorta, ascending aorta, descending aorta, superior or inferior vena cava, or any of the cardiac arteries or veins) . . . if the right ventricle loses its ability to contain and pump blood, that blood won't reach the lungs to get oxygenated.

So, blood loss from the hole in the ventricle aside (which is a second huge problem), the purpose of blood is to circulate oxygen and nutrients to the body. If what blood that is circulating isn't oxygenated because the right ventricle isn't getting it to the lungs, the guy's going to be unconscious fairly quickly (due to the brain not getting oxygen if nothing else).

And the heart is a constantly active muscle, typically 60-100 beats per minute. On adrenaline, in fight-or-flight mode, higher. Could easily be 150 or 200. Every contraction is moving the heart against the blade. Leaving the blade in the hole might help stem blood loss some, but he'll still be bleeding out. Blood pressure is highest at the heart (it's the source of all blood pressure).

Expecting the guy to live ten minutes before medics get to him seems like a stretch. An internal wound like that can't be bandaged or closed by a paramedic. They'd be able to buy him a little time by running a blood expander or two into him (basically a saline IV to replace lost blood volume; doesn't replace the blood, but would keep what blood he had left more able to keep circulating). Further expecting him to live through the ambulance ride, where (if he was rolled in still alive) he'd be rushed to emergency cardiac surgery, is a bigger stretch. Not impossible, but a stretch. People survive trauma that pierce and penetrate the heart; it's not unheard of. But it's uncommon.

If it were my story, I'd be purposefully fuzzy on the details of the wounds. Lay audience might find it a stretch for someone to get stabbed in the heart and live 20-30 minutes before the character is hooked up to a blood transfusion and on a surgical table having his chest cracked. Medical audience members will be raising their eyebrows at it.

And if you're going to have a scene where medical characters explain (to the guy, to his family, to whoever) the injury and what they did to fix it and so forth . . . I'd use phrases like "he was very, very lucky" and "it's a miracle he lived long enough to get into surgery".

As far as treatment, having your chest cracked is exactly what it sounds like; they saw your sternum apart and part your ribs. Then they'll have to repair the cardiac damage, plus all the other injuries (lots of internal stitches and staples and so forth). His thoracic and abdominal cavities will have to be drained of any bleeding into them; and his abdominal cavity will additionally have problems due to leakage from the intestinal injury. If the lung wound caused significant bleeding there, more drainage to clear the lung before re-inflating it. He's looking at a lot of blood transfusions during surgical prep and the actual procedures.

Post op, antibiotics to counter the sepsis from the intestinal problem. Immense amount of pain from the injuries and surgery. He'll likely be in intensive care for days, possibly a week or more considering how stabbed up this guy would be. His full recovery time would be at least two or three months. That much damage would take a while to heal. 'Simple' non-emergency open-chest cardiac surgery can be two or three months to recover from. The extent of his wounds would slow the recovery (takes the body energy to heal, and there's only so much energy to go around).

If you just want him seriously injured but recoverable in a believable manner, I'd lose the heart wound and replace it with something like getting stabbed in the liver. The liver has a lot of blood vessels that go in and through it, so you can have lots of bleeding. But he'd live longer getting stabbed there than in the heart. And the liver regenerates. He could take the knife in the spleen or a kidney as well; both can be removed it not repairable, and could still have serious blood loss that would disable him and require surgical recovery.

If you want the 'gurgling blood' thing, the lung hit is enough for that if the wound opens a sufficiently important pulmonary artery or vein. He'd be 'okay' for maybe a minute or so after the injury (in lots of pain), but would soon start gasping as both the lung deflated and the bleeding began filling it. It would easily start aspirating up through the trachea and appear in the mouth as he struggled to keep breathing.

Hope some of that helps.

Cath
04-15-2014, 02:30 AM
Great and detailed post, but this is an old thread. Closing this now so newer threads can take precedence.