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IAMWRITER
08-05-2012, 12:35 AM
Hey guys. I'm currently working on my crime novel and I need help on what would happen, regarding treatment and procedure for gunshot wounds.

My character is female, 30y/o and is in good shape/health. She is shot at close range in the back of the knee and the abdomen with a 9mm. She gets to hospital about 15 mins later but hasn't recieved any treatment at the point and is unconscious.

My questions are;

1. What would happen on arrival and how quickly would she be taken to surgery?

2. How long would surgery take and would anymore be needed in the future?

3. What sort of surgery be required for a knee injury like this?

4. How long would it be until she is released from hospital and what would be resulting limitations?

Any help at all is much appreciated!

amschilling
08-05-2012, 04:06 AM
Your best bet for a good answer is to talk to a trauma surgeon or ER doctor/nurse. A local hospital would be a good place to research--nurses especially might be willing to answer your questions, assuming they're not slammed with patients. You could contact the business office and see if there's someone who'd be willing to discuss.

That said, I can answer a few of the questions vaguely. Mainly just to show you that you'll need more specifics to get good answers from medical folks:


1. An abdominal gunshot wound gets rolled into triage (an ER room) stat, where she'll be assessed without the wait most people see. Depending on the organs involved, she'd probably get sent to surgery as soon as she's stablized. The knee would take a back seat unless the gut shot didn't actually get any organs or her intestines.

2. Most likely multiple. It's possible they'd repair her knee and other injuries at the same time, but often a joint injury needs to be assessed by a specialist, and sometimes time has to pass for all repairs to be done/swelling to go down/etc. So more than one would be my guess. How many past that depends on the extent of the damage from both wounds.

3. No idea. Depends on if the whole joint is obliterated, if she's still got a kneecap, etc.

4. Again, depends on what got hit in her stomach. If her bowels were perforated and leaked into her abdominal cavity, she'd be on antibiotics and they'd be watching closely for infection for a while. If she had her spleen removed, that's something else. Liver injured? Different time line again. A knee shot is going to have her down and out for a while, at least as far as mobility. Physical therapy will be needed once everything has healed.

Trebor1415
08-05-2012, 08:09 AM
Let me rephrase your questions:

How BADLY do you want her to be hurt? A 9mm to the abdomen and a second to the knee could realistically take her "out of commission" for whatever (relatively long) length of time you need her to be out.

We're talking months of recovery, just for the wound to the abdomen. Add in the knee injury and your looking at months of physical therapy on top of that to try to regain some use of that knee/leg.

Let's put it this way: If you want her to be permamently disabled with little use of the injured leg, due to trauma to that knee, and that's after underoing reconstructive surgery, that would still be realistic.

If you don't want her THAT badly injured than don't have her get shot in the knee specifically. Make it a leg wound instead which, while still bad, wouldn't have the same consequences of the type of joint damage that being shot in the knee would have.

Heck, if you want her to mostly be confined to a wheelchair afterwards, that wouldn't be unrealistic. Or walking with a walker or cane, etc.

EDIT: Her care would go from ER > Surgery > Inpatient and then after a few weeks she'd likely be discharged to a rehab center for rehab. After that she'd most likely follow up with outpatient physical therapy and/or occupational therapy for several months.

cornflake
08-05-2012, 08:33 AM
This totally depends on you and how badly you hurt her, heh.

You can shoot someone in the abdomen and back of the knee and hit a whole bunch of organs, go through ligaments, shatter a kneecap... or you can have bullets that miss major elements, lodge in a sock or just under the skin (yes, does happen), etc.

IAMWRITER
08-05-2012, 01:43 PM
To be specific, I need her sidelined for quite some time - probably looking at 3-6 months.

cornflake
08-05-2012, 02:05 PM
To be specific, I need her sidelined for quite some time - probably looking at 3-6 months.

Sidelined how? In a mobility way? In a direly ill in hosp way?

I mean you can do that with less than shooting her twice. Shoot her in the gut, penetrate a bunch of organs including the bowel, give her eventual sepsis.... but that's a pile on thing. Like this happens then that happens etc.

Unless you mean she just won't be 100% for 3 monthws... so...

IAMWRITER
08-05-2012, 02:38 PM
Yeah a bit of both - more mobility though. As she is a cop, I need to keep her out of action in that sense.

Trebor1415
08-05-2012, 06:05 PM
Just so you know, a shot to the knee is likely to be a career ender for a cop. She'd likely never regain full mobility and use of the knee, even after extensive physical therapy, and likely wouldn't be able to meet whatever physicial standards her agency has.

I could believe that someone could succesfully rehab and return to duty from a bullet wound to the leg. But, a 9mm to the knee would likely be a career ender.

"I used to be a cop, but then a took a bullet to the knee."

EDIT: And three to six months, minimum, is definitely a realistic recovery period for a gunshot wound to the abdomen (or leg). A shot to the knee, assuming she recovers, would likey take longer due to the need for physical therapy and the fact she couldn't start the physical therapy (except in bed) until she was healed enough from the abdominal wound.

I'm actually thinking 3 to 6 months might be on the low end of recovery time for those two wounds, taken together, especially if you want "return to duty" instead of "just able to get around on her own."

IAMWRITER
08-05-2012, 11:49 PM
Yeah, I did sense it would be a career-threatening injury - presume most gunshots are - so it'll work in the sense I'll use it.

Thanks guys for the all the responses! :Thumbs:

cornflake
08-05-2012, 11:55 PM
Yeah, I did sense it would be a career-threatening injury - presume most gunshots are - so it'll work in the sense I'll use it.

Thanks guys for the all the responses! :Thumbs:

They're not necessarily at all. You can be shot and go home with a band-aid a half hour later. You can also be shot and be dead before you hit the ground. It's a very, very wide range and depends on a whole slew of factors including caliber, type of round, where someone is shot (very specifically, you can be shot in the thigh, say, and end up with a bandage or a giant broken bone or a severed major artery or....) what happens afterward, etc. That's why we've been asking these questions! Heh.

IAMWRITER
08-06-2012, 12:04 AM
:gone:Sorry! Kinda forgot that! D'oh!

cornflake
08-06-2012, 04:09 AM
:gone:Sorry! Kinda forgot that! D'oh!

Well that's why the forum is here to ask! :Hug2: Everyone has stuff they know and stuff they don't, so we share. :)

Unimportant
08-06-2012, 04:12 AM
Hey guys. I'm currently working on my crime novel and I need help on what would happen, regarding treatment and procedure for gunshot wounds.

My character is female, 30y/o and is in good shape/health. She is shot at close range in the back of the knee and the abdomen with a 9mm. She gets to hospital about 15 mins later but hasn't recieved any treatment at the point and is unconscious.

My questions are;

1. What would happen on arrival and how quickly would she be taken to surgery?

2. How long would surgery take and would anymore be needed in the future?

3. What sort of surgery be required for a knee injury like this?

4. How long would it be until she is released from hospital and what would be resulting limitations?

Any help at all is much appreciated!

I think you need to specify where (and when, though I'm assuming contemporary) this is happening. And, if it takes place in the US, whether or not she has medical insurance.

IAMWRITER
08-06-2012, 04:21 AM
Its in modern day Virginia with health insurance.

HarryHoskins
08-06-2012, 04:23 AM
I copy posted the OP's OP and sent it to a reliable source for analysis.

The reliable source said:




If the story needs the victim to be unconscious then significant bleeding needs to have occurred. Which might not depending on the actual shots & where they landed. Horrid I know but you could potentially be awake after 15 mins of that. (btw that is very, very prompt arrival at hospital). The knee injury could have gone through the popliteal artery, which would bleed a lot. The abdominal wound is variable, ok to leave knowing about that until the surgeon opens her up.


Anyway,


Arrive hospital, ambulance radios ahead. She is taken to a major trauma centre : if in London this is "the London" (air ambulance can land there too). Goes straight to resus area where trauma team already assembled waiting for her : does "ATLS" procedure, but essentially gets observations, blood tests (including cross-matching of blood for a transfusion), fluids, scans, x-rays, immediate staunching of bleeding, and then straight to theatre. In theatre the abdominal wound is nasty - poo leaking into peritoneal cavity plus bleeding - might need a temporary stoma. The knee, depends on penetration of bullet but potentially knee cap lost and depends on the arterial damage.


Then to ITU For variable amount of time then slowly through HDU then normal wards with patient controlled analgesia and physio etc. definitely in hospital for weeks, really depends on how bad writer wants to make it.


But getting back to normal like in the movies is unlikely. If there is a stoma reversal is months later and long term sequelae from internal scars (adhesions) are chronic pain, constipation and possible intestinal blockage. With the knee, if arterial damage is really bad the leg down stream would die leading to amputation, if not would just be severe arthritis and definite limp.


And more than likely at some point, wound infections, internal abscess from abdo wound, pneumonia from lying around, DVT possible, malnutrition - from "resting"the gut after surgery, oh, she would also have a bladder catheter on itu to measure urine output, this is because kidney failure post op possibility. Then there is ARDS & DIC as sequelae of major trauma.

He/she should do a bit of online research & decide how far he wants to go!

Hope this helps.

IAMWRITER
08-06-2012, 07:20 PM
Will google some of those terms. Thank You.