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View Full Version : How long would it take to die from these injuries?



breaking_burgundy
12-16-2013, 10:08 PM
I'm writing a scene where two characters are shot.

1) 18-year-old female, on the chubbier side. She takes a gunshot wound to the chest. It would probably break a rib on its way in, go through one of her lungs, and possibly tear through a bronchus or pulmonary artery/vein. How long would it take for her to die (assuming a trained healer was present)? Also, would she be more likely to die from respiratory failure or blood loss?

2) 19-year-old male, skinny but muscular. He takes a GSW in the shoulder/armpit, which ruptures the axillary artery and part of the brachial plexus. How long would it take for him to bleed out?

Cath
12-16-2013, 11:48 PM
I'm really not sure why you feel their weight is important. Are they otherwise fit? Does the trained healer have access to medical supplies and equipment?

TheGreySentinel
12-17-2013, 01:18 AM
According to the book "Body Trauma" by David W. Page (I keep it on my desk) the both victims would probably die in minutes with a major vain ruptured. If the setting is anything but modern (and there is no magic) the character is doomed to death rather quickly. Having that much blood filling the chest cavity would cause them to drown in it.

For the first character, if the medic has access to tools to treat such things then they might be able to survive. With the character having a tension pneumothorax (a punctured lung) you would need to put a three-sided valve on the sucking wound. That is, essentially, a piece of saran wrap or plastic taped down on three sides. This will prevent more air from getting into the wound, but allow air to escape to prevent the further collapse of the lung. The medic would then make an incision into the chest cavity and insert a tube to allow blood to escape. It would be a massive, bloody mess. That would not stop them from bleeding out, necessarily (if they aren't taken to an ER in time for surgery) but it is roughly what would be done by a medic.

Caveat: I have no medical training. I get all my knowledge from books and reading EMT materials. Most of this came from "Body Trauma" by David W. Page; a wonderful resource on medicine for writers looking to create realism in injury.

WeaselFire
12-17-2013, 01:51 AM
With a battlefield trauma kit and medic, neither would survive to get on a chopper if they had major arteries hit. That makes it under five minutes in most cases. On an operating table, with plenty of blood/plasma available and trained surgeons, both could survive.

What do you need to have happen? Since you mention a "trained healer" I assume it's a fantasy setting. Do "trained healers" there have powers that trained medics and surgeons here don't?

The systemic drop in blood pressure will likely render both unconscious in case you were looking to question them. The secret to gunshot wounds is to figure out what needs to happen for the storyline, then decide on the injury. Not the way you're doing it.

Jeff

ULTRAGOTHA
12-17-2013, 03:50 AM
The secret to gunshot wounds is to figure out what needs to happen for the storyline, then decide on the injury. Not the way you're doing it.

Can we cast this in gold and glue glitter on it, please?

So very, very, very true!

asroc
12-17-2013, 04:16 AM
For the first character, if the medic has access to tools to treat such things then they might be able to survive. With the character having a tension pneumothorax (a punctured lung) you would need to put a three-sided valve on the sucking wound. That is, essentially, a piece of saran wrap or plastic taped down on three sides. This will prevent more air from getting into the wound, but allow air to escape to prevent the further collapse of the lung. The medic would then make an incision into the chest cavity and insert a tube to allow blood to escape. It would be a massive, bloody mess. That would not stop them from bleeding out, necessarily (if they aren't taken to an ER in time for surgery) but it is roughly what would be done by a medic.


No offense to your book, but that's not what a medic would do. What you're describing is tube thoracostomy, a surgical procedure that happens in a hospital, not in the field.
What a medic does in case of a tension pneumothorax is called needle decompression. You take a large bore needle and insert it in the second intercostal space. If you do it right, the air rushes out with an audible "whoosh"-sound.
It won't be a bloody mess because you're removing air, not blood. It also doesn't stop any bleeding; that's not the purpose of the procedure. A medic stops bleeding by applying direct pressure. Since the bleeding with penetrating thoracic trauma tends to be largely internal, there is very little he can do about that.

(Regarding seals, improvised seals are mostly ineffective and you're not likely to see any in modern EMS. Just about the only reliable option is a prefabricated Asherman seal.)

Also, I keep seeing this and it's annoying the hell out of me, a pneumo- or hemothorax is not the same thing as a punctured lung (or, for that matter, a collapsed lung.) They're related, one often causes the other, but they're not the same and any can be present without the other. "Drowning in your own blood" is another thing, too. If you have a pneumo-/hemo-/hemopneumothorax, air and/or blood is filling your pleural space, not your lungs.

Anyway, OP questions:

Patient One: You're going to have to decide whether there is arterial and/or bronchial damage. Just rupturing a lung doesn't have to kill you. Most fatal penetrating thoracic trauma I've seen involved several blood vessels, since they're all very close together in that area. If there was, for example, aortic damage you could be dead in less than a minute. The ultimate cause of death would be cardiac arrest.

Patient Two: A couple more minutes, maybe. These things can be hard to predict. I've had patients where the damaged tissue actually blocked their hemorrhage to some degree, so there's no definite number. How long do you want them to live?

CoolBlue
12-17-2013, 09:13 AM
I'm writing a scene where two characters are shot.

1) 18-year-old female, on the chubbier side. She takes a gunshot wound to the chest. It would probably break a rib on its way in, go through one of her lungs, and possibly tear through a bronchus or pulmonary artery/vein. How long would it take for her to die (assuming a trained healer was present)? Also, would she be more likely to die from respiratory failure or blood loss?

If any major vessel is disrupted (remember that the shockwave caused by the bullet can tear vessels, even without a direct hit, depending on calibre and type of round, etc), she would die a rapid (minute or so) death. If no cardiovascular injury, not at all, or much longer, or much later.



2) 19-year-old male, skinny but muscular. He takes a GSW in the shoulder/armpit, which ruptures the axillary artery and part of the brachial plexus. How long would it take for him to bleed out?

Depends on where the artery is hit, and whether compression can be applied. If close to the origin, under the clavicle, he will likely die in a few minutes without immediate surgical intervention. Further distally, compression might buy time.

It all depends on context: where does it happen, what level of skill and what level of support (people, supplies, equipment) is available.

These injuries are not the type that will likely survive "in the field" alone.

HTH
CB

snafu1056
12-17-2013, 09:25 AM
According to the book "Body Trauma" by David W. Page (I keep it on my desk) the both victims would probably die in minutes with a major vain ruptured. If the setting is anything but modern (and there is no magic) the character is doomed to death rather quickly. Having that much blood filling the chest cavity would cause them to drown in it.

For the first character, if the medic has access to tools to treat such things then they might be able to survive. With the character having a tension pneumothorax (a punctured lung) you would need to put a three-sided valve on the sucking wound. That is, essentially, a piece of saran wrap or plastic taped down on three sides. This will prevent more air from getting into the wound, but allow air to escape to prevent the further collapse of the lung. The medic would then make an incision into the chest cavity and insert a tube to allow blood to escape. It would be a massive, bloody mess. That would not stop them from bleeding out, necessarily (if they aren't taken to an ER in time for surgery) but it is roughly what would be done by a medic.



Yeah. I was just about to say all that.

CoolBlue
12-17-2013, 09:36 AM
N
Also, I keep seeing this and it's annoying the hell out of me, a pneumo- or hemothorax is not the same thing as a punctured lung (or, for that matter, a collapsed lung.)

A good way to think of the chest cavity is this:

The lung is a balloon. It is inside a sealed rubber box, the chest cage. ETA: the mouth of the balloon is open to the outside of the box, through a sealed hole. When the rubber box expands as the muscles change the shape of the chest cage, the pressure inside the box is reduced. Air flows in through the neck of the balloon (nose/mouth > trachea) and the lung expands.

If a hole is made in the rubber box, the lung will no longer expand, as air rushes in through the hole, not the neck of the balloon.

We call this a pneumothorax. Pneuma=air, +thorax.

If the lung is injured, air may also be leaking from the lung. This is also called a pneumothorax.

If the air gets trapped in the space between the lung and thorax (pleural space), a secondary phenomenon called tension may occur, where progressively more air is trapped under tension. This is called a tension pneumothorax, and is a true emergency, as both oxygenation and cardiac output are impeded. This is what Asroc is talking about, in reference to a "needle decompression", which means simply putting a needle into that compressed air, and releasing it.

Hemo refers to blood in the cavity, which could be alone (hemothorax), or with air, (hemopneumothorax),and which may also be under tension.

If there is a wound in the chest wall that is sucking air, a good stopgap could indeed be a three-sided occlusive dressing. Not so much for a smaller wound, such as a knife stabbing.

HTH
CB

breaking_burgundy
12-18-2013, 05:00 AM
I'm really not sure why you feel their weight is important. Are they otherwise fit? Does the trained healer have access to medical supplies and equipment?

I gave their ages, genders, and body types because I wasn't sure whether or not they would be relevant. For instance, I've heard that muscle can sometimes have a "cushioning" effect in gunshot wounds, but I wasn't sure how true that was.


The systemic drop in blood pressure will likely render both unconscious in case you were looking to question them. The secret to gunshot wounds is to figure out what needs to happen for the storyline, then decide on the injury. Not the way you're doing it.

That's exactly what I did. In the case of the female character, I needed something lethal but not instantly lethal. In the case of the male character, I needed something life-threatening that would also cause neurological damage.

I came here because I wanted confirmation on whether or not these injuries are compatible with my intended plotline. (Although I have a decent amount of anatomical knowledge, I have almost no practical experience with traumatic injuries, and I figured at least one of you did.) If I'd have come in asking "I need [x and y] to happen. What injuries should my characters have?" that would have been the equivalent of asking other people to do the work for me.


Patient One: You're going to have to decide whether there is arterial and/or bronchial damage. Just rupturing a lung doesn't have to kill you. Most fatal penetrating thoracic trauma I've seen involved several blood vessels, since they're all very close together in that area. If there was, for example, aortic damage you could be dead in less than a minute. The ultimate cause of death would be cardiac arrest.

Patient Two: A couple more minutes, maybe. These things can be hard to predict. I've had patients where the damaged tissue actually blocked their hemorrhage to some degree, so there's no definite number. How long do you want them to live?

Patient One: 5-10 minutes. Is that feasible at all with the lungs? Or should I go for the abdomen instead?

Patient Two: 10-15 minutes. Could he live longer if help came immediately (like if someone clamped off the part of the artery that was proximal to the tear and gave him blood right away)?

Thanks.

MDSchafer
12-18-2013, 09:43 AM
Patient One: 5-10 minutes. Is that feasible at all with the lungs? Or should I go for the abdomen instead?

No one with a severed pulmonary artery is likely to be conscious for that long. A lung is going to collapse, the trachea is going move over to the unaffected side and partially compress the SVC, which is a life threatening issue in of itself.

She might survive for a few minutes, and be resuscitatable for a few moments after that.

Abdomen wounds tend to be more survivable, but sepsis is a witch.


Patient Two: 10-15 minutes. Could he live longer if help came immediately (like if someone clamped off the part of the artery that was proximal to the tear and gave him blood right away)?

Thanks.

Yeah, ripping into your auxliary is a serious wound, but like Cool Blue there are a lot of variables. It's entirely believable that he could be conscious for that length of time after a shoulder wound.