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View Full Version : Abdominal stab wound - operative and post-op questions



Rennie1989
06-08-2014, 09:39 PM
Hello

Basic information:
Male character, 19 years old, no health problems. He has a slight to average build and is 6'0. He lives in England (so admitted to an NHS hospital).

My character is walking home with his girlfriend when a man tries to mug them. He hides his girlfriend behind him when the mugger presents a knife (let's say around 7-5" kitchen chopping knife). My character is frozen stiff on the spot but when he goes to lower his hand (to give the mugger his phone and wallet) the mugger panics and stabs the character in the abdomen.

Main character collapses and is conscious for only a minute or two. His girlfriend calls 999 and talks to her boyfriend. She applies pressure on the wound. He is taken straight to hospital, operated on and admitted to ITU. 36 hours later there is a bleed and he is operated on again.

The liver is affected and there is a lot of bleeding (not sure how long a stay in hospital would require). Ideally a scenario where he would stay in hospital for 2-3 weeks (I would like to reiterate that this is not my field of expertise).

So, my questions are:
- How long would my character be in hospital for, giving that there are no more complications after the second op?
- How long would sutures, staples or stitches be on for?
- How long would the wound need a dressing for?
- When would he start receiving physiotherapy and would an occupational therapist visit him and his home?
- Aside nursing care, what other care would a patient like him receive in hospital?
- Would a nurse practitioner visit him at home? His mother is a nurse so would she be able to partake in his care?
- Would be transferred to a medical or surgical ward?
- How long would he be signed off work after discharge (I've heard it's 6 weeks but wanted to double check).

If there's anything else that I should know then please let me know. I'm sure to come back with more questions as the ones above get answered.

Thanks in advance!

sheadakota
06-08-2014, 09:46 PM
with a 15" knife there is no way he's getting away with the minor injuries you've described. That's a big-ass knife and it's going to do some kick-ass damage. the very least of which is perforating his bowel which would lead to a colostomy and peritonitis and major sepsis. we are talking months of hospitalization and at least that long recovery. So do you want to re-think that weapon of choice?

Rennie1989
06-08-2014, 09:51 PM
with a 15" knife there is no way he's getting away with the minor injuries you've described. That's a big-ass knife and it's going to do some kick-ass damage. the very least of which is perforating his bowel which would lead to a colostomy and peritonitis and major sepsis. we are talking months of hospitalization and at least that long recovery. So do you want to re-think that weapon of choice?

We'll go for a 5-7 inches. I just found my tape measure and realised how ridiculous my measurements were! I think I confused my centimeters with my inches (doh!).

sheadakota
06-08-2014, 10:11 PM
you might have to tweak your scenario a bit;


Hello

Basic information:
Male character, 19 years old, no health problems. He has a slight to average build and is 6'0. He lives in England (so admitted to an NHS hospital).

My character is walking home with his girlfriend when a man tries to mug them. He hides his girlfriend behind him when the mugger presents a knife (let's say around 7-5" kitchen chopping knife). My character is frozen stiff on the spot but when he goes to lower his hand (to give the mugger his phone and wallet) the mugger panics and stabs the character in the abdomen.

Main character collapses and is conscious for only a minute or two. His girlfriend calls 999 and talks to her boyfriend. She applies pressure on the wound which saves his life (he would have bled to death before the paramedics arrived, otherwise). He is taken straight to hospital, operated on and admitted to ITU. 36 hours later there is a bleed and he is operated on again.
Putting pressure on an abdominal wound is going to do very little to stem internal bleeding. most likely all she is doing is keeping the blood from leaking out and forcing it into the abdominal cavity
No organs are affected but the knife nicks a blood vessel (I'm assuming that stabbing a major artery or vein could cause the casualty to bleed to death very quickly).you assume correctly, however most abdominal vessels are covered and protected by organs in the abdominal cavity. pretty hard to knick a vessel without hitting an organ He is in ITU for three/four days before being transferred to a different ward.
I think a better scenario would be if the knife nicks his liver or spleen. Lots of internal bleeding or are you going for a clean strike with nothing hit? That would be his side then not abdomen. Lots of important things in your abdomen hard to miss with a knife. Bottom line- either you extend his hospital stay and make him sicker or or hit nothing and barely any stay is needed. no herics on the girlfriends part and he probably doesn't even collapse.
So, my questions are:
- How long would my character be in hospital for, giving that there are no more complications after the second op?
- How long would sutures, staples or stitches be on for?
- How long would the wound need a dressing for?
- When would he start receiving physiotherapy and would an occupational therapist visit him and his home?
- Aside nursing care, what other care would a patient like him receive in hospital?
- Would a nurse practitioner visit him at home? His mother is a nurse so would she be able to partake in his care?
- Would be transferred to a medical or surgical ward?
- How long would he be signed off work after discharge (I've heard it's 6 weeks but wanted to double check).

If there's anything else that I should know then please let me know. I'm sure to come back with more questions as the ones above get answered.

Thanks in advance!

Rennie1989
06-08-2014, 10:26 PM
you might have to tweak your scenario a bit;

Edited.

sheadakota
06-08-2014, 10:30 PM
too what?

Rennie1989
06-08-2014, 10:40 PM
The original post was edited.

sheadakota
06-08-2014, 11:24 PM
Hello

Basic information:
Male character, 19 years old, no health problems. He has a slight to average build and is 6'0. He lives in England (so admitted to an NHS hospital).

My character is walking home with his girlfriend when a man tries to mug them. He hides his girlfriend behind him when the mugger presents a knife (let's say around 7-5" kitchen chopping knife). My character is frozen stiff on the spot but when he goes to lower his hand (to give the mugger his phone and wallet) the mugger panics and stabs the character in the abdomen.

Main character collapses and is conscious for only a minute or two. His girlfriend calls 999 and talks to her boyfriend. She applies pressure on the wound. He is taken straight to hospital, operated on and admitted to ITU. 36 hours later there is a bleed and he is operated on again.

The liver is affected and there is a lot of bleeding (not sure how long a stay in hospital would require). Ideally a scenario where he would stay in hospital for 2-3 weeks (I would like to reiterate that this is not my field of expertise).

So, my questions are:
- How long would my character be in hospital for, giving that there are no more complications after the second op?I would say at least three weeks.
- How long would sutures, staples or stitches be on for?Staples- not stitches
- How long would the wound need a dressing for?No dressing- it would be left open to air
- When would he start receiving physiotherapy and would an occupational therapist visit him and his home?No OT or PT would be needed this is for orthopedic injuries, when at home
- Aside nursing care, what other care would a patient like him receive in hospital?respiratory therapy, mostly but when they are critical no pt or ot
- Would a nurse practitioner visit him at home? His mother is a nurse so would she be able to partake in his care? Yes she could but by the time he's ready to come home he won't need much nursing care. he will be up and walking- they aren't going to discharge him unless they are certain he is not at risk for bleeding.
- Would be transferred to a medical or surgical ward?If he is stable that is where he is likely to be admitted in the first place
- How long would he be signed off work after discharge (I've heard it's 6 weeks but wanted to double check).6 weeks sounds good.

If there's anything else that I should know then please let me know. I'm sure to come back with more questions as the ones above get answered.

Thanks in advance!

I'm in the US, so you might have to ask what works in the UK- but I'll answer the best I can. The liver is very vascular - in surgery they would probably glue ( yes glue the wound or cauterize it to stop bleeding) a drain would come from the wound to keep fluids from collecting. he would have an naso-gastric tube in to keep his his stomach empty and so he could be kept NPO (nothing by mouth) also to prevent him from vomiting.

there would be a mid-epigastric incision closed with staples, not sutures. he may or may not be intabated ( have a breathing tube placed) if he starts bleeding again- they will do everything NOT to go back in again- give him blood, give him meds to help clotting to occur. The liver has the capability of healing itself. if i were you I would nix the second surgery in favor of having them watch him and monitor his hemoglobin ( blood count) for the bleeding to stop. we will wait until the Hemoglobin to drop fairly low before going back in for surgery- with a second surgery ( or even with the first, there is a great risk of going into something called DIC-particularly with a very vascular organ- this is a life threatening condition where your blood does not clot and you will bleed to death.

Rennie1989
06-08-2014, 11:37 PM
Thank you for your help, it is very much appreciated. I do not want to delve too deeply into the medical side of the story, it is more on how his condition affects his family and friends. I just want to make sure that what I write is logical and valid, for example the length of stay in hospital, post-op care and what symptoms a patient would experience (pain, scarring, lethargy etc).