Gunshot wound treatment (for a novel set in the USA in the 1970's).

Welcome to the forum. Since this type of question is routinely asked, you'll want to start with a search and narrow your scope to a far more specific question. If you still need help after your search and reading the posts, ask as specifically as possible and please, please, please give us the situation and the outcome you need for your story. Don't ask "My hero is shot in the shoulder with a 45 caliber pistol, what are the effects and treatment?" Instead, ask "My hero needs to be shot in a bank robbery by a guard and have a wound that will heal within a few weeks and leave a scar but no lasting mobility issues, what would cause that?"

By the way, the 1970's treatment will be very similar to current treatment.

Jeff

Thanks for the detailed question, StarryNight! I'm sure someone will be along who can answer soon. Meanwhile, welcome to the forum.

StarryNight95 said:

Hello everyone !
I'm really new to this forum so please tell me if I do wrong things because I am not very used to it. Also I'm french so excuse me if my english is not truly perfect

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Well, your English is definitely better than my French, so I can't really complain. It'd really be very helpful if you could narrow down what you need. What you've told us so far sounds very possible, but there are many different ways this could go down depending on the details.

StarryNight95 said:

I am writing a novel that is now set in the early 1970's in the United States (first start in Ohio and set my characters go on a sort of crime spree through Arkansas and Texas). My characters try to steal a bank at one point and one of them, the best friend of the hero, gets shot at by the bank guard. I am really, really not an expert in guns, nor gunshot wounds or medecine so I need some help from that point. The wounded character would have a wound that seems minor at first (I thought maybe at the arm or the leg) but that would in the end drive him to the hospital, because of some infection and the blood loss. How long would it be until this character would start to feel really bad and need hospitalization ? Does it seem possible to you that he would almost die because of an arm or a leg wound ? While doing some research on the internet (and almost passing out in front of a quite gruesome gunshot wound picture because I am kinda easily scared), I read something about hypovolemia (I hope I wrote it right) that is caused, among others, by blood loss and can make a person almost die. Does it seem at all possible to you that this character could suffer from it ?

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You wrote it right. Hypovolemia, or hypovolemic shock in its more dangerous state, is a pretty common problem when people are shot. Bad cases will kill you if not properly treated. You can easily get it from being shot in an arm or a leg, but people tend to notice very quickly that they're injured there. But it happens quite often that people don't realize they were shot in the torso right away, especially if there was a lot going on when they were shot and it's a wound they can't readily see (back, abdomen, when wearing heavy, baggy clothing, for example.) Either can be life-threatening.

StarryNight95 said:

Oh and thanks for telling me that the treatment in the 1970's is similar with the one today

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Fortunately that's not really true. The basic principles are mostly the same but there's been massive advances in diagnostics, emergency medicine and surgical treatment options, like minimally invasive vascular surgery. How exactly this plays out really depends. If the character arrives at the hospital in shock (did his friends bring him or did he come by ambulance?), that needs to be treated first. That means the cause of the blood loss must be stopped (various methods for this, depending on what exactly happened) and the lost blood volume must be replaced, typically through a blood transfusion if it's very serious. Then you try to fix what the gunshot destroyed. Then recovery, rehab, possibly more surgery, infection control if applicable and so forth. But a few days should be possible, even in the 1970s.

Hypovolemia more or less literally means "decreased blood volume." It can happen quickly or slowly, depending on the cause. Dehydration leading to low blood volume is a slow process compared to bleeding out from a trauma wound. Whether or not it is "hypovolemia" doesn't rest on whether the person realizes it, but if someone is bleeding enough to cause problematic hypovolemia, it would be hard not to notice.

It's harder to notice internal bleeding, since you cannot see it. However, blood is very irritating when it goes places it shouldn't, such as into the abdominal cavity, so losing enough internally to become hypovolemic would be hard to ignore. The body has ways of signalling you.

I wonder if sepsis (or "septicemia") might not be a better fit. Sepsis is infection in the bloodstream, and it can result in the person going into shock. It would not be unusual for this sort of injury to seem to get better--or at least seem okay--then get rapidly worse. Sepsis from simple gunshot wounds to soft tissue such as the muscles of the leg or arm isn't common [except for gut wounds--those can be ugly], but it becomes more common with through-and-through injuries that are delayed in treatment, or if there is gross contamination of the wound.

Added: There's a great review article about the history of gunshot wounds from the US National Institutes of Health here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2706344/

Scroll down to the section "Wounds and Wound Management." This is geared toward battlefield management. It still may be helpful. Recall that the US's involvement in this war spanned about 1962-1974.

During the Vietnam War, semiautomatic rifles with high-velocity rounds caused considerable soft tissue damage, complicating wound care. Patients frequently sustained multiple wounds from bursts of automatic fire or booby traps. Surgeons could receive patients as early as 1 to 2 hours after wounding [reference], although in reality conditions during combat often delayed evacuation and resulted in an arrival time of 4 to 6 hours after wounding. On arrival, the patient was infused with Ringer’s lactate and antibiotics. The wound was débrided and lavaged and packed open with occlusive dressings. Patients with fractures and vascular injuries typically were treated by vascular and orthopaedic specialists. Fractures were treated by reduction and initial traction or casting depending on the severity of the wounds. Secondary closure of the wound usually could be accomplished in 7 days. Wounds with massive soft tissue damage were covered with occlusive dressings or a mesh graft. Innovations included increasingly sophisticated vascular repair and treatment of hypovolemic shock [reference].

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If you had a soft tissue injury to the thigh that became contaminated, it could take days to nearly two weeks before things got very bad. Depends on your story. When the character finally got to hospital, he's likely get IV fluids and antibiotics, have the wound debrided and lavaged as described above, and then packed open to allow it to drain while the infection cleared. Then there's closure.

Also added: 2010 blast from the AW past on gut wounds and some peripheral discussions thereof: http://absolutewrite.com/forums/showthread.php?174427-Recovering-from-an-abdominal-gunshot-wound

A pleasure. Hope the writing goes well.

WeaselFire said:

By the way, the 1970's treatment will be very similar to current treatment.

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Only the people administering it will be wearing really wide ties.

And lots of ugly polyester.

StarryNight95 said:

So, here are my little questions... Thanks in advance for your help, you have already helped me a lot since my first ideas Can the bullet stay in his arm for the whole time or is it more possible if it went through and through ? If the bleeding is stop and he is given a painkiller, would Mike be able to feel better (and by that I mean except for the limited movement for his arm) during the next evening and night ? And, finally, about the hospital, would the friends be able to bring Mike without showing any sort of IDs to the doctor and the emergency ward staff ?

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What do you need for the story? The bullet could be lodged in the arm or pass through. Septic shock is unlikely in this case, but possible infections can cause it, so if you need this, go ahead and write it. For that, it would be better to have the bullet stay in the wound, as well as debris from the shirt he wore, the road trip, a dirty bandage or something to generate the infection.

Bleeding would likely have stopped on its own and not be an issue. Depending on the patient, pain medication may not even be administered, but it's quite likely he would be able to leave the hospital the following day if the infection is under control. Doctors would not normally wait for him to be better enough to undergo surgery but a single day is just a normal process anyway. Just have the surgeon schedule him for the following day. Add a car crash with an infant injured taking priority as an excuse why he gets delayed and you're good there. Normally they would want to remove the bullet and clean the wound as part of fighting the infection, so as soon as they can do it.

Bullet wounds get the police called. Everywhere in the US, it's required by law. No reason they can lie to the police about what happened, but you'll need to account for the police finding out and responding pretty quickly. The friends can always duck out but the police will show up.

Jeff

The police are notified as soon as the doctors know it's a gunshot wound. I most cases the police would have an officer there within fifteen minutes or less. If his friends drop him off, say he accidentally shot himself with his father's/uncle's/granddad's gun while cleaning it, and then leave, they're possibly in the clear. If the victim is unconscious, from pain, infection, whatever, police will possibly just take photos and ask to be called after the surgery is done so they can get details. It's pretty hard to sneak someone out of recovery or intensive care after surgery, but the victim could be given pain medication and the police callback delayed long enough for his friends to sneak him out.

Outside stuff will influence this. If the police are investigating a burglary where the property owner says they think they shot a kid, then they will likely put a guard on him in the hospital. If the police are in a different jurisdiction and haven't heard about the shooting (make it a big city where shootings are common, like Chicago or Detroit), and if the accidental shooting sounds like it could be legit, it's plausible they could get out.

The alternative would be to take them to a retired rural doctor or an old military medic, or even a veterinarian, instead of a hospital. This guy (or girl) might have a grudge against police and not bother to tell the cops at all about the bullet wound.

Whichever works for your story.

Jeff