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View Full Version : Gunshot wound, medical expertise please



MkMoore
02-25-2016, 06:38 AM
I need some help getting medical details right. I have a 17 year old boy shot through the abdomen, at pretty close range with a handgun. Details about the wound: clean shot that goes all the way through, no fragments, no organs hit. I want it to bleed well enough that he's in danger of dying before getting to the hospital. His friends are with him but unable to call 911.


One of his friends has the ability to manipulate other people's body chemistry--enough to alleviate pain and maybe clot the blood (is that a good idea? what would be the side effects?)


If they drive him to the hospital, what is a reasonable distance to be worried about getting him there on time? They're in a sort of rural area, but close to town.

Once they get to the hospital, what would happen? I don't need a lot of details per surgery and such, just what his friends would witness upon bringing him in. Who would meet them? What questions would they ask? How long would he be in surgery?

Recovery-- How long would he be in the hospital? What shape would he be in after a couple of months?
Any experience or anecdotes are helpful! Thanks in advance!

Kerosene
02-25-2016, 06:44 AM
Can't help you with the medical details, but I can say that I don't know of any handgun nor hangun bullet that could sail straight-through a human abdomen. Perhaps a FN Five-Seven due to its high velocity, at a short angle with a thin body. But most handgun bullets either tumble after an inch deep or break apart and spread. High speed rifle rounds will go through. Perhaps if it's just a graze to the side and it happens to curve out.

cmhbob
02-25-2016, 07:10 AM
Gun needs to be a small caliber revolver, like a .38 or .32 with round-nose ammo. Not uncommon these days. It's what some would call a Saturday Night Special.

Friends won't see much once the triage nurse sees the blood. Kid's going to go on a gurney and back to whatever passes for a trauma bay, and the friends won't be allowed back there for a while.

The round could nick the liver and cause a lot of bleeding there. I'm not going to guess on time frame, but the liver has a lot of little blood vessels, so lots of blood. This page (http://www.rci.rutgers.edu/~uzwiak/AnatPhys/Blood_Vessels.html) has some good images of blood vessels, and you'll get an idea of why a through-and-through without organ damage is so unlikely.

If/when they get to see him, he'd be on oxygen (probably) via nasal cannula, have a couple of IVs going, and probably bandaging over the incision(s).

At some point, cops/sheriff's deputies will show up (hospital staff would call because of the gunshot wound), and will want to talk to the kids separately. Might be uniformed officers; might be detectives. If it's rural enough, it might be the Sheriff or chief him/herself, rather than deputies.

MkMoore
02-25-2016, 06:34 PM
Hmmm... That is helpful. Thank you. It doesn't have to go all the way through; that's just how I wrote it. As long as it bleeds plenty and doesn't do any major permanent damage, whatever works. I don't go into detail about the gun used, but it wouldn't be anything particularly special, considering the circumstances.

WeaselFire
02-25-2016, 06:59 PM
You'll need to hit an artery. Best would be the femoral artery in the inner thigh, but bleeding out can be really quick there. In the abdomen, without impacting a major organ, you're going to almost need a magic bullet that can wind around things to hit other things. Catching an iliac artery would work, you'll have some damage to intestine or bowel, but that's generally negligible with a modern hospital in reach. There is also very little to stop a bullet here, and most handgun calibers can penetrate entirely through the body in this area.

Now, the details you ask about, time to hospital, recovery time, how he or his friends would feel or what they would see are all variable. Distance to the hospital is relative for example, 10 miles at 100 miles an hour is six minutes. Ten miles over washed out, abandoned dirt paths crossing deep, fast moving water can take an eternity. Time matters, not distance.

What happens at the hospital will depend on the hospital. Being more rural, they probably don't get a lot of gunshot patients in a night and may not have a trauma surgeon available. Might just apply pressure and call for a helicopter to a larger, better equipped hospital. Or you may hit a nurse who is a combat vet with three tours as a para rescue tech in Afghanistan, who has dealt with hundreds of this exact situation. Patients brought into an emergency room with chest pains or heavy bleeding receive priority care, bypassing a lot of the questions and paperwork.

His friends may or may not be able to stay with or near him. The police will be called and the friends will have to give statements. Nurses/doctors will want to know the patient's name, what happened, where, what has been done so far and how to contact the patient's family.

Most of this can be written to the needs of the plot, so concentrate on fitting the injury to the plot, don't contort the plot to fit a preconceived injury.

Jeff

WhitePawn
02-28-2016, 11:01 PM
Abdominal wounds are problematic, for all the reasons stated above. If you want a danger of bleeding, then why not go with the classic? The bullet ruptures the spleen. Major bleeding issue, immediate surgery needed. Interesting side note, there are secondary/accessory spleens in some individuals, <10% iirc.

The thing about the spleen is it doesn't need a bullet to rupture. A good, hard hit to the abd can do it, most anything blunt force with enough force. Immediate symptoms are going to be blood pressure drop and then a rock hard abd from the blood build-up. Percussion will be off, though getting that far will likely involve yelling and jerking from the patient, curling in on him/herself to "hug" their left side.

Coffee Monster
02-29-2016, 03:14 AM
To address your question regarding the friend's ability to "clot" blood and potential related side effects--medical professionals, too, have this ability (through the magic of pharmacology). When we administer pro-thrombotic (clot-inducing) agents, the risk is that we will not only clot the vessel at the site of active bleeding, but also clot blood in vessels elsewhere. This can result in ischemia (lack of adequate blood flow) to various organs. Some examples include bowel ischemia, ischemia of distal extremities (think fingers and toes), skin necrosis, and even strokes. It depends on how specific the friend's ability is to generate a clot, but these are some potential complications that you could use in your story.

GeorgeK
02-29-2016, 11:27 AM
Blood spreads and stains. It doesn't take a lot of blood to look like a lot of blood. It doesn't take much panic from bystanders to make the patient panic. It doesn't take a lot of panic for someone to hyperventilate and mimic some of the symptoms of hypovolemia even to the point of passing out. A rural area is good. That means no trauma center, no trauma team, no taping the patient to a backboard, cutting off all their clothes, inserting a foley etc. It's a whole trauma response team thing.

As others have said, it's unrealistic for a bullet to go through without hitting anything important. However bullets do weird things. It's not impossible, just nearly impossible. What would be very believable is the assailant was using some off brand knock off Saturday night special POC with cheap ammo, something 32 or smaller, short barrel. The bullet goes through skin and some of the muscle but is stopped by the inner abdominal fascia (a sheath of connective tissue, gristle) So there is no intra-abdominal injury, just the abdominal wall. Those can result in major hemorrhage if nobody is precisely sure how to do a proper pressure dressing and even with a proper pressure dressing some people will require surgery to stop the bleeding and it is possible for people to bleed to death.

In the rural ER, they would apply a pressure dressing, insert a couple large bore IV's get a plain film of the chest and abdomen AP and Lateral (If they have an actual ER they will at least have that available) and a CT (if they have a CT scanner and a CT tech available. Rural places often don't have a CT tech in-house 24 hours a day and some if they have a CT, may only have one and it might happen to be down for repairs) They'd probably see if there is a general surgeon in house or call one in (again, assuming one is available. If they have fewer than 3 general surgeons on staff, there might not happen to be one on call that particular day.)

If the X-rays show no free air and the bullet localized to outside the abdominal cavity, the patient responds to fluids and is stable. Labs are stable. They continue to watch, observe for a day or two and schedule a follow up with somebody. Anything else and either surgery or ship them out.