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View Full Version : Recovering from Gunshot and Surgery/Hospital Stays



Jenbob
06-12-2016, 05:23 AM
Hey all,

I have two separate but related issues I'm trying to deal with.

I have one character who gets shot from 15-20 feet away. His vest takes the hit, but he suffers enough blunt force trauma that he suffers internal bleeding and related problems. He gets triage-type care for maybe a couple hours before he eventually gets to the hospital (it's touch and go for awhile before he is able to make his way to the hospital, but once he's there, he's expected to be fine.)

QUESTION 1: What would be a reasonable hospital stay for this guy?


The second guy gets shot at close range in the abdomen. He gets immediate assistance by a by-stander doctor, ambulance care in less than a few minutes, and then is taken to the hospital. Obviously massive blood loss here even if people are immediately trying to help, and surgery is going to be necessary to repair the damage caused by the bullet (not planning on being overly specific in the story about exactly what has to be repaired, since the injury itself if clearly serious enough to be life threatening).

QUESTIONS 2, 3 and 4: How long could this guy reasonably be unconscious after all of this, and is there anything that could cause/help to keep him unconscious for a longer time OTHER THAN a head injury. And finally, after he has recovered consciousness, how soon seems reasonable for going home AMA (with in-home medical care) but not so soon that the guy seems clearly stupid/suicidal for leaving the hospital?


Thanks in advance for any help!

MaeZe
06-12-2016, 05:52 AM
You can write whatever you want and match the injury to what fits the story. It would be easier to say what you want in the story then ask us what injuries would fit that scenario.

I am having trouble picturing the blunt force trauma through the bullet-proof vest that fits your scenario. Maybe a good smack right over a kidney could cause enough trauma that a longer hospital stay would be needed? You could also have the trauma cause a heart arrhythmia, there have been people smacked in the chest with a batted ball that stops the heart. Not much in the chest that isn't penetrating would be that severe. Maybe someone else knows of something.

Catherine_Beyer
06-12-2016, 07:41 AM
how soon seems reasonable for going home AMA (with in-home medical care) but not so soon that the guy seems clearly stupid/suicidal for leaving the hospital?

Pretty much by definition, leaving AMA (against medical advice) is a stupid move. If it wasn't stupid, they wouldn't be keeping you (and your insurance wouldn't be paying for it).

neandermagnon
06-12-2016, 10:28 AM
You can write whatever you want and match the injury to what fits the story. It would be easier to say what you want in the story then ask us what injuries would fit that scenario.

I am having trouble picturing the blunt force trauma through the bullet-proof vest that fits your scenario. Maybe a good smack right over a kidney could cause enough trauma that a longer hospital stay would be needed? You could also have the trauma cause a heart arrhythmia, there have been people smacked in the chest with a batted ball that stops the heart. Not much in the chest that isn't penetrating would be that severe. Maybe someone else knows of something.

This is what I was thinking, re blunt force trauma from the bullet and internal bleeding. Also, internal bleeding wouldn't result in just a couple of hours in A&E then being sent home. Even if he's not in shock (circulatory shock) from the internal bleeding, there's a risk of shock developing if the doctors don't stop the internal bleed. If you mean he gets bruising (which is kind of internal bleeding but just from capilliaries etc, not from any major blood vessel) then he would be sent home. AFAIK this doesn't get called "internal bleeding" although I'm not a doctor so I'm not 100% on what things are called.

Re the abdominal bullet wound questions:

unconscious - if he hasn't sustained a head injury he won't necessarily lose consciousness. If he's bleeding heavily then he may pass out due to falling blood pressure (circulatory shock). How quickly this happens depends on how quickly he's losing blood. He won't regain consciousness until his blood pressure rises to fairly normal levels again. However, blood loss from an abdominal wound isn't usually fast enough to lose consciousness quickly - look up the symptoms of circulatory shock* so you get an idea of what he'll be going through following the injury. People don't usually lose consciousness that quickly and there are a series of symptoms that they go through as they lose more and more blood before losing consciousness. If bleeding is from a crucial blood vessel (aorta, vena cava, carotid) or directly from the heart then you would get rapid loss of consciousness and also a very high chance of dying even with immediate medical attention. These vessels aren't in the abdomen so rapid unconsciousness from a gunshot wound to the gut seems unlikely. He'd go through various shock symptoms then lose consciousness.

*It's usually just called shock, but many people confuse the term with psychological shock. Circulatory shock is caused by low blood volume, i.e. bleeding. It can happen from internal or external bleeding and it's a medical emergency.

If he's lost that much blood he'll need a blood transfusion (or several). If he's unconscious due to heavy bleeding then he'd need blood transfusions.

How long he has to stay in hospital would depend on how quickly he recovers. If the surgery's a success and blood transfusions and saline then his recovery wouldn't take that long. He'd be up and about within about 48hrs. The doctors would want to keep him in until his digestive system is working again - surgery to the gut causes the whole digestive system to temporarily shut down and it takes a while for it to get moving. In the meantime, he'd be on a drip to keep him fed. The doctors would want him to stay in hospital until they're sure his digestive system's fully functioning, i.e. eating fine and shitting fine. He'll have nurses asking him if he's done a bowel movement yet. he could leave the hospital once he's started eating again and feeling fine, but before he's done a bowel movement, much to the horror of the nurses. He could be kind and text them to let them know when one makes an appearance. I don't know how long exactly this whole process would take, it probably would be best to check with a doctor or nurse, however anything from 72hrs to a week post-surgery sounds reasonable to me. If you're being vague about the exact details then you can just choose a reasonable number of days.

GeorgeK
06-12-2016, 08:09 PM
This is what I was thinking, re blunt force trauma from the bullet and internal bleeding. Also, internal bleeding wouldn't result in just a couple of hours in A&E then being sent home. Even if he's not in shock (circulatory shock) from the internal bleeding, there's a risk of shock developing if the doctors don't stop the internal bleed. If you mean he gets bruising (which is kind of internal bleeding but just from capilliaries etc, not from any major blood vessel) then he would be sent home. AFAIK this doesn't get called "internal bleeding" although I'm not a doctor so I'm not 100% on what things are called.

Re the abdominal bullet wound questions:

unconscious - if he hasn't sustained a head injury he won't necessarily lose consciousness. If he's bleeding heavily then he may pass out due to falling blood pressure (circulatory shock). How quickly this happens depends on how quickly he's losing blood. He won't regain consciousness until his blood pressure rises to fairly normal levels again. However, blood loss from an abdominal wound isn't usually fast enough to lose consciousness quickly - look up the symptoms of circulatory shock* so you get an idea of what he'll be going through following the injury. People don't usually lose consciousness that quickly and there are a series of symptoms that they go through as they lose more and more blood before losing consciousness. If bleeding is from a crucial blood vessel (aorta, vena cava, carotid) or directly from the heart then you would get rapid loss of consciousness and also a very high chance of dying even with immediate medical attention. These vessels aren't in the abdomen so rapid unconsciousness from a gunshot wound to the gut seems unlikely. He'd go through various shock symptoms then lose consciousness.

*It's usually just called shock, but many people confuse the term with psychological shock. Circulatory shock is caused by low blood volume, i.e. bleeding. It can happen from internal or external bleeding and it's a medical emergency.

If he's lost that much blood he'll need a blood transfusion (or several). If he's unconscious due to heavy bleeding then he'd need blood transfusions.

How long he has to stay in hospital would depend on how quickly he recovers. If the surgery's a success and blood transfusions and saline then his recovery wouldn't take that long. He'd be up and about within about 48hrs. The doctors would want to keep him in until his digestive system is working again - surgery to the gut causes the whole digestive system to temporarily shut down and it takes a while for it to get moving. In the meantime, he'd be on a drip to keep him fed. The doctors would want him to stay in hospital until they're sure his digestive system's fully functioning, i.e. eating fine and shitting fine. He'll have nurses asking him if he's done a bowel movement yet. he could leave the hospital once he's started eating again and feeling fine, but before he's done a bowel movement, much to the horror of the nurses. He could be kind and text them to let them know when one makes an appearance. I don't know how long exactly this whole process would take, it probably would be best to check with a doctor or nurse, however anything from 72hrs to a week post-surgery sounds reasonable to me. If you're being vague about the exact details then you can just choose a reasonable number of days.
Nicely done. :) The only things I'd add is that people can just faint from a vasovagal response. Loss of consciousness doesn't need to be from hypovolemic shock (blood loss.) So unconscious and then conscious screaming is not that unusual a thing.
The technical term for the post op gut paralysis is ileus and 3 days to a week is normal.

Also to the OP, having a doctor on the scene at an abdominal GSW is not really going to any better than a paramedic because all you can do in the field is bandage it