Can you talk if you have a collapsed lung?

mia_rw

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Hello! I'm new to this forum, but it seems that this might be the place to find the answer I'm looking for :)

During a fight my MC has received a pretty bad blow to his chest with a crowbar, which has severely broken his ribs. My question is, if the injury is severe enough to puncture his lung, can he still survive long enough to get away from the fight (aided by another character)? And will he be able to talk, even if with great pain and difficulty, during this time?

I've did research on collapsed lungs and hemothorax, but I wasn't able to find out how long it takes from the situation to go from bad to extremely bad, nor if it's possible to talk.

What I basically need is to put the MC in a situation where he has an internal wound, not treatable by someone without medical knowledge, that is life-threatening but still allows him to move from place A to place B (he can collapse, once he's in place B) and talk a bit in the process.
 

_Sian_

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It depends on how collapsed the lung is, and whether or not the patient has "tensioned".

I went to three stabbing victims who had a pneumothorax (air in the pleural space) - all were up and walking around. One was cursing quite loudly, from memory. I do know that sometimes the ED just let a pneumothorax (not from stabbings, but other causes) "look after itself" in the way that broken ribs "look after themselves".

I didn't see much in the way of haemothoraxes? That, or my priority was making sure a pneumothorax didn't tension, so I wasn't really looking for the presence of blood in the pleural cavity. Haemothoraxes also tend to involve surgery and chest tubes (quite major surgery, tbh), and that's not really my area.

I presume though, that how incapacitated the character is will relate to how much blood they have lost, whether that blood is making it difficult for the other lung to inflate, and whether or not they have a pneumothorax to worry about as well. Also, while a pneumothorax doesn't always require surgery, a haemothorax will.

The major issue with pneumothoraxes are when they tension. This is when the air that's trapped in the pleural space and can't escape. Thus, the pressure inside the pleural space increases, upsetting the pressure gradients that get air into and out of your lungs. It also pushed the deflated lung and the heart and everything inside the chest cavity to one side as the amount of air trapped in that space increases. By doing this, it makes it both hard to impossible for your heart to beat, and compresses the other working lung. I've not seen a patient tension, but a college of mine did, and it's quite dramatic, and the person definitely won't be talking or walking around - unless someone ruptures the tension, they're shortly to be dead.

You sort out a tension by opening a hole in the pleural cavity so that air and pressure can escape. You then put chest seal ( a one way valve that enables air to leave the pleural space, but prevents it from going in the other way,) on the wound, or you make your own by taping down three sides of a 4 sided plastic square (you can use sandwich wrap if need be).

Knowledge from: Running around in an ambulance as a paramedic.
 

mia_rw

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So I guess that it's possible that the MC can be up and around at least until the lung "tensions" ... Thank you! That's been very helpful
 

JNG01

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I don't know about people, but deer (mammal of similar size, similar biology) can sometimes run for more than a mile after shot in only one lung with an arrow. Other times, they drop really fast in the same situation. I wonder if the difference is the "tensioning" talked about above? Anyway, if it's possible for a deer to run for awhile, it seems like it ought to be possible for a person to talk for awhile.
 

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I knew someone who walked around with a partially collapsed lung for a couple of days. In his case, he'd had a terrible cough with a case of influenza and he actually got a tear in some alveolar sacs from that. So air leaked from the ruptured air sacs into his thoracic cavity on that side. This is more common with people who have lung tissue that is already damaged/less elastic from emphysema or some other chronic lung disease, but it can happen to otherwise healthy people with really acute chest infections (and injuries, of course). It was only on one side, though, and there was no real bleeding into the space to complicate things, so he recovered fairly quickly, and was able to talk during that time (though he was short of breath and in pain). When there's an actual hole in the chest cavity and severe injury to lung tissue, the space can fill with blood and even collapse the other lung too, which is much, much worse.

Pneumothorax can be caused by blunt force trauma as well as piercing injuries. In either case, the severity can vary as much as you need it to for your story. I think you can allow your character to speak, though his breathing may be labored and he may be short of breath and in enough discomfort that he won't be (pardon the pun) very long winded.
 
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Matchu

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My friend's lung collapsed at my wedding reception after he rushed, or flew across the Atlantic to be there. Guests asked how he was. He just replied 'not so great.' Other guests avoided him because he was so depressing to look at. I recall his grimace was off-putting. Also he had this habit of gurning which only became more exaggerated.

I drove him to hospital in the morning. He stayed much longer than original intention and that was the bonus for us all, looking back.
 

Tsu Dho Nimh

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So I guess that it's possible that the MC can be up and around at least until the lung "tensions" ... Thank you! That's been very helpful

The injuries are widely variable as far as how incapacitated he'll be. There's not much effective first aid for this - you need O2, suction and often surgery to survive the bad ones.

You can have him mobile and vocal for as long as the plot takes ... you can have him look ok for a while and then "go bad" quickly.

One problem with broken ribs is that IF the bone shards sever any of the nearby blood vessels, there's not much to stop the bleeding, which leads to lung cavity full of blood and respiratory distress. And that can happen with ... just moving around.

Or the shards can puncture the lung and lead to pneumothorax.
 

Tsu Dho Nimh

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I don't know about people, but deer (mammal of similar size, similar biology) can sometimes run for more than a mile after shot in only one lung with an arrow. Other times, they drop really fast in the same situation. I wonder if the difference is the "tensioning" talked about above? Anyway, if it's possible for a deer to run for awhile, it seems like it ought to be possible for a person to talk for awhile.

Nope ... it's whether the arrow hits a large enough blood vessel.
 

JNG01

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Nope ... it's whether the arrow hits a large enough blood vessel.

Most single-lung shots are the result of too raking of an angle (vertically or horizontally). Suppose it makes sense that you'd be more likely to see less swift of a blood pressure drop in cases where the arrowhead doesn't pass through all the vessels and stuff on the centerline.
 
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mia_rw

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One problem with broken ribs is that IF the bone shards sever any of the nearby blood vessels, there's not much to stop the bleeding, which leads to lung cavity full of blood and respiratory distress. And that can happen with ... just moving around.

Or the shards can puncture the lung and lead to pneumothorax.

That's interesting, because I was thinking to have his condition worsen very quickly once the destination is reached, which I guess at this point could be further explained by the previous moving around (that, for plot reasons, cannot be avoided). It'll be really fitting, thank you!
 

EMaree

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A colleague I work with was happily walking around and talking for days without realising he had a partially collapsed lung. Between that and all the TV show characters chatting away with broken ribs, I wouldn't really blink twice at your character talking with their injuries.
 

_Sian_

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That's interesting, because I was thinking to have his condition worsen very quickly once the destination is reached, which I guess at this point could be further explained by the previous moving around (that, for plot reasons, cannot be avoided). It'll be really fitting, thank you!

Keep in mind that if there's blood in there, he's going to need extensive surgery quickly. So I'd make sure you have time in your plot for a mad rush to hospital in an ambulance.
 

WriteMinded

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My husband managed to collapse a lung when he was a young man. Yes, he could walk around, but it was very painful, made breathing almost impossible, until he finally got to a hospital and they stuck a tube in the side of his chest to let the air out. He was in the hospital for about a week.
 

Dave Williams

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As an aside, if the lung is collapsed and normal measures to restore function don't work, such as can happen with advanced lung disease, the next step is to use super glue to attach the lung to the inside of the chest cavity.A friend had that done. He'd already been though anti-rejection drugs, chemo, and radiation therapy, which he shrugged off as minor inconveniences. But he said every time he breathed out he could taste the glue, and it tasted *terrible.*