Knife Wound/Collapsed Lung

Try the Share Your Work forum here.

Jeff

No. There's basically nothing that can be done in the field for this injury other than bandaging it preferably if possible in such a way as to act like a flap valve. Suturing the skin does nothing for the lung injury. Without repairing the lung injury, sewing the skin will convert this to a tension pneumothorax. Unless the next scene is hunter dying and Cora ripping open the wound that she just sewed so the tension can be relieved, it's just not believable at all. Avoid injuries that have people coughing up blood. They basically are not survivable without a decent hospital. Lungs are very friable and someone who used to assist, is not going to be able to sew lung. Most surgeons don't sew lung, they use staples, big honking staples out of one of many auto suture devices and even then you need to be able to see what's going on. They are just going to make a bigger defect with bigger holes. You'd need a rib spreader at a minimum to even see what you were sewing and a head light and a passed out patient

Airway trumps bleeding, even if it looks like a lot of bleeding. Over sewing a bleeder is fine but this is one of those times you don't want a water tight or air tight closure

Now what could be done is to use a foley catheter, some duct tape and a bucket of water as a make shift low tech chest tube.

M.C.Statz said:

Okay! Done

http://absolutewrite.com/forums/showthread.php?330854-Knife-Wound-Lung-Puncture-Scene

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You have to keep in mind that the human is designed to not have excess holes in vital areas. Sewing up the exterior of the wound means that there's still a hole in the lung that now is going to be venting directly into the body cavity. Fixing holes in the lung is not easy - does it have to be that particular injury?

M.C.Statz said:

Thank you. If I give her a rib spreader and we hand-wave/wink about her experience, does this field surgery become the least bit plausible? Or should I ditch it for another injury entirely?

If ditch, I am looking to demonstrate her growth, both is knowledge and in confidence, from a scared vet intern. What injury would you suggest?

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It's not in any way plausible. However if you want to show growth and confidence, then realizing that she did the wrong thing and taking steps to correct it may be the way to go. For example, in your scenario, skip the whole part about sewing the lung and have her sew the skin, feel proud and then realize that all she did was convert a stab wound to a more dangerous scenario, a tension pneumothorax. She then rips out the stitches and hears and feels the woosh of air escaping from the wound and figures out that the lung injury will just have to heal from the inside out. She makes a flap valve bandage over the wound so that any air attempting to build up in the pleural space can escape but that inhaling won't suck in air from the outside. Hunter will invariably seek a sitting upright posture rather than laying down. If you use alcohol to clean the oils off the skin you can probably get duct tape to stick for a day, maybe two.

The wound will likely have a pinkish to red foam around it and the skin around it will have crepitence (a crackling sensation to the skin when touched and sounds and feels like maybe there's rice crispies popping under the skin.)

If he's lucky the fibrin from the bleeding will clot and seal the lung laceration within a day or two and a few more days for the lung to reexpand and the pneumothorax to resolve adequately enough that the chest wound will seal. He'll be weak and worn out because that kind of gasping and sitting up for 3+ days is horribly exhausting and he's lost some blood as well. He also will not likely have been able to do anything regarding hygiene and will have fouled his pants. He's going to need to do not much more than rest and light walking for a couple weeks. It will really take 2-3 months before he's back to full activity.

In your post-tech world probably the easiest way to make a flap valve is to make a new incision 1 and a half ribs inferior to the stab, in line with the rib itself. Tunnel under the skin to connect the incision with the stab. Place a drain (a penrose, a piece of clean plastic tourniquet) through the new incision and by feel, poke the proximal end of the drain into the chest cavity and then sew up the skin at the stab wound and remember to sew the drain in place so it doesn't fall out but can be removed over time once there's minimal wound drainage and no more coughing up blood and breathing is easier

M.C.Statz said:

What specifically is the most implausible? Is it access to the wound, the repair of the lung itself, or something else? What would likely happen if she did attempt the procedure? From your original post I assume she would make the lung worse, nor better, but I wasn't sure.

Again, I am very appreciative!

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Exactly. There's no way to access the lung injury without cracking the chest. If she did get access she would not be able to repair the lung and so in both instances there's a worse injury

I also see that I was editing while you posted, so you may want to reread the previous post

GeorgeK has it right. The lung tissue should not be "sewn', it needs to heal on its own. The immediate problem is preventing more air from entering the chest cavity, thereby collapsing the lung. The flap GeorgeK mentions is the right way to go. Liquids may also have to drained off so suction will be needed, but with liquids you may also be able to use gravity, but not for air removal. For air removal, suction is required. The most basic would be a tube and a mouth.

GeorgeK said:

No. There's basically nothing that can be done in the field for this injury other than bandaging it preferably if possible in such a way as to act like a flap valve. Suturing the skin does nothing for the lung injury. Without repairing the lung injury, sewing the skin will convert this to a tension pneumothorax. Unless the next scene is hunter dying and Cora ripping open the wound that she just sewed so the tension can be relieved, it's just not believable at all. Avoid injuries that have people coughing up blood. They basically are not survivable without a decent hospital. Lungs are very friable and someone who used to assist, is not going to be able to sew lung. Most surgeons don't sew lung, they use staples, big honking staples out of one of many auto suture devices and even then you need to be able to see what's going on. They are just going to make a bigger defect with bigger holes. You'd need a rib spreader at a minimum to even see what you were sewing and a head light and a passed out patient

Airway trumps bleeding, even if it looks like a lot of bleeding. Over sewing a bleeder is fine but this is one of those times you don't want a water tight or air tight closure

Now what could be done is to use a foley catheter, some duct tape and a bucket of water as a make shift low tech chest tube.

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Grant you I'm no medic, but as a combat soldier the nomenclature for this type of injury was a 'sucking chest wound' that may or may not involve penetration of the lung itself, but certainly the inner plenum. First aid for this was to place a piece of plastic over the wound, with the casualty oriented so the wound is at the top, applying pressure as the victim inhaled, as to bleed the air out, then to secure with gauze and wrapping but not overly tight. What happens next I suppose would be a function of how quickly the casualty can be transported to surgical facilities.

And by the way, in a combat environment the most likely mode of receiving this type of injury is flying shrapnel. A gun (rifle) shot wound to the chest cavity is almost always fatal.

I have a reference book 'Body Trauma- A writers guide to wounds and injuries' by David M Page MD. The Howdunit Series - Writers Digest Books. The author has 'extensive experience in trauma surgery'.

It covers symptoms, effects and treatment (including field care) of bites and stings to impalement, including the 'dirty dozen' dreadful, but survivable chest injuries.

According to the blurb on the back of the book 'Here you'll find graphic exploration of serious bodily damage. You'll be able to work backward, deciding how severe a characters wounds should be and then writing the action that causes the pain. You'll put your characters in harms way and mistreat them - believably - to within an inch of their fictional lives.
ISBN 0-89879-741-1

May be good if you are still looking for options

Hope this helps