View Full Version : Resuscitation of someone with severe blood loss

12-09-2017, 03:29 AM
Hi guys! A character in my story has been injured in a fight, getting a large slash wound across her abdomen. She's not able to get emergency treatment on-site, and by the time her friend gets her to the nearest hospital, she's gone into cardiac arrest from the amount of blood she's lost.

Basically, I'd like some info on how exactly the doctors/paramedic, etc at the hospital would go about keeping her alive on the way to and during surgery. Her friend is doing CPR when they get to the hospital, but I'm not sure how the doctors would keep that going while she's being moved, and I'm not sure how the surgery would go in terms of stitching up the wound and doing blood transfusions (she does need at least one, I just don't know if it's normal to have it during surgery or afterwards). Anyone got any insight?

I don't want there to be any brain damage afterwards, but I don't quite know how long someone can be in cardiac arrest for and still make a full recovery.

Thanks in advance! ^_^

(Extra info: Character is 19 years old, female, pretty fit and generally in good health; hospital facilities are on par with 2013 America. The wound is deep and long, but hasn't damaged any internal organs.)

12-09-2017, 07:19 AM
Okay, so you have to loose a lot of blood to have an Myocardio Infarction, it happens, but it's rare. The problem is that bystander CPR isn't really going to help you at that point because even though your compressing the heart there's not a lot of volume in the CV system so CPR, which fails like 83 percent of the time anyway, isn't super effective.

What will happen though, is after losing 20 percent of your blood you go into hemorrhagic shock/hypovolemic shock. The first signs of this is that they get cold. They can have blue lips and finger tips, they're breathing increases and typically they get confused before they pass out. Heart failure is a pretty late development in hypovolemic shock, especially if they're healthy and not really old or really young.

The treatment is fluid resuscitation. What happens is that the EMS will grab and go. They start an IV and start running in Lactated Ringers, which is essentially sterile water and electrolytes as they run to the nearest trauma center. Once they get to the hospital the nursing staff starts at least two more IVs and starts rapidly transfusing O negative blood until you get a crisis type and cross back. Then you can start transfusing the patient with type specific. Typically you don't transfuse more than two or three units in a trauma situation.

I found the military combat procedure manual online and cut it down for you.

Treatment of Hypovolemic Shock—Control Bleeding!
The goal in the treatment of shock is to restore tissue perfusionand oxygen delivery (dependent on hemoglobin, cardiac output,and oxygenation).
 Secure the airway and administer oxygen for SaO2 <92%.  Control obvious bleeding and assess for occult hemorrhage.
 Assess circulation and establish IV access.
 Administer IV fluids.

Hemorrhagic shock: Resuscitate initially with any fluidavailable. But strong consideration must be given for earlyblood product transfusion, particularly in those casualties atrisk for a massive transfusion (>10 units of PRBCs [packedred blood cells] in 24 hours).
♦ Physiological/laboratory predictors of massivetransfusion include: Systolic blood pressure <110. Heart rate >105. Hematocrit <32%. pH <7.25.
◊ 3 of 4 risk factors = 70% risk massive transfusion.
◊ 4 of 4 risk factors = 85% risk massive transfusion.
These patients should be immediately resuscitated withblood products (red blood cells:fresh frozen plasma:platelets) in a 1:1:1 ratio or consider fresh whole blood iffull component therapy not available.

After that they've addressed the blood loss they'll bring a GI surgeon, who will do an emergency surgery and after that, depending on what the lab work shows they'll go to either an ICU (Not super likely) or the floor. Any time you touch the abdomen it's a fairly significant recovery time, at least a three to four day hospitalization because they need to make sure bowel function returns before discharging them.

I don't know if your wedded to the concept of a cardiac arrest, but the survival rate is around six percent and only about 25 percent of the country has a valid CPR card, and that includes healthcare workers.

12-09-2017, 01:28 PM
That's really helpful, thanks so much! I'm not 100% set on the cardiac arrest idea, so if the survival rate is that low I'm fine with leaving it out. I do want it to be a close call, though.

With the recovery time, roughly how long would it take for them to wake up after surgery? Would the blood loss mean it would take longer than usual, or would it just be a case of waiting for the anaesthetic to wear off? Also, how many days would it be before they were able to get out of bed?

12-09-2017, 03:01 PM
With the recovery time, roughly how long would it take for them to wake up after surgery? Would the blood loss mean it would take longer than usual, or would it just be a case of waiting for the anaesthetic to wear off? Also, how many days would it be before they were able to get out of bed?

Once you replace the lost blood it stops being an issue, unless they're still bleeding. I'm assuming this cut is enough to go through the abdominal muscles and nick the bowels.

Recovery time is normally less than three hours. They'll wake them in the OR after the surgery, and they'll go back to sleep. After that they'll go to the Post Anesthesia Care Unit for an hour to two and half. Then they'll be transferred to the floor. Typically they'd be out of bed in less than 24 hours, unless the damage done to their abdominal muscles is crazy extensive. After GI surgery its super important that patients get up and walk because they're at such a high risk of developing a paralytic ileus, which is what happens when you're bowel stops moving.