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View Full Version : Medical Knowledge Re: Gunshot Wound to Abdomen?



rainbowsheeps
07-29-2018, 07:07 PM
Hey everyone. Does anyone have some medical knowledge they might share? I'm writing about a character who has a self-inflicted gunshot wound just around the heart, but not through the heart. The character is rushed to the hospital and survives. Some questions:

1. If the bullet punctured beneath/around the heart, I'd imagine we're talking about damage to the liver or lungs. Does anyone have knowledge of what complications/treatment these each entail?
2. What might be a good estimate of the trajectory of the patient in the hospital? ER -> ICU -> Recovery somewhere?
3. How many days might he spend in the hospital?
4. How long would someone take pain medication for these wounds?
5. How long to keep the dressing on the wound? Upon release, would there will be a bandage that needs to be changed, etc.?
6. If the gunshot was self-inflicted and the patient is 19 years old, what might be the protocol upon release? Do some states mandate psychiatric intervention?

That's a lot of questions. But, if anyone does have any insight or thoughts about any, I'm all ears. :)

Cobalt Jade
07-29-2018, 08:21 PM
No info, but I think you also need to determine the caliber of the bullet as well.

rainbowsheeps
07-29-2018, 08:29 PM
Ah thanks! Yeah, that would probably make a difference. I was thinking a typical 9mm round from a pistol - or at least, a common ammunition type in a handgun.

cornflake
07-29-2018, 09:21 PM
All of this stuff is heavily dependent on what happens, which brings us to the salient question -- what do you WANT to happen?

I mean if you shoot yourself in the chest (which is a weird angle to shoot btw, and also kind of dumb), pretty much anything could happen, from the bullet just glancing off a rib and leaving a little flesh wound to a bullet actually piercing chambers of the heart, ricocheting around and puncturing both lungs if it hits a rib interior, penetrating the spinal column, etc., etc., etc.

So work backwards from what you need (how incapacitated do you want someone, etc.) and you'll be much better off.

RolandWrites
07-30-2018, 09:52 PM
Yeah, both previous people are right. I work in Critical Care, and I've worked with gunshot wounds, but I would need caliber of bullet, angle, and what it is you want to happen exactly. There are so many things that could happen. The bullet could lodge in a bone, or fracture bones and pierce both lungs, or ricochet around in there and do major damage. The last gunshot wound I helped treat, he was shot in the hip, and though the bullet went straight through, the caliber of bullet was big enough it meant the hip bone was shattered like a dropped piece of glass. So many things could happen.

Just general info if you want something clean:

He would be rushed to emergency surgery to fix whatever internal damage you want to happen. Stop the hemorrhaging in the lungs if the bullet went in there, remove the bullet if it's in there, fix the bones, stitch up everything (if it can be, sometimes it's best to leave the wound open or partially open). Surgery often takes hours if it's severe, which it is. He'll be emergently intubated and on paralytics. When all that is done, he'll be transferred, often still intubated, to the critical care unit. He'll be kept intubated and on paralytics, blood pressures meds, and heavy pain meds until everything stabilizes, and that depends on how bad you want him hurt. Some people come off the intubation after a day or two (depends how fast they can pass a spontaneous breathing trail to breath through the tube on their own and how fast they can wake up when all the sedation is taken away). They might give him a PCA, which is a morphine pain pump that lets him push the button to control his own pain meds for a while (like an epidural pump for childbirth) or give him morphine or dilaudid every 4 hours. He would have a central line or a PICC line rather than a standard IV (or at least that would be procedure at our CCU).
For the dressings, likely he would have a wet to dry dressing changed every day, which would involve packing the wound with gauze wet with a saline solution pushed into the wound with a sterile, long qtip made for the purpose. Then we would put what is called an ABD pad over that and tape it down.
Generally, if there are no complications at all, he might be with us a week or longer before going to a regular room on a different floor. When they get ready for him to leave the hospital, they'll transfer him to a psych hospital like we do with all of our suicide patients and he'll be there are long as they deem to keep him. Just some random things are that we would bath him every day (washcloth bath in the bed performed by a patient care tech), he would be turned every two hours with pillows alternated under either side and laying on his back, they monitor his bodily fluid outputs every two hours after surgery (this is actually really important) so someone is pretty much constantly in the room looking at a catheter/suction container (he'd probably have a little nasal tube if he ends up intubated longer than a few days to suction if he has too much stuff coming into his throat or to give him tube feeding)/tube feed amounts/how much his IVs have given him etc or to ask him how he feels because there are hourly assessments on CCU patients (at least in our unit). CCU patients have non-stop telemetry monitoring (unlike what you see in movies) so they stay hooked up to a 6 lead heart monitor, blood pressure cuff (on a 30 minute cycle usually, if not every 15 minutes if his pressures are low or high), and O2 probe all the time and if they take any of those off (like the do in the movies all the time) the nurses at the desk will know about it immediately because have alarms that go off to tell us if you've taken them off, and we will come down there to put them back on you because those alarms are loud and very annoying. Our rooms in the CCU also have cameras, so we can see you at all times, so we can see if you are just taking things off or if you're in legit trouble, so we know to rush down there cause you're dying or walk down there to get onto you about taking off your O2 probe for the 15th time. I also just watched a show where someone unhooked a person's respirator tube (the one going down their throat that you get right after surgery like your character would have) and just watch them suffocate to death, and that is impossible. Those things have loud, irritating, and very obvious alarms that go off when they aren't even unplugged (they go off when you cough with one in or if the breathing isn't even exactly even, and the alarm for when they are unplugged if even louder and more angry than the one that happens when you're coughing), so there's that info for you too.

I hope I've given you a lot of info to work with. If you have any other questions I might be able to help with, or if you think of a more specific set of circumstances for your gunshot wound, I'd be happy to come back. :)

WeaselFire
08-02-2018, 09:39 PM
Example from two recent, semi-local gunshot wounds to the chest below the heart. Coincidentally, both were 9mm, though the outcomes probably didn't depend on it.

Case one, guy holding the gun out with his elbow at 90 degrees, about six feet, robbery gone bad. One shot to the abdomen just below breast bone. Bullet hit the abdominal aorta, victim was dead before medical team arrived.

Case two, argument between supposed friends, guy holding gun at arms length, about ten feet, pointed at victim's chest, slightly to the victim's right side. Victim moved, guy jumped back and fired, bullet struck just below the breast bone. Bullet missed the aorta but penetrated the upper stomach, ruptured spleen and damaged the kidney. Victim survived, with serious complications from splenectomy.

There are a lot of things to hit in the human body, and a lot of things that get missed simply through the grace of God. In fiction, the author gets to play God and decide what exactly happens. After all, normal life is pretty mundane and not worth reading about until some enterprising author finds the right story. :)

Jeff

bwebs
08-02-2018, 10:28 PM
So many variables it's whatever you need really. For most stories that come to my mind I'd think you'd want miraculously few complications. A hollow point to anything serious could be days/weeks in an induced coma, months in the hospital, and never really recover. On the other hand it could bounce off a rib/sternum, hit nothing and exit immediately and still be a serious event/hospital stay, but story goes on kind of thing. Couple weeks on stitches/dressings. They would see a psych team, and the police.

jclarkdawe
08-05-2018, 07:15 AM
As Cornflake said, very unusual and hard to do suicide approach.

Not only do you need the caliber of the gun, you need its barrel length and weight of the gun. I'd suggest taking a TOY gun and trying this on yourself. Your wrist is going to be an a very awkward angle. You're probably going to end up with a somewhat funky angle.

Then this is a contact wound. Not only does the bullet, but the entire muzzle blast enters the body. Massive damage, and a much higher risk of infection. It would clearly be a suicide attempt, and the patient would have a hold until he was deemed safe for himself. Your character is not going to get out of the hospital fast with any contact type would.

Jim Clark-Dawe

Linnabelle
09-04-2018, 01:38 AM
As mentioned above, a self inflicted gunshot wound to the chest would be very awkward to pull off. Additionally, at point blank range, there is going to be a LOT more damage. Not just from the initial explosion of gunpowder escaping the barrel (muzzle flash), but from cavitation as well. This is what happens when a round is fired through flesh. (https://i.ytimg.com/vi/n6KejbDokRo/maxresdefault.jpg) It does a LOT more damage than the neat little hole you see in movies. That cavitation ruptures organs. If the round passes near the heart, which is surrounded by a LOT of important blood vessels, (https://s3.amazonaws.com/ai2-vision-textbook-dataset/dataset_releases/rc2/train/question_images/human_system_circulatory_3633.png) there is very little chance the patient would survive. If they did, it would be MONTHS of recovery, and weeks in the hospital. Depending on the damage, and how well they healed, they may need to take medication (pain or otherwise) for the rest of their lives.

Other things to consider is suicide method. Most females don't want to leave that much of a mess, or suffer, so overdoses or cut wrists in the bathtub are most common. Males are more likely to try gunshot wounds or hanging. Males are more likely to jump from buildings, females are more likely to jump off bridges, if at all. Jumping is very public, and females tend to try more private methods.

MichaelC
10-14-2018, 05:46 PM
As others mentioned, this would depend on the type of weapon used. A pump-action shot gun is going to do different damage than a .22 handgun.

1. Damage "around" the heart could hit the trachea and great vessels if above the heart, the great vessels if below the heart, the lungs if to either side, the pulmonary vessels if to either side, the spine, and damage to the sac that surrounds the heart. Blood in the chest cavity can put pressure on the lungs, causing them to collapse.

2. ER/Trauma --> Surgery --> Surgical ICU --> Step-down Unit ---> Surgical inpatient floor --> Psychiatric inpatient --> Home health care

3. This depends on the extent of the injuries and complications. Probably weeks.

4. Again, depends on the extent of the injuries. If there is spinal cord or nerve damage pain could be lifelong.

5. I am not sure about this one. The initial injury and subsequent wounds from surgical sites and chest tubes would probably need a few weeks of outpatient wound care.

6. As reflected in #2, the person would be committed to an inpatient psychiatric unit regardless of age.

Al X.
10-14-2018, 07:33 PM
The question in my mind is why would someone choose to shoot themselves through the heart to commit suicide? Intentional self-inflicted gunshot wounds are almost always to the head.

But to add to the previous information, the type of bullet plays in to the scenario as well. A standard 9mm NATO ball round or other small caliber handgun equivalent will be the most likely to penetrate cleanly (barring hitting a bone) causing the least damage. An expansive round like a hollow point or a Glaser slug is likely to incur significantly more damage in that area of the body.

Roxxsmom
10-14-2018, 10:16 PM
Given all the issues about someone shooting themselves through the heart (deliberately) instead of the head as a suicide attempt: could he have been attempting to shoot himself through the head but messed up in some way and missed, but the bullet ricocheted and came back somehow to strike him in the chest? Or the gun goes off by accident before he gets to where he's deliberately pulling the trigger?

CWatts
10-15-2018, 04:58 AM
The question in my mind is why would someone choose to shoot themselves through the heart to commit suicide? Intentional self-inflicted gunshot wounds are almost always to the head.


This a second-hand anecdote but a former boss told me of a man who lost everything in the 90s tech stock crash. He was a handsome guy and shot himself in the chest, apparently so he could have an open casket funeral. It goes to show the disordered thinking of suicidal people - I'm sure his wife and family would have much rather had him alive.