Healing stab wounds in a dystopian teaching hospital with limited resources

Waterlyric

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Hi there! :)

In my current story, one of my main characters is almost done with her training as a nurse/medic at a teaching hospital, and her best friend (who she was separated from a few years ago) is brought in as a stab wound patient. Of course they re-unite again, the stab wounds were inflicted by the totalitarians and there's a rebellion, blah blah. My issue is that I'm not sure exactly what the procedure would be, in terms of how the stab wounds would be treated and handled, and what my character would have to do. I have researched "how to care for stab wounds" but everything I got was mainly either for how to handle it as a layperson while 911 is on the way, or for people who are doctors in hospitals with excellent conditions.

The factors in this scenario are:

- The hospital is in a run-down and mostly abandoned sci-fi city that's devolved into slums. Standards and regulations are much lower, if even existent. People aren't going to med school for 8 years; instead, they learn via apprenticing and hands-on training. The girl performing the healing on her friend is like 17-18 years old and is at the teaching hospital doing a vocational medic/nursing training program in lieu of high school.

- The hospital does not have the resources to have a team of people working on an injured person. Usually it's one medical worker struggling to balance like 3-5 injured people on their own. Obviously many people die due to this. Therefore, the medic girl is responsible for healing her stabbed friend all by herself, since the other workers are stretched too thin with other patients (the city has a lot of violence and chaos.)

- They do have modern style tools and chemicals to heal a stab wound properly. They don't have things like complex heart-pumping machines and life sustaining systems (someone in a coma would be SOL), but they also aren't using medieval blood letting or magic attempts or anything like that. They have tools like gauze, stitches stuff, disinfectants, etc (likely no painkillers or other adequete medications though)


Let's say her friend was stabbed a few times in non-fatal parts of the torso/sides/back, in places not puncturing a vital organ or plunging really deep, but more like side-cuts where the main damage is to the muscle. The main danger is blood loss. She's able to get the equivalent of an ambulance and perform some basic blood-stopping techniques while they arrive, then the paramedics in the ambulance are able to do a temporary patch-up, then the friend/nurse at the hospital has to handle the rest of it.

What would this look like? When the medic friend reaches her in the treatment room, what types of basic care may have already been administered (by either the stab victim herself or the ambulance people) and what would she have to do on the wounds? What would the victim's condition be like? What would be the level of urgency/time frame?

Thank you so much for all your help - if you'd like help on your own question in return, let me know and I'll do my best. :)
 
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PiaSophia

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Hello!

Most people think that dying from blood loss is messy, blood everywhere, etc etc. But most people who die from blood loss die from internal blood loss. Having multiple stab wounds would be a huge risk for that and not much can save the victim except for an operation to get the blood loss to stop (so she would have to be patched up from the inside).

Basic care should at least contain:
- NOT removing the objects with which she's been stabbed--removing the objects would mean there's nothing left to stop the bleeding. If she's lucky, the objects might just save her.
- Giving her oxygen, if she's having severe blood loss her organs aren't getting enough oxygen, so she would have to get some in one way or another
- Infusion with any liquid, basically. But of course, preferably some natrium chloride. With severe blood loss, her veins will be less filled, which means shutting down of organs, which can result in death. Filling her up with natrium chloride will at least keep the veins open until she can receive blood or stop the blood loss ASAP

The victim would probably be on the verge of death if she's been stabbed and is suffering from severe blood loss. Depending on the wounds, this can be a matter of minutes (big, multiple wounds) or hours (smaller, mainly internal ones). She would be passed out and having trouble breathing. Her blood pressure would be very low and her pulse extremely high. She should get in the OR right that second to stitch up the wounds and see which organs would be damaged and which ones could be saved.

Good luck! Hope it helps.
 

CWatts

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I'm no medical expert, but your best bet may be to research how they might treat these wounds in developing countries and modern war zones.

Natural disasters are another low-resource scenario. This book about by a doctor who was at a New Orleans hospital during Katrina might help: https://www.npr.org/2013/09/10/220687231/during-katrina-memorial-doctors-chose-who-lived-who-died
Normally I'd think the doctors would prioritize a young, otherwise healthy patient, but an oppresive regime twists those ethics.
 

Kinsman

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In a facility where supplies are limited and equipment is far from optimal... Stab wounds penetrating the torso suddenly becomes a race to equalize pressure. Stuffing the wound site with gauze (an insertable tampon works great) in order to increase pressure within the wound while providing a cotton (or like) material for blood to slow/stop/clot. Depending on the injury and location, further intervention may be needed after the blood loss is controlled. Shallow slash wounds also require pressure but the bandage may be applied against the wound, either held or tied in place. For deeper cuts, more definitive measures are needed quickly. Blood vessels may be clamped (hemostats), bonded with a clotting/cauterizing agent (Chitosan or other product), or cauterized directly by heat. Severe wounds to the extremities immediately get a tourniquet. These arteries (arterioles, etc) and Veins (venules, etc) can then be tied closed (sutured) if clotting isn't sufficient, but the tissue that is now denied that blood supply will be negatively affected. Assuming there are no vascular surgeons available, there may be longer lasting negative effects. In a dystopian environment, the real threat occurs after the blood flow has stopped. Sepsis/Infection kills, too. Antibiotics will be a key factor in survivability. Hope all that helps.

Edit: Additionally, if the patient is bleeding from severe internal wounds, IVs would certainly be used if available (especially Lactated Ringers) *however* they wouldn't be run a full speed/capacity until that patient was relatively stable. By that, I mean, if the IV fluid is infused too fast, it could increase the patient's Blood Pressure to a point where internal clots could be "blown out". In a case of severe/several internal bleeds, a medical professional in an austere environment would want to add fluid to bring the systolic pressure above 60 (enough to perfuse the brain and kidneys) and try to reach (but not exceed) 90. At 90, the risk of blowing out clots that have formed are minimized, but all organs should be receiving a decent blood supply. If enough blood loss has occurred, then providing blood (transfusion) will be required, since something has to carry the oxygen to the organs.
 
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lonestarlibrarian

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Looking at an old pre-Civil War-era surgeon's textbook--

Punctured wounds are those made by a pointed instrument. They have also been called penetrating wounds, but this is a very loose phraseology, for an incised wound may also be penetrating, as in those created by small-swords, &c. The wound in the skin in these cases may be either incised or lacerated according to the nature of the point of the instrument. More of less contusion, however, is usually present in all punctured wounds, particularly if the point inflicting the wound be blunt. In these wounds the first danger is from the injury that may be done to important organs... (but you said organ damage wasn't an issue.) ...Thus if an artery be wounded it will bleed more profusely, and if a nerve be punctured the consequent irritation will be greater in a punctured than in any other variety of wounds; hence tetanus is more frequently met with in this class of injuries. The second danger is from inflammation leading to suppuration beneath fasciae, and resulting, if the pus be not evacuated, at the proper period, in extensive infiltration of the tissues.

The third danger is that resulting from the presence of foreign bodies in the wound, for it may happen that the whole or a part of the instrument making the wound will remain in it, as in the case of splinters or arrow-heads. A bayonet or a boarding-pike, broken off in the body by contact with a bone... will, of course, add to the dangers to be apprehended.

Treatment - The indications for the treatment of punctured wounds are, 1st, to arrest the hemorrhage, and, 2d, to allay irritation. The latter indication is, in some cases, the more important of the two, and may demand the earliest attention, as where the instrument has been left in the wound.

In the attempt to arrest hemorrhage it may be necessary to dilate the wound in order to tie the bleeding vessel, as not unfrequently a vessel which bleeds profusely from a puncture will contract and retract upon being entirely divided, to such an extent, that the bleeding will cease. Where the hemorrhage, though free, is not sufficiently so to justify the surgeon in boldly cutting down and securing the bleeding vessel, the tampon may be employed, or a piece of patent lint, charpie, sponge, or agaric, be thrust into the wound and kept there till a clot is formed.

An important point in the treatment of punctured wounds is to prevent the healing of the skin before the peeper points are thoroughly united, so as to insure a free vent for the pus, as the skin heals more readily than other tissue. Should the skin unite while suppuration is yet going on below, a large abscess would be formed, the pus from which, by infiltrating the cellular tissue, invading muscles, and other deep-seated structures, might do much mischief; but when, notwithstanding every precaution, matter yet forms beneath the fascia, the parts should be incised freely to give it ample opportunities of escape.