Author Question: Bullet Wound to the Chest

Gwyn Asks:

I’m writing a scene in which a cop is injured during a confrontation with a suspect.  I’d like to tell you about the scenario I have in mind and hopefully you can tell me how realistic it is.

ammunition-2004236_1920Cop, mid-thirties, in excellent health and physical condition is shot with a low caliber bullet from about 10 feet away.  The bullet hits his chest, goes through the lung and exits out the back.  He’s got colleagues nearby who administer basic first aid and the EMTs get there within 5 minutes.  Say about 15 minute drive to the hospital.  They radioed ahead so the hospital is expecting them and has an OR ready.

First of all, what are the chances of survival?.  Second of all, assuming survival, what are the chances (best case scenario) of full recovery – to the point he can return to active duty.  How long would the recovery time be, how soon would he get out of the hospital, and what complications — pneumonia, blood clots, etc should the doctors be worried about?

Finally, if a full recovery is highly unlikely, are there little changes I can make to the scenario to make it more likely?

Jordyn Says:

Hi, Gwyn! Thanks so much for sending me your question.

In short, this is a survivable injury.

You don’t specify in your question whether this police officer is shot in the right or left chest. Right chest would probably be preferred as there are less vital structures on the right side of the chest then the left.

ambulance1You give your victim immediate first aid and EMS responds quickly. Keep in mind that you’re going to need a paramedic to respond to give more advanced field procedures. A basic EMT is limited in what they can do— CPR, wound dressings, assisting the patient with some of their own medication administration. Depending on the state, some EMTs can start IVs, so if your novel is set in a specific location then I would research this for that area. Assuming he has a paramedic respond then he’ll get an IV, IV fluids, oxygen, and possibly pain medications. Of course, a set of vital signs and cardiac monitoring.

In an urban setting, a drive time of fifteen minutes to the hospital seems a little long. If a rural setting then you’re probably fine but you might need to adjust there as needed.

A bullet passing through the chest is likely going to puncture and deflate the lung. This character will need a chest tube to get the air out of his chest and reinflate the lung. A chest tube can be placed in the ER. This patient would get a CT scan of his chest. If the medical team isn’t worried about any other injuries than this patient may not even need to go to the OR.

A patient with a chest tube will need to be admitted into the hospital. How long it takes the lung to reinflate depends on the size of the pneumothorax or the degree to which the lung has collapsed. Generally, a patient’s chest tube is connected to a drainage box that uses suction to help the lung reinflate. Patients with this type of injury will get daily (or every other day) chest x-rays to see how the lung is expanding. After the lung is fully expanded, the suction is stopped, but the box remains in place. This is generally referred to as placing the chest tube to water seal.

If the lung stays expanded to water seal for one to two days then the medical team would feel good about removing the chest tube. Then the patient would be observed for another one to two days to make sure the lung stayed reexpanded.

Pending any complications, you’re looking at a hospitalization of 4-7 days. Pneumonia is probably your more likely complication. Having a tube in your chest hurts. Because of this, patients don’t want to take deep breaths. This can lead to the smaller air sacs in the lung staying collapsed and trapping bacteria which could lead to pneumonia.

If you add a complication like pneumonia, then you’re easily adding another one to two weeks that he’s out of commission.

If you just stick with a “simple” collapsed lung I would say he’d be out of work for about two weeks. He won’t be physically 100% of what he was before the injury but he should feel back to his physical baseline in about a month.

I would say he can work, but he’s going to have some physical limitations. It would be up to his department what his physical capacity needs to be before he can return to work. Half days at a desk job is not unreasonable for a few weeks.

He’d likely become short of breath during any exertional activity (like running after a bad guy). However, considering his physical shape, he should bounce back fairly quickly.

A nice overview can be found here.

Hope this helps and good luck with your novel!

A Chance to Win 45 Books And a Kindle Fire!

Hello Redwood’s Fans,

romantic-suspense-i-redwoodWe’ll get back to our usual medical mayhem on Wednesday. Today is just a brief note to let you know about this fabulous contest where you have the chance to win 45 romantic suspense novels and a Kindle Fire. I’ll be giving away my debut medical thriller, Proof. You can find the contest by clicking on this link.  Don’t delay as the contest ends tonight— February 20th.

Good Luck!

Author Question: Complex Traumatic Injury

Rachel Asks:

I love your blog, and I have a fictional medical question for you.

motorcycle-654429_1280I have a young teen character in the near future (about 2075) who is a motocross racer. She has a horrible crash near the end of her freshman year of college and suffers a large injury – she has to stop school.

I want her to recover in 3-6 months, well enough to go to school, and show up full of plates and wires. I was thinking a severe shoulder fracture would do it, and assuming she got good enough PT, she could eventually race again (and even move onto a more demanding kind of racing.)

Is this a likely enough scenario? What would be a typical range of wires and plates to put in? I want a specific number for her to obsess about as she overcomes her fear of biking. Other injuries you could suggest? What about the recovery timeline? I need her off the bike for about 6-9 months, but some of that could be psychological, not physical recovery.

In this novel, there is some integrated AI technology. Obviously, the answer can incorporate speculative medical advances, but I’d like to know what is typical today so I can make them sound convincing.

Jordyn Says:

My first impression is that the shoulder may not be the best option if you want lots of plates and screws. You have to consider the bones that make up the shoulder and how those injuries would be treated. The scapula is very hard to fracture and likely wouldn’t be repaired that way. I’ve only actually seen one scapula fracture in my entire ICU/ER career in the span of almost 25 years. Collar bones we basically let heal on their own without surgical intervention. Even the upper arm— at least in kids— is not even splinted if you can believe that (most often)! Ligament repairs, labral tear, rotater cuff repairs, etc, could potentially take your time frame (with some complications) but would not involve a lot of plates and screws.

If you wanted to stick with an upper body injury— you could do amputation and then have your character learning to use a prosthetic which might tie in nicely with your integrated AI technology.

If you want to stick with a ton of plates and screws, alternative injuries could be a pelvic fracture or a complex upper or lower (or both) leg fracture. For instance, you could probably Google– x-rays of pelvic fractures repaired using plates and screws or x-rays of lower leg fractures repaired using plates and screws as references to come of with a specific number for her obsessive counting, etc.

Hope this helps and good luck with your story!

Laurie Alice Eakes: The Midwife Versus The Physician

Physicians Take over the Practice

lady-in-the-mistFor centuries, even millennia, midwives served as the primary practitioners called in to assist in childbirth. Then a family of ?French Huguenots, established as “man-midwives” invented the forceps, an instrument resembling two spoons with a handle holding them together. The Chamberlain family kept this invention a secret for over a hundred years. When it was sold to, or leaked to the public, other physicians began to use it and midwives began to lose their power over child birth, except in rural areas.

At first, midwives shunned the use of forceps. By law in some places and practice in others, they possessed small enough hands to pull out the baby in difficult births. After a while, though, laws changed and Midwives were not allowed to use forceps.  By the beginning of the nineteenth century, doctors were also using opiates to relieve the pain of childbirth.  Unfortunately, opium, as noted In Martha Ballard’s diary, A Midwife’s Tale, tended to prolong and even stop labor.  In the nineteenth century, ether and chloroform replaced opiates, especially after Queen Victoria allowed herself to be sedated during childbirth.

Lying –in hospitals came into practice, especially for poorer women. These were used as training fields for physicians wanting to deliver babies. Although germs were little more than a myth to medical practitioners until Joseph Lister and Louis Pasture proved their existence and harmfulness in the latter third of the nineteenth century, midwives and physicians made the observation that women who gave birth in hospitals suffered from childbed fever more often than did women who gave birth at home.  Women attended by midwives also had a lower mortality rates than did women attended by physicians.  After all, man midwives often went straight from an autopsy to the birthing chamber without washing their hands.

Why physicians strove to take over obstetrical practice is open to speculation.  Evidence, however, leads one to suspect that the motive was for financial gain.  Being men, thus having more power than women at that time, suppressing female childbirth practitioners was all too easy and financially lucrative.

Author’s Note: This article is adopted from a paper I delivered at the 1999 New Concepts in History conference under the title “Women of Power: Midwives in Early Modern Europe and North America”. My sources vary from newspapers, to diaries, to books difficult to obtain outside of a university library system, as many are hundreds of years old. If you wish to learn more, Google Books has some fine resources on childbirth practices in history.

*********************************************************************************************lauriealiceeakesMidwives historic role in society began to fascinate Laurie Alice Eakes in graduate school. Before she was serious about writing fiction, she knew she wanted to write novels with midwife heroines. Ten years, several published novels, four relocations, and a National Readers Choice Award for Best Regency later, the midwives idea returned, and Lady in the Mist was born. Now she writes full time from her home in Texas, where she lives with her husband and sundry dogs and cats.

You can read an excerpt from Lady in the Mist here and discover more about Laurie Alice Eakes at her website.

***This is a repost from December 1, 2010.***

Author Question: When Was Pregnancy Related Anemia Discovered?

Robin Asks:

I’m looking but I can’t find gestational anemia. I need to know if they would have diagnosed that in 1912 and what they might have called it. If it was diagnosed, what treatment might they have prescribed?

Jordyn Says:
First of all, I’ve never personally heard the term gestational anemia so I started my Google search with “when was anemia first discovered” and then started narrowing it down from there to pregnancy related anemia. I wasn’t having much luck on doing a basic Google search and decided to head over to Google books where I’ve had better luck with historical questions.

There, I found a book called An Antropology of Biomedicine and from that found the following information:

The discovery of the link between macrocytic anemia (a lack of red blood cells in which those that remain are swollen) and folate (a water-soluble form of vitamin B) was first made in India in 1928, when a British scientist Lucy Wills traveled to Bombay to work with “Mohammedan women” who were commonly found to have this particular form of anemia during pregnancy.

So, it looks like the discovery was made after your time frame, Robin.

Fitbit Saves Man’s Life


Fitbit Charge

If you know me and this blog then you know I’m fascinated by weird and interesting medical things. Now I know you might be thinking, “Of course! Fitbits help improve physical activity so that’s what saved this man’s life.”

It’s so much better than that!

This case was reported in the September 2016 issue of the Annals of Emergency Medicine. It describes the case of a 42 y/o male who was a known seizure patient. Emergency services were called when the man suffered a seizure. Upon EMS arrival, the man was noted to be in a postictal state and also in a rapid heartbeat called atrial fibrillation which they treated with IV medication.

Upon arrival to the emergency department, the man continued to be neurologically intact, though still a little sleepy from his seizure. He continued to have atrial fibrillation and the hospital had a protocol that favored electrical cardioversion for a-fib if the patient had been in the rhythm for under forty-eight hours.

Problem was, this man didn’t have any symptoms with his irregular, fast heartbeat. Someone on the medical team noted him to be wearing a Fitbit— specifically one that monitored heart rate and they retrieved the data from his smart phone. From that information, they could clearly tell when their patient went into the abnormally fast heart rate and were able to treat him safely with electricity.

Using activity trackers that specifically monitor heart rate can be useful in many medical conditions where the patient’s heart rate plays a role. I think it would be particularly useful with a particular fast heart rate called SVT (supraventricular tachycardia).

This can be a particularly sneaky rhythm to catch and it would be possible for a patient to be diagnosed with something like anxiety simply because we were unable to ever catch the rhythm. Even patients who receive 24-48 hour Holter monitoring might not have episodes captured.

It would even be useful in capturing certain rhythms that cause very low heart rates and could cause the patient to black out.

The crux is— it wouldn’t tell us the exact rhythm— only that the heart rate was low or high, but from that information we could look further.

Now, I’m thinking furiously about how to use this in a novel.


Author Question: Surviving Stab Wounds to the Abdomen

Anonymous Asks:

I have a character in my story who is stabbed three times with a three inch, narrow blade trench knife in the abdomen. I’m trying to avoid the guts or arteries and make it as non-lethal a spot as possible. He is a doctor and also a spy. I would like him to live and make a complete recovery.

He is two hours away from a hospital and has a friend to help him get there. Here are my questions:

1. Would it be feasible for him to live that long while he gets to the hospital for treatment?

2. Would he want to leave the knife in during travel time so he doesn’t bleed to death?

3. Or do I need to rework the scene so he’s closer to the hospital? If two hours is too long, what’s the maximum time he could have in travel before it’s too late?

Jordyn Says:

anatomy-254129_1280This is an example of all things are possible, but not necessarily probable. Of course, people survive devastating injuries every day. Miracles do happen. This is the category I would put your character in to.

The largest problem with him surviving these injures in the length of the knife and how many stab wounds he has. Three inches is long when it comes to knife wounds— particularly if the full length is buried into the abdominal area. We have to operate on a worst case scenario until the patient proves otherwise. Looking at the picture to the right, you can see all that is located in the abdomen and how likely it is that something devastating to this patient would be punctured or nicked.

If you want to keep the scenario as is, then I would have all the punctures be to the lower abdomen and to either side. This could puncture the intestines and bladder. These would need to be surgically repaired, but should be survivable (if the bleeding is minimal) for a couple of hours.

You’d definitely want to avoid the left upper and right upper abdomen which house the spleen and the liver. If these are punctured, your character would likely bleed out within two hours. Also, more midline to the abdomen is the descending aorta (a very large blood vessel), which also would lead to rapid hemorrhage and low survivability.

Leaving the knife in is up to you as an author. I could see his friend doing either thing. In a panic, he removes the knife. Or, maybe he has some medical knowledge where he thinks leaving it in place might be a good idea. I would pick whatever increases the tension for your scene.

Two hours is reasonable if you pick the injuries I describe above. I would caution you, though, to give the reader an image that there is little bleeding and the pain is somewhat tolerable. Rapid bleeding, a hard distended belly, accompanied by signs of shock (rapid heart rate, rapid breathing, sweating, paleness, clammy skin) would be poor prognostic indicators for surviving two hours.

Hope this helps and good luck with your novel!