Bleeding

Author Question: Stab Wound to the Lower Abdomen

/ Jordyn Redwood / Leave a comment

Katerina Asks:

My character, Faith, is stabbed with a switch blade (about  8.5 cm long)  in the lower abdomen. I have three questions about this.

1. Can she die from this and how long would it take?
2. Would she have to go to the hospital?
3. If she survives will there be any permanent or semi  permanent  damage?

Jordyn Says:

Hi Katerina! Thanks so much for sending me your question.

You don’t give specifics on exactly where in the lower abdomen your character gets stabbed (left, right, or mid line). If stabbed in the lower abdomen, there are fewer things that can be hit that will cause you to die immediately— generally from blood loss. Though there is that descending aorta to worry about.

The lower abdomen mostly contains intestines, the bladder, and reproductive organs for the female. A person can die from injury to these body parts– most likely from infection leading to septic shock. This would be unlikely should your character receive medical care shortly after the injury.

If you choose to go this route, I would say death from sepsis could be as early as 48-72 hours to as long as a few weeks. On the early side if the character did not receive any medical treatment and there are some nasty germs either on the knife or the intestines are punctured leading to contamination of the abdominal cavity and no surgical repair or antibiotics are given.

Longer if there is surgery and antibiotic therapy but the person is infected with a resistant strain of a bacteria or fungus, or is immunocompromised, etc.

A stab wound of this type should be evaluated in the hospital. Again, this would be up to you as the author and what kind of conflict you want to have for your story.

It’s hard to say if this character would have any lasting effects from the wound as you don’t give specifics as to the injury.

Best of luck with your story.

Video on Treatment of Excessive Bleeding

/ Jordyn Redwood / 1 Comment

Since I get LOTS of questions regarding bleeding, I thought this would be a nice instructional video to post regarding treatment of excessive bleeding.

The post is mildly political at the beginning and does contain some profanity (bleeped out), but at the end it is a great discussion of controlling bleeding— particularly use of tourniquets.

Thanks ZDogg, MD for the great information and keep up the good fight.

How Fast Can Someone Bleed Out? A Real Life Example with Video

/ Jordyn Redwood / 1 Comment

I get asked often as a medical expert and host of this blog how fast someone can bleed out from a variety of injuries. When I say fast, I think many people are doubtful. I’ve said many times that all bleeding can lead to death if not controlled, whether venous or arterial.

Recently, Bo Johnson,  a friend of mine who is an ER nurse and avid outdoors man had a very close call with nearly bleeding to death. This story does have a happy ending (thank heavens.)

Bo was riding his bike to his children’s school while carrying a razor scooter in one hand. The scooter became caught in his bike and when he fell, his neck landed on the edge of the scooter, severing his right internal jugular as well as a large muscle. What follows is video of the bleeding before surgery that Bo graciously gave me permission to post here. WARNING: The following video is a graphic representation of active bleeding.

Photo Courtesy of Bo Johnson

Keep in mind, this is a large vein, and not an artery. However, the bleeding is still quite brisk and if uncontrolled would be deadly. If it had been arterial, the blood would be a brighter red in color and would spurt from the wound, and would be more difficult to control.

Bo spent two hours in surgery to repair the injury. The jugular vein could not be repaired so was tied off. The jugular vein on the other side of the neck will hopefully compensate. He spent one night in the hospital and should be back to work helping to heal others in about a month.

All who know Bo are so thankful that he is going to be okay after this freak accident. I personally publicly thank him for allowing me to share his story, video, and photo with you so you can see just how significant bleeding can be.

Speedy recovery, my friend.

Author Question: Gun Shot Wound/Severed Brachial Artery

/ Jordyn Redwood / Leave a comment

Sandy Asks:

I am writing a scene where my heroine gets shot in the scuffle with the bad guy. If she’s shot in the brachial artery in her left arm, is it conceivable that she’d pass out and bleed a lot? Her firefighter hero is there and immediately rips off his shirt and balls it up to stop/slow the bleeding. He then uses a strip of fabric from another shirt to tie around that and then carries her to a waiting police car to get her to the hospital—in this case, an ER clinic.

How much danger is there of bleeding out? Is the pressure wrap enough? Can she survive? What would be the treatment? Surgery, I assume, and blood transfusions. Would she remain unconscious and for how long?

Jordyn Says:

Yes, it is conceivable that she would pass out and bleed a lot. The brachial artery will bleed briskly and quickly and without direct intervention she could bleed to death in a matter of minutes (3-6 min). I think both methods to control the bleeding need to happen quickly. The firefighter can direct a bystander to apply direct pressure while he fashions the tourniquet as he will have more experience. The tourniquet should be applied above the level of bleeding. After those two measures, I would have the firefighter continue direct pressure at the sight with a compression dressing. This will be better than continuing to hold direct pressure.

To your specific questions:

Without intervention, this character is in great danger of bleeding out. With immediate intervention, she should be all right.

I would do both the tourniquet and the pressure dressing.

Initial treatment by EMS would be to establish IV access very quickly and start supporting the fluid loss with IV fluids. A set of vital signs. Possibly oxygen if her heart rate is really elevated, her oxygen level is low, or she’s exhibiting any kind of distress.

Since she is being transported by a police car, these would then become the initial steps performed in the ER.

Upon arrival to the ER, labs will be drawn to check her blood counts. If low, then blood transfusion would be warranted. Repairing a severed artery will require surgery.

Whether or not the character goes unconscious depends on a lot of factors. A person can just pass out from looking at blood and the stress of being shot in addition to blood loss. If a person passes out from blood loss, they should regain consciousness as soon as their blood pressure is normalized either with IV fluids and/or blood transfusions.

You mention an “ER clinic”. I’m not quite sure what you mean by this, but a free standing ER, urgent care, or an “emergency” room outside a major hospital can have limitations in the type of care they can deliver. So, if it’s such a situation, the patient would need to be transferred to a larger hospital (for surgery, admission, etc).

Best of luck with this story!

Author Question: Surviving Stab Wounds to the Abdomen

/ Jordyn Redwood / Leave a comment

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!

Author Question: Delayed Death by Crossbow

/ Jordyn Redwood / Leave a comment
Ben Asks:

Here’s my scenario that I would appreciate some advice on:
I’ve got a 25 year old woman that is shot through the left calf and the upper torso (I was thinking, maybe having the upper body shot piercing her shoulder) by crossbow bolts made of wood in my fantasy novel. The weapons that shoot her are each one-hand-held, meaning that they can be aimed and fired with only one hand.
What I need to know is this:
1. Would this outright kill the character?
2. If yes, where on the average human female body can I have two crossbow bolts made of wood puncture that body in such a way as to negate instant death, but still leave months of recovery time for that character, if she gets the proper medical help fast enough?
For background information, the science level of the world I am writing is roughly the same level we have today in America and Europe, the same with this world’s medical tech and knowledge.
Jordyn Says:
Thanks for sending me your questions.
1. A wound to the calf is unlikely to outright kill someone immediately. Any bleeding that’s not controlled if brisk enough can lead to death. Infection is a risk with any wound– particularly those that are caused from things (like arrows) that penetrate the body deep into its tissues leaving bacteria and other microorganisms behind.

The shot to the torso has more likelihood to cause death if it hits the right structure. On the left side of your chest are your heart, great blood vessels, and lungs. If the shot was more to the shoulder then an outright kill would be less likely and the risks above would be more prominent (bleeding and infection).

2. A shot to the calf and the shoulder have the potential to set your character back several months. If you don’t want the character to die– I would avoid having a shot to the torso. A projectile to any extremity can cause the bone underneath to fracture. Fractures typically take 6-8 weeks to heal.

If you didn’t want to go with a fracture of the bone from the projectile– you could have onset of infection (depending on how sick you’d want her to be for those months). Systemic infection can easily cause death. Local infection to the wounds can be problematic as well. You could also go with tendon damage to the arm or leg which would inhibit movement of the extremity. Healing and rehab of tendon and/or ligament damage can take months as well. Whenever an extremity isn’t used because it’s immobilized you always get muscle atrophy (muscle wasting) which causes weakness of the arm/leg, etc. It takes time to rehab that as well.


Good luck with your novel!

New Medical Device: X-STAT

/ Jordyn Redwood / Leave a comment

As a medical nerd, I’m always a little fascinated by new medical devices and what they can do. I was alerted to this device by Mike H. via Facebook (Thanks, Mike!) and found it worthy to post upon to keep all your medical treatment scenes in those novels up to date.

The Blaze

It is true that not all bleeding can be controlled by direct pressure. It is also true that bleeding is the leading cause of death when it comes to bullet wounds (unless you have suffered a direct hit to either your heart, brain, and/or spinal cord which is likely the end of your life here on earth.) Uncontrolled bleeding from limbs is one thing that harkened back the use of the tourniquet. First by the military and now by civilian EMS agencies. They found the concern over tissue damage didn’t pan out in the research.

For those other folks who get shot in the chest and/or abdomen, it’s always a race to the hospital where definitive control of bleeding can happen– which usually necessitates a trip to the OR– which takes time. You may have heard the term “Golden Hour” which is generally the preferred window to get the patient to definitive treatment before they die.

Rapid control of bleeding could actually extend this hour in my opinion.

Enter the X-STAT.  For lack of a better term, the X-STAT is a tampon shaped (sorry, guys) device that is filled with dime-sized medical grade sponges that are coated with a hemostatic (stops bleeding) agent. It is inserted into the wound and the plunger places these sponges deep into the wound where they expand (like the firework snakes) and stem bleeding without direct pressure. The expansion of the sponges prevents them from being forced out of the wound.

Genius.

Thus far it seems to be listed as an investigational device and its use is limited but if it does what it says it does I think this could mean a big difference for trauma patients.

You can read more about the X-STAT here. 

What do you think of the X-STAT? Would you use it in a novel? You can bet I’ll find a way to.

Author Question: Exsanguination

/ Jordyn Redwood / Leave a comment
Heather S. asks:

I came across your website while browsing for some information for a project. I am currently a nursing student and am doing a project on arterial bleeding. I am trying to find specific exsanguination times for the major artieries in the body. I have had no luck after searching online and multiple medical books. I just need a simple answer, i.e carotid artery 2-20 minutes. I have a few times, however, I feel that they are inaccurate. Please see below:

I-stock Photo

Carotid – 2-20 min

Brachial – 5-60 min
Femoral – 5-60 min
Aorta – 1-2 min
Popliteal – 5-60 min

I would greatly appreciate your help as it seems you are extremely interested in medicine. This might go on to help your other readers as I came across the questions dated January 12, 2012 where you discuss exsanguination. Thank you!

Jordyn Says:
Your question is not an easy one.

Any major artery (and the ones listed are major) that is completely severed will likely lead to the patient’s death in less than five minutes. I saw a demonstration once where a physician simulated this happening.

He took a 2 Liter bottle (an empty pop bottle) and filled it with water. He drilled a hole into it (to simulate arterial severing) and then squeezed it at a regular rate to simulate the heart pumping. That bottle was empty in a matter of three minutes. Yes, we timed it.He said the diameter of the hole he drilled equated to the popliteal artery which is behind your knee.

However, the injury may not be a complete separation which is why you have the varying time lengths. Of course, if the person gets some type of medical treatment (like a pressure dressing that stems the bleeding) they may last a lot longer as well.

I know this answer isn’t a clear cut answer but in medicine . . . they usually aren’t.

Heather’s Follow-up Question:
Could I say the smallest time is the fastest time to bleed out without medical attention and the longest time is a small bleed from an artery?

Jordyn Says: Yes, this is reasonable. 

Author Question: Bleeding to Death

/ Jordyn Redwood / Leave a comment

S.W. asks: This is the scenario: A woman has given birth attended only by her partner. After an exhausting long labor, the birth goes reasonably well, but a couple of hours later, she hemorrhages. My question is, would it be possible for her to bleed to death while sleeping?

My plot needs her partner to be in the same room, under the influence of alcohol or drugs which he takes to ‘celebrate’ after the birth. I need him to not realize what’s happening until it’s too late to save her.

Jordyn Says:

I do think this scenario is plausible on a couple of levels.

When a woman has bleeding complications related to delivery– she’s obviously losing blood. Simply, blood carries oxygen to each of your organs.

When there has been significant blood loss– the woman will lose consciousness because of two aspects: not enough blood to carry the oxygen to her brain and/or low blood pressure. You have to have a certain blood pressure to perfuse your brain– and therefore stay conscious.

She would go unconscious and could appear just to be sleeping to the one who’s under the influence of all those meds/alcohol.

The pregnant woman would continue to bleed and never regain consciousness. She would die from exsanguination.

Medical Question: Exsanguination

/ Jordyn Redwood / Leave a comment
Dee asks: How long would it take a character to bleed out if they were shot in the arm and the back? What organs can be hit to bleed but not be lethal?
Jordyn says:
If an artery is hit, bleeding out (exsanguination) can happen very quickly. Like a matter of minutes. So, if you want these people alive, I wouldn’t have the bullet hit any artery. You have several major arteries in your chest (aorta, pulmonary artery, etc) and the brachial artery in your arm that lies under your bicep. A truly severed artery will pump blood out with each heart beat and the bleeding is hard to control. So, I would go for venous bleeding which can also be dangerous but will allow more time and can be easier to stop.
Dee asks: I’d like the character to be in the hospital for a few days. What is the option there?
Jordyn says:
You’d asked what organ could be hit but not be lethal. I would personally go with a lung injury if there is a bullet to the chest/back. The lung could collapse and cause bleeding as well. This would require placement of a chest tube to resolve so they’d be hospitalized for 3-5 days depending on how the lung re-inflated.
Keep in mind, venous bleeding can be deadly as well. If some of the larger veins are hit like the subclavian vein which is up by your clavicle– bleeding could be swift enough if not stopped to cause death. All bleeding can lead to death if it’s not stemmed (either by your blood clotting or by someone applying pressure to keep the blood in place until the blood clots). I once heard a coroner give a talk about a man who was drunk and on Coumadin which is a blood thinner. He dropped a knife onto his foot and happened to cut an artery. Well, in his drunken state, he didn’t realize how serious it was and he bled to death. Sad but true.