Author Question: Stab Wound to the Lower Abdomen

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.

Author Question: Stab Wound to the Abdomen in a Young Girl

Loinnir Asks:

There’s a scene in my story where one of the main characters, a short and slightly underweight 13 year old, is stabbed in the abdomen (I was thinking the epigastric region) with a 4-5 inch blade which is almost immediately ripped out by the perpetrator. Around 25-30 minutes pass before she arrives at the hospital (she is transported by car, not an ambulance as the witnesses don’t have any way to call one).

So, I was wondering how likely she is to survive, the type of treatment and expected length of recovery, and what would the protocol be for the witnesses (her five friends, all minors)?

Jordyn Says:

Thanks for sending me your question.

I think the biggest risk in an underweight (thin child) being stabbed with a 4-5 inch blade (which is fairly long) in the epigastric region is hitting the descending aorta (or one of the large veins). Particularly if the blade is pulled out, there would be little to stem the bleeding. Of course, it would depend on the angle and depth of the blade but this would be one of the more concerning injuries. If the blade is angled up, you could also hit the diaphragm, a lung, and possibly the heart. Angle the blade to the side and you have the spleen on the left and the liver on the right.

Biggest risk of death for this victim would be hemorrhage. Considering she is being transported by car versus ambulance, she would die in just a few minutes if her descending aorta or heart were hit. A lung injury could be survivable if care is given within thirty minutes depending on how much of the lung is deflated.

If you want her to live, I would also avoid hitting the liver or spleen on either side as she would bleed to death before getting to the hospital.

Getting stabbed in this area could also injure the small intestine. This is probably the more survivable injury. It would require surgical repair and a short hospital stay if the surgery went well and there was no other damage. They would have to ensure her bowels were working, she was passing gas, and could tolerate food and fluids before discharging home.

Medical treatment in the ER for a stab wound would be a set of vital signs, continuous monitoring of ECG, oxygen levels, and breathing. IV placement (likely two—one in each arm in the antecubital space), normal saline fluid boluses, labs (particularly those that measure blood levels and organ function of the abdomen) and blood if needed. They’ll check her urine for blood and if she’s menstruating she will get a pregnancy test. She would likely get x-rays of her chest and abdomen as well as a CT scan of her abdomen checking for injuries. Antibiotics would likely be warranted if her intestine had been perforated. Then to the OR to repair any injuries.

I’m not sure what you’re asking as far as the five minor witnesses. I checked with my brother who works in law enforcement and he said there are no legal issues in interviewing a juvenile witness. If your question is concerning medical care, I don’t see a reason for these kids to be evaluated if they are uninjured. At the scene, they would likely be held until parents arrived to pick them up.

Best of luck with this novel.

Author Question: Gunshot Wound to the Torso

Heather Asks:

If my hero gets shot in the torso, is there somewhere it can hit that won’t be fatal? It can be a “miraculous” miss, that kind of thing. He can be weakened and bleeding, but I just need him to stay conscious for maybe five to ten minutes after? Any ideas?

Jordyn Says:

Sure, there are always miracles.

In medicine we view the torso as including the chest and abdomen. Generally the diaphragm is the dividing line between the two. So the chest is everything above the diaphragm and the abdomen is everything below it.

Gunshot wounds to the chest not hitting anything is tough. Think about everything that’s there. The heart, lungs, major vessels and arteries. Can a bullet pass through and miss everything— or hit something less minor and just cause bleeding? Sure. Anything is possible. I would recommend staying away from the left side of the chest for the wound— just so much there. The right chest and lower might be more believable because it’s just the lung sitting there. There are major blood vessels that underline each rib so nicking one of those could cause the bleeding you want. Hit outside or inside enough and you could miss the lung.

Abdominal wounds could go either way. A lot to hit in the belly as well, but also good odds for missing. If he’s wearing a bullet proof vest, you could have the bullet enter through his side and low– just under the lung and diaphragm. Problem is you have highly vascular organs on either side– the liver on the right and the spleen on the left. So, I’d aim below that as well or merely have them be grazing wounds to these organs. This could also cause significant, but survivable bleeding.

Hope this helps and happy writing!

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!