Bullet

Virginia Asks:

I’m putting the final touches on a romantic suspense novel in which my hero is shot. The most important part of this is that he has to continue to function until he saves the day, then falls and has to be treated. The wound cannot be bad enough that he can’t pass the physical and qualify to become an FBI agent within a few weeks.

My fit male character (34 years old) is in a shootout. He’s shot with a 9mm handgun but the bullet ricochets, grazes his chest, and fractures a rib. He doesn’t notice initially. He begins to feel some pain after about five minutes. Then feels woozy and has a head rush. I want him to fall after the action is over, but be able to talk a little with some struggling.

He’s far from a hospital when he’s shot, but a military medic is there with his kit. The hero can be medevaced to a hospital on a military helicopter. What would the medic do in the field? I don’t want the bullet to penetrate the chest wall, but would the medic check for pneumothorax and if so how?

What would happen at the hospital? How long would he be hospitalized?

I’ve read and re-read about pneumothorax and hemopneumothorax, but think that might require too much recovery time and be too much for him to qualify and be able to pass the physical. I’ve done some research on pulmonary contusion but am a bit overwhelmed with the possibilities of the use of continuous positive airway pressure and high-frequency chest wall oscillation. And the long term recovery.

Since I really don’t know what would be best as a gunshot wound that my hero can recover from and pass a physical in a few weeks, I really need some guidance and specific information that can easily be explained in a romantic suspense novel. I’m hoping this “bullet grazes the rib” scenario is workable. If not, what should I consider instead?

Jordyn Says:

Thanks so much for sending me your question, Virginia.

I think the simplest thing to do is to have the bullet graze his chest. It could potentially hit the rib, break it, and ricochet away. Leaving a nasty gash with a broken rib underlying but nothing else injured. Generally, a fractured rib will heal in 4-6 weeks so he will have pain and limited movement until then. The worst pain will probably be in the first 1-2 weeks and then should taper off after that.

As far as the military medic assisting off duty. I think it’s fine if he has a small first aid kit that he could dress the wound with. He likely would not be carrying an oxygen tank, etc. So the dressing to control bleeding is necessary. Lots of emergency medical types might have a small kit in their car (I do), but not an oxygen tank or a way to deliver oxygen to the patient.

The military medic could check for a pneumothorax by listening to your hero’s breath sounds. Clear and equal breath sounds bilaterally generally indicate no pneumo (though a small one could still be present). It will hurt to take deep breaths if his rib is fractured.

If he’s transported by a military medevac then they could start oxygen, an IV, and give some IV fluids. Place him on a monitor to keep tabs on his heart rate, breathing, oxygen levels, and blood pressure.

In the hospital, he’ll get chest and belly films and possibly a CT of his chest and abdomen. If it seems like a fairly benign wound, the wound could just be irrigated with a lot of saline and sutured closed. He needs an updated tetanus shot if he hasn’t had one in over five years.

If his breathing is good and he suffers just one cracked rib, there is likely not enough injury criteria for him to be admitted into the hospital. He’d likely be observed in the ER for several hours to make sure everything is okay. He’d be sent home with a short course of narcotics (like three days) and instructed to take over the counter pain relievers to help with the pain as well. He should have limited activity but not be bedridden. He’d be encouraged to take deep breaths (usually at every commercial break if watching TV) to prevent lung complications because patients don’t like to breathe deep when they have a cracked rib.

Hope this helps and good luck with your story!

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_1920 Cop, 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.

You 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!