Author Question: Bullet Graze Wound Near the Ribs

Ella Asks:

I’m writing a pseudo-novel, and in order to inflict the most possible pain on my character without leaving him entirely incapacitated or even dead, I have a couple questions.

1. Would one be required to go to the hospital for a bullet graze?
2. If one is grazed on the side in roughly the 6th-8th rib area, how much would they bleed?
3. If you were grazed in the 6th-8th rib space, would it be possible that the bullet would fracture a rib?
4. If so, how severely?
5. How would a fractured rib and graze impact basic motor functions?

Jordyn Says:

Hi Ella!

Thanks for sending me your questions.

I think first it’s important to understand what a graze wound is medically— which would be a skin injury without serious underlying injury. The bullet nicked the person and that’s about it. Is it required that the person goes to the hospital? No, I think going to the hospital would be determined by if they could get the bleeding to stop and how extensive the injury is. The smaller the graze the less likely the need for the hospital.

Treatment would be:

1. Apply direct pressure to stop the bleeding.
2. Clean the wound thoroughly– sometimes vigorous flushing with relatively clean water and a touch of something like dish washing soap can be enough if the character is choosing not to go to the hospital. This can reactivate bleeding because the clots are getting washed out as well. After cleaning, apply direct pressure with the cleanest item available (preferably sterile gauze) or a really clean cloth.
3. If the wound edges can come together consider using butterfly closures to close the wound. This might also indicate that the person requires stitches. Sometimes you can apply antibiotic ointment over the butterfly closures to help control infection (something like over-the-counter antibiotic ointment), but keep in mind the oily nature of these ointments will tend to loosen anything with adhesive (like the closures as well).
4. Cover with a bandage.
5. Consider a tetanus shot if it’s been over five years since the last one.

Reasons to consider visiting the ER would be a large wound, unable to control the bleeding, and/or the wound is nicely approximated (and might benefit from stitches to control bleeding and reduce scarring), and to update the character’s tetanus shot. If the character is exhibiting any difficulty breathing this would be another reason for an ER visit.

How much bleeding would occur if the graze was near the 6th to 8th rib? Again, considering a graze wound is mostly a skin injury then applying pressure should be enough to stop the bleeding. Think of this type of wound as a cut or abrasion.

Could a graze wound fracture a rib? Yes, this is possible. How severely? This could be up to you as the author. The fracture could range from a simple fracture (a line is seen through the bone but the bone is stable and the parts stay together) to a type of fracture where the bone breaks apart into small pieces. The more extensive the rib injury, the more extensive the skin injury will likely be (and also increase the chances for internal injury) and could border past a simple graze wound.

A fractured rib and graze wound will have some effect on motor functions— mostly to the upper body. The person should still be able to walk and run but the motions of the arms (while running) will be painful. Fractured ribs are very painful so a person will naturally inhibit motion of the upper body to keep the pain from flaring up so raising the arm on that side while holding a weapon will hurt, but won’t be impossible. Taking deep breaths will be painful so anything that increases a person’s respiratory rate (like running) will hurt. Pain can be treated with over-the-counter pain medication like acetaminophen or ibuprofen particularly if just a simple fracture. Every day the pain should improve and be pretty tolerable in seven to fourteen days. The actual fracture (depending on how complicated) will take four to six weeks to heal.

Hope this answers your questions and best of luck with this story!

Author Question: Gunshot Wounds and Rib Fractures

Shanda Asks:

I have a scene where (in my mind at least) someone very physically fit is shot in the torso as they dive to save another from being shot. They then land excruciatingly hard on the edge of raised concrete (think like the front of an outside step) and break three ribs but that injury goes unnoticed as a result of the gunshot wound.

human-skeleton-163715_1280So my questions are as follows:

1. Would it be possible for someone to pick up the injured and run say a mile or two to get them to where help is waiting?

2. Could it be possible to have surgery for the gunshot would and the rib injuries be missed and hours later cause internal bleeding?

3. What would be the typical recovery time for the first and the latter?

4. Would it be realistic that after the second surgery (for the internal bleeding) the patient could not wake up for days having had two trauma surgeries so close together?

Jordyn Says:

Thanks so much for sending me your questions.

1.  Can someone carry an injured person one to two miles for treatment? It would depend on the physical characteristics of the character who is lifting the other person. Carrying someone one to two miles is a long way. I could possibly imagine a man doing this for an injured female and possibly a very fit male for another male, but a female doing this for a male might be stretching it. It would have to be a very fit female character.

On the other hand, could a character with these injuries get themselves to the hospital? The three cracked ribs are definitely going to slow them down and it also depends on what the gunshot wound has injured which you’re not clear on here. If the gunshot wound deflated a lung then they are going to have a lot of trouble breathing.

2. Could the broken ribs be missed on the first medical exam? Probably no. Any patient with a gunshot wound to the torso is going to get plain x-rays of the chest and probably a CT scan of the chest as well— both of which would show the rib fractures. So in the setting of modern medical care it would almost rise to the level of negligence to miss the rib fractures with a gunshot wound to the torso. I don’t see that happening.

3. To determine your typical recovery time I really need more information on this gunshot wound. Where was the character shot and what was injured specifically? The rib fractures themselves will take 4-6 weeks to heal. Rib fractures are very painful and could inhibit breathing based on their location. Also, successive ribs that are broken in more than one place can create a free floating segment that can be very detrimental to breathing as well.

4. A patient could still develop internal bleeding and need to go back to surgery even if the rib fractures are found right away. This would not be a rare event. It is reasonable for a patient to not wake up for a couple of days if they suffered a code during the second surgery due to extreme blood loss and had flat lined for a period of time.

Even the stress/shock of the surgeries close together might be enough for the brain to check out for a time. The problem with a comatose patient is they have to be in the ICU, on a vent, with a tube in every orifice as they say. For instance, a patient can’t be out cold and have no way to pee— so a catheter has to be placed so the urine can come out.

Going down that road can get very complicated for a novel depending on whose POV you’re telling it from.

Best of luck with your novel!