Author Question: Multiple Survivable Stab Wounds

Joseph Asks:

I am writing a story inspired by the Saw franchise in which a man is forced to stab himself with three Swiss army knives. The knives will remain in. For the best chance of survival, should all the stabs be in the lower abdomen, or also bladder and/or hands/forearms?

I’ve heard the hands, forearms and lower abdomen are the three safest places to survive a stabbing, although of course technically there is no safe place, but those three areas avoid major organs/arteries/blood vessels. Though I’ve also heard stab wounds to the extremities i.e. hands can cause lasting disabilities. Where should he stab himself and how long until he is expected to die? He will be able to call an ambulance immediately, and maybe could use some cloths nearby to help put pressure on the wounds, assuming the pain is not debilitating.

Jordyn Says:

Hi Joseph!

Thanks for sending me your question.

I would agree with most of your assumptions as far as the extremities in general and the lower abdomen. You don’t include the legs. I think another relatively *safe* area would be the front of the thigh into the muscle or the back of the calf. Anywhere in the extremities where there is a large muscle mass. You could browse anatomy pictures of the extremities looking for diagrams of where the arteries are located to make sure you avoid them.

The lower abdomen is a good choice as well for suvivability. The problem can be puncturing the intestines and spilling gastric contents into the the abdominal cavity. If this happens, this can set up infection and sepsis though this would take a couple of days. You mention in your question that your character will be able to call for an ambulance immediately, not sure if that’s what you intended to say, as a delay in calling for an ambulance would definitely increase the conflict in your story.

Next to bleeding out, developing infection and sepsis would be the greatest risk of death for this character, but would likely take 2-3 days to develop.

Any stab wound to the hands or feet could be a set up for a life long debilitating injury. Many of these can be repaired, but I personally ruptured a tendon in my hand over twenty years ago and have limited range of motion to that thumb. The decision to make as the author is what, if any, long lasting effects you want the character to suffer.

Hope this helps and best of luck with you novel!

 

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: Stab Wound

Sandi Asks:

Where can you place a stab wound that wouldn’t instantly kill your character, but keep him around for a few hours?

diagnosis-1476620_1920-1Jordyn Says:

You have a couple of options here. One would be a stab wound into the right side of the chest. This could partially collapse a lung and cause some bleeding as well. Think of the lung as a balloon. A small nick to the lung could cause it to slowly leak air into the chest, keeping the character alive for a few hours, but killing him in the end if the collapsed lung isn’t treated. The more collapsed the lung is, the less it is able to function. The more air that accumulates in the chest, the more it will push other structures.

We call this a tension pneumothorax.

Imagine the right chest is now full of air. Air will keep building unless it is given a way out (like a chest tube) and can actually squish the heart and lungs on the other side of the chest to the point where the heart may not beat anymore.

If a tension pneumothorax is left untreated, this will cause the patient to die. They may die from blood loss, or low oxygen levels, or from the heart being impinged to the point where it can no longer beat.

Why not a stab wound to the left chest? This has an increased chance to kill instantly because you have the heart and several large blood vessels that come off the heart that sit there. Can anyone say aorta?

Another option would be to have a stab wound to the belly. All sorts of stuff in there. If you wanted the character to die in a few hours, this could happen from untreated bleeding. There are two organs that sit in your abdomen that have a rich blood supply— the spleen and the liver. The medical term is highly vascularized . . . meaning rich with blood supply. You could also have an infection set in and this could keep him alive for a couple of days until he is overwhelmed by sepsis.

What signs and symptoms would a patient with a collapsed lung (pneumothorax) have? What’s the difference between and sign and symptom?