Author Question: Details for Chest Tube Placement

Rachael Asks:

I’m sure you get questions on this all the time, but I was wondering what insight you can provide on traumatic wounds. My project is science fiction and the characters in question have enhanced healing and a sped up metabolism which I’ve just been using as my cure-all, smooth-over for any inaccuracies thus far. But then I found your blog- which has been incredibly fascinating and entertaining.

The first question I had which led me here was in general for a gunshot wound to the chest though not involving the heart. Namely, the various potential complications, the meds, supplies, or procedures that may be employed, and the sorts of phrases and terminology and reactions that may be overheard from the staff working on the patient. I’ve read on the risks of things like a sucking chest wound and consequential lung collapse, punctured lung, of course blood loss, but I still am at a loss for particularly the things the medical staff on hand would be saying or doing. (Bonus points if you have any tips for the internal monologue for the victim besides “ow.”)

Jordyn Says:

Hi Racheal! Thanks for sending me our question.

Your question is hard to answer. You don’t give specifics of the injury though it looks like you’re leaning toward a collapsed lung. There are a couple of ways you can research the feel of an emergency and that is by watching reality based (non scripted) shows that center on emergency medicine or look for teaching videos (or live videos where they capture the procedure on a real patient on You Tube).

For instance, a patient with a collapsed lung will likely need a chest tube placement. You can search You Tube for “placement of a chest tube” and see what comes up. The below video is pretty good as it gives lots of technical detail on what the physician is doing, seeing, feeling, and even what medicines might be prescribed for the patient. However, it does lack a lot of language of what would be said to the patient during the procedure.

The next video shows more patient interaction and what might be said. Between these two videos you could probably extrapolate together a scene. I will say that typically patients are connected to a larger suction device, but what the below physician is connecting to looks to be a more portable device so the patient can be up and walking. Also, a patient with a tension pneumothorax who is crashing may not receive local anesthesia and may even be unconscious.

Your best option, once the scene is written, is have a medical person who actively is practicing in the field review it. If your scene is written from the POV of the doctor placing the tube, it would need to be more technical versus if you’re writing it from the POV of the patient. You can also search Google for patient experiences of having a chest tube placed to get a feel for the inner dialogue you’re looking for.

Hope this helps and good luck with your story!

Author Question: Law Enforcement Shooting with Vest in Place

Carol Asks:

I have a cop who is involved in a shooting. She’s wearing a vest and is hit outside the vest’s protective area. I need her hospitalized long enough that the shooter (who she killed— they shot simultaneously, more or less) to have been claimed post autopsy. I can’t have her debilitated for months— just a week or two. Where would I shoot her? Hip? Leg seems hard to hit and shoulder does too. I don’t want her disabled, nor do I want a months long rehab.

Jordyn Says:

What I would recommend is a shot coming through the side, under the armpit, causing the lung to collapse. I would pick the right side over the left— there’s just a lot more vasculature on the left that could prove deadly/problematic. If her right arm was raised and she was say . . . turning into the shot . . .  it could leave her vulnerable.

She would have difficulty breathing. How difficult would depend on how quickly the pneumothorax (air moving into the chest and deflating the lung) expanded. She would be transported to the ER via ambulance and receive an IV, oxygen, and vital sign monitoring.

A chest tube would be placed, likely after a quick chest film, unless she is in significant distress to re-expand the lung. If in significant respiratory distress or cardiovascular compromise then she would get a rapid needle decompression to buy some time or some facilities will go straight to chest tube placement. For a “simple” pneumothorax she would be admitted into the hospital (regular floor— not ICU) and observed.

Generally, depending on the size of the pneumothroax, it’s a few days to get the lung to re-expand, a day or two with the tube to “water seal” to make sure it stays up without suction, and then the tube would be removed. Maybe one or two more days after that to make sure all was well.

If she’s young and healthy she should recuperate pretty quickly, but would still be winded, perhaps easily fatigued for another week or two.

Hope this fits your time frame.

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?