Tag Archives: Starke is not a real doctor

Q&A: Honeyed Wounds

I watched The Equalizer recently. Is it really possible, in your opinion, to seal up a gunshot wound with boiling hot honey? McCall does this as a quick patch up so can keep fighting later on. Wouldn’t it just hurt more when he tries to take off the honey to treat the wound?

I’m honestly not sure. I know honey is bacteriostatic, so you can use it as an antibacterial salve on minor wounds. As for actually sealing a wound? Especially one with deep trauma. I’m skeptical. This would be (almost exactly) like trying to treat a gunshot wound with Neosporin. Yeah, it’s great for minor cuts or mild burns, but against a bullet, not so much.

If this is after field surgery to keep the wound from getting infected, it’s a lot more plausible, but not just, “boil and pour it in there.”

My recollection is that boiling honey breaks down the enzymes that make honey bacteriostatic, which is vital to preparing it for fermentation into mead. …but, the internet says I’m wrong, that you can get honey to ferment at room temperature if you cut it with enough water, and that there’s no enzyme function involved.

I suspect that, as with a lot of organic mater, your body can pretty safely absorb it during the healing process. So, getting it out of the wound is a lot less important than you might think. That said, if you do need it out of the wound, you can wash it off, which you need to do when cleaning most wounds.

-Starke

Q&A: Stab Wounds

Hi in my fanfic I’ve just been writing my character dies after having a thrown knife stab her in her side and then ripping it out to kill the other person. Is it feasible that my character dies quickly or will she need help?

Yeah, so, basic first aid. If you’ve been stabbed or impaled, do not remove the foreign object. The exception is if the object is causing more damage by staying there.

This even extends to situations where a character’s been run through on a piece of rebar. They’re better off being cut down and taking the pole with them to the hospital than pulling it out.

Pulling out a knife (or any impaling object) will result in more immediate trauma. It got in there, but pulling it out won’t reliably follow exactly the same path. This is especially true of things like serrated or hooked blades.

So long as the object remains it will still obstruct the bleeding… some. This isn’t going to be enough to save their life, but pulling it out can tip the balance the other way. This is especially true if you end up with a blade nicking an artery, or a blood rich internal organ like the kidneys or liver. You’ll lose some blood, but pulling the blade out can turn things to life threatening very quickly.

-Starke

Q&A: Starke is not a Real Doctor

Starke, as you have reminded us on 24 occasions, you are not a doctor. How then did you manage to build up such a large amount of medical knowledge?

Scouts, family, and research.

I’ll snark on the subject occasionally, but the Boy Scouts do actually force you to learn some intermediate first aid procedures. It never gets into the range of full field surgery, but there’s actually a lot of training that goes into reaching Eagle. Medical, and otherwise. Some basic stuff comes straight from that.

Second, there’s a stupid number of medical professionals in my immediate family. My mother taught pharmacology and substance abuse (diagnosis and treatment) for most of my life growing up, and a lot of that rubbed off. It’s also part of why I have a more solid grasp of drug interactions and effects than basic A&P.

My father was a certified EMT for a few years, and, while less of that rubbed off, he was also one of the people responsible for handling the first aid classes in Scouts, which meant it ended up more advanced than was probably strictly necessary, by the book. My oldest brother is an actual doctor, and, while I’ve never lived with him, I did have the misfortune of being stuck at the table during extensive discussions about his work. Forensic radiology, and later emergency radiology, if anyone’s wondering. Also, as with my father, he’s an Eagle Scout as well, which gets towards the slightly skewed perspective I have of thinking, that the rank, and associated skills aren’t that unusual. Even when they are.

Finally? Research. This is one that’s, technically, open to anyone. It depends on exactly what the question is, but with some stuff, like the intracardiac injection question yesterday, or the malnourished teenager question a while back, I just need to look it up and check. There’s a couple decent medical resources online. WebMD comes to mind, though honestly I use google on the term, and then sort through the responses based on where it’s coming from. The other thing about researching basic medical information is, this stuff is really well documented. It’s not always as accessible as medical professionals think it is. But, it is out there.

Part of the reason for the disclaimer is, since I’ve never had the full range of training, I want that out there. I’m doing the best I can, but it’s not technically my area of expertise, even though I’ve had to learn a lot on the subject.

-Starke

Q&A: No Such Thing as a Safe Gunshot Wound

dogmatix said:

I think what they’re asking is ‘how do I shoot someone without killing them?’ Yes, there is no safe way, but you’re not really explaining WHY. Probably something to do with the possibility of hitting veins/arteries, organs, etc, I’d guess?

That’s the basic gist of it. Also, we have talked about gunshot wounds before; here, and here. We even have a tag on the subject. (It actually manages to make the tag cloud with 12 entries… I should probably switch that to alphabetic sorting for everyone’s convenience.) The short version is that bullets have a nasty habit of doing unexpected things. It’s not exactly random, but there’s way too many variables to predict in the field, meaning any bullet could turn your internal organs into goulash. Even under the best circumstances, any untreated gunshot wound can result in death.

This is before you even get into weirdness like hydrostatic shock, which might not be an actual thing. Though, I do need to expand that tag, and might need to do a more detailed post on it, because I know I’ve talked about it more than once.

-Starke

Q&A: Introcardiac Injection

Can regular needles be used to get a shot to the heart?

You mean an intracardiac injection? No. It requires a longer needle than a normal injection would. It’s also an obsolete technique because there are better, faster, and safer, ways to get medications into someone, that don’t involve stabbing them in the heart and hoping you don’t cause a hemorrhage.

Anyway, as always, I’m not a doctor, and this is something that was certainly never covered in Scouts. So, I could be wrong here.

-Starke

Q&A: Arrow to the Leg

I read somewhere that an arrow to the thigh can kill someone. Is that true? How?

If it severs the femoral artery? That can kill in minutes. Combine that with the fact that arrows excel at cutting tissue apart, and the risk of severing something important is pretty good.

Even if it misses anything major; you’re still pumping a lot of blood through your legs, so without medical attention, bleeding to death is still a real possibility, even if the arrow doesn’t hit anything vital.

-Starke

Q&A: Fourth Degree Burns

My MC’s arm got brunt to the bone in her hand/wrist, to the muscle (and a bit further) to the elbow and to the muscle from her elbow to her shoulder. She lost her nerves from her elbow to her fingers and the feeling comes back from her elbow up. She gets some treatment, mainly just ointments/herbs. She has 2 years until she joins the military. Would that be enough healing time? How would this affect her fighting? She fights in a style similar to tai chi, ninjato and teakowndo, does this matter?

Oh god, I can already tell this would be a nightmare to fully research. What you’re describing is a fourth degree burn… well, technically at least three fourth degree burns, requiring surgery, and possibly, in this case, amputation.

If your character has had enough of their arm burned away to destroy the nerves running down the arm, then everything “south” of the burn will be paralyzed, including her hand. If the burn also destroyed the artery in the arm, which is possible, then the tissue beyond the burn will die and proceed to rot. Technically this is called “tissue necrosis,” or gangrene, but, the reality is far less clinical and more horrifying.

Even if that’s not the case, third and fourth degree burns both carry a pretty serious risk of infection. For someone in a pre-modern setting, without an understanding of bacterial infection, and without access to a sterile operating environment? This is probably a death sentence.

Long term survival for burns like this, usually involve grafting tissue from elsewhere on the body. In that case, arterial grafting is possible today, though I don’t know how old that particular technique is. Muscle and skin grafts have been around for awhile. From what I can tell, nerve grafts are still semi-experimental, the technology is getting there, but it’s still tricky.

But, for a character limited to herbs and ointments? Unless they’re explicitly magical, and you’re in a setting where magic can repair egregious injuries like this? No, that’s how your character died, not a thing that happened to her before she started serving in her military.

-Starke

Character Critique sumbittion: Eleanor

characterandwritinghelp:

  • Name: Eleanor Mark.
  • Age: In this part of the story, starts off as 16 and ends at 21.
  • Gender: Female.

[Pleased to meet you. -H]

Read More

Well, since we got mentioned… say the devil’s name and, “oh, why hello there.”

TW Savaging A Character Concept

(The original post had an actual TW for Abuse)

There’s actually more issues on the drinking, smoking, and generally not eating subject. If you’re fighting, or even just very physically active, you need to eat. That’s just non-negotiable.

We’re talking about a character that might be able to make it about 24 hours without a serious hit of protein before it starts to affect her. By three days, she’s going to be lightheaded after physical exertion, and might actually faint mid-fight.

As a quick guide, malnutrition will result in feelings of lethargy, which will get you killed in a fight. It slows down healing, and makes you more vulnerable to infections. Difficulty concentrating. Depression. Irritability, and difficulty staying warm, though the cigarettes would help with those two.

Staying warm might seem a little weird, but, remember, just like every other mammal, you (and your character) need to burn energy to maintain a constant body temperature. It’s actually a big part of why we have to eat as frequently as we do. If your character isn’t eating, over a period of time, her body will decide that’s less vital than maintaining a pulse, so she’ll have to work harder to stay warm.

And, make no mistake, if she’s not getting enough to eat, she is malnourished. For teenagers, persistent malnutrition can impair bone growth, meaning she’d actually be smaller than she would if she’d just eat a cheap burger every day. 5’10” is possible, but without malnutrition, she would have been huge.

Also, and I’m making an educated guess here, but if she’s suffering injuries that will result in scarring, she’s probably going to suffer a fatal infection long before her 5 years are up. Because her body simply won’t have the resources to fight it off.

Smoking isn’t automatically a deal breaker, but anything over a couple cigarettes a day is going to start cutting into her ability to fight. Now, nicotine does work as an appetite suppressant, but it won’t let her continue going after her body starts shutting down from malnutrition.

A habitual smoker will suffer impaired respiratory functioning, that means, once she starts fighting, she’s going to have to choose between fighting, and breathing.

Seriously, go look up smoking symptoms online. This does not mix with a highly active street fighter.

Also, smoking is expensive, a pack of cigarettes today (well, the last time I checked) is around $4 – $5 a pack, with 20 cigarettes per. If you’re smoking a common brand, a pack a day smoker will be going through roughly $120 to $150 a month. For a runaway on the streets, that is four to five months of burger money.

The problem with alcohol is a little different. When you fight, or are otherwise physically active, you sweat. For most people, this will never be a real issue. They’ll do something, sweat, stop doing the thing, and rehydrate. But, if your character is in prolonged combat, and an alcoholic, this will rapidly turn into dehydration.

So again, the symptoms to keep an eye out for are: weakness, dizziness, confusion, sluggishness, and fainting. As with malnutrition… in a fight those are all going to be an effective death sentence.

Also, because the body will try to generate a fever to deal with an infection, she’ll actually be losing even more moisture from sweating, leading to dehydration.

Some other fun stuff associated with an alcoholic combatant:

Habitual alcoholics develop a form of anemia, they face longer clotting times, and reduced healing. When combined with the malnutrition, your character will bleed for longer, and take a lot longer to heal her wounds. It might not be scars, it might actually be open wounds that just refuse to heal.

The anemia also results in easier busing, so, that will make her even more of a mess.

Dilatation of blood vessels which results in a loss of body heat, when combined with the malnutrition difficulty regulating body temperature… while I’m not sure exactly what would happen, it would be deeply unpleasant.

Alcohol dries out respiratory tissues (the sinuses and lungs), making them more vulnerable to infections, which she can’t fight off, because she’s malnourished.

Muscular atrophy, and myopathy (cramping, muscular pain, muscular degeneration, and weakness.) These are all chronic symptoms.

Two long term symptoms that, I’m not 100% certain of. Amenorreah can result in women skipping their menstrual period. I don’t know what that will do to a teenager. But, it’s just this side of possible she could completely shut down her ovaries. Also, I remember reading that, in a teenager, alcohol induced anemia will impair bone formation, resulting in weaker bones, though, I can’t find anything on the subject at the moment.

And, of course, as we’ve said before, combat takes a toll. I’m in my early thirties and there have been several points in my life where I’ve had to use a cane. My knees are beyond shot, and on a day to day basis I can feel bone on bone grinding. That’s without fighting every day. For someone who’s in constant combat every day, she’s going to be wrecked before she hits 20.

Also, if she’s malnourished, she’s going to slip into depression. That’s just her brain flipping her off and storming out of the room.

Okay, after all that, I almost don’t want to rake over the rest, but, here’s a few quick things:

In the words of Law & Order’s Lenny Briscoe: “You’ve got the flaw of most basically honest people. You’re a lousy liar.”

Honesty and lying don’t really work out well together. Someone from an abusive or dysfunctional family can easily end up as a fantastic (or terrible) liar, but they’re not going to be a basically honest person. For them, the truth becomes something that they’re punished for, so, more often than not, they’ll actually find lying more comfortable than telling the truth.

Car accidents that are severe enough to total a car (and kill someone) suck. Realistically, you’re going to keep finding new aches and pains for about a year. Even when you can walk away with a few scratches.

So, honestly, you probably need to ditch the malnutrition. Even if she’s getting enough to eat, while being highly active, she’s going to feel like she’s starving constantly anyway.

The alcoholism needs to go as well, that just wrecks the body in too many ways. When you combine it with malnutrition, you set up a vicious cycle that will kill your character.

Like I said, smoking isn’t a deal breaker, particularly if she’s scavenging for cigarettes when she can get them. It’s not healthy, but, it’s (ironically) a lesser evil here.

Finally, she can’t fight all the time. Well, she can, but realistically “all the time” means between 2 and 4 fights a week. Anything more than that and her body would just break down too fast for her to stay functional for more than a month.

-Starke

Q&A: Shot in the Leg

what would happen if a character were shot in the thigh? would they die of blood loss or would it depend on where on the thigh the bullet went? also if the character somehow survived, would they be left with a scar or possibly a limp? eventually how long would they be limp (forever)? sorry for my english, and thank you!

If the bullet severs the femoral artery, death would occur within… I want to say two minutes, but it could be as much as five. If the bullet blows through cleanly, and the blood loss is managed, it shouldn’t result in anything more severe than scar tissue at the entrance and exit wounds. If it damages the bone and that’s not treated, or treated incorrectly, it would permanently impair movement (barring corrective surgery).

If the bullet tears up the muscle tissue, and it doesn’t heal properly, I think that would result in permanent mobility issues, but I’m not 100% certain how that would manifest.

Again, I’m not a medical professional; my familiarity with gunshot wounds is academic. So, I could be wrong here.

-Starke

EDIT: I’m going to attach this reblog to the main post because it’s actually really useful, and I did drop the ball a bit last night after tumblr ate my first draft of the entry and exit wounds answer. So, with thanks to Disasterintow.

disasterintow:

Gunshot wounds vary depending on the type of round used, special attributes to the round (hollow point, armor piercing, etc), the distance from the shooter. A normal sized male (6’ 180lb) shot at close range to the thigh with a simple 9mm round would be in a lot of pain, but risks only moderate damage to bone, and supposing the femoral isn’t stuck, the most you would to be dealing is a hopeful through-and-through. That way, as mentioned before the most to be dealt with is stopping the blood flow and stitching up entry and exit wounds (the latter of which will be significantly larger).

Do. Not. Dig. A. Fragmented. Bullet. Out. Unless you are a skilled surgeon, though even these days, a majority of those professionals choose to leave non-life threatening shards inside. Removing the bullet damages muscle tissue, connective tissue, and tears nerves, all of which are needed to counteract the trauma of the initial wound. And you run the risk of more blood loss.

Now, when it comes to larger caliber bullets and shotgun shells, there is a problem with distance. Up close and personal, a .45 caliber handgun round could shatter bone and leave an exit wound the size of a Granny Smith apple. broken bones (shattered ones, at that) have a very high risk of sepsis, and if not dealt with quickly, could spread to the rest of the body.

AP rounds – Armor Piercing – go straight through flesh and have very little sign of slowing. There is risk to bones, however, as the amount of power (force) they carry with them hits full on if it meets a hard structure. The kinetic energy alone can fracture shoulder blades.

As for buck shot and slug for shotguns, those are trickier. They do need to be a certain distance to be effective, but make no mistake: these rounds will break bones and most certainly leave holes in you. Buckshot is pelleted, but deadly in a closer range.

A safe bet would be to say the person was shot by a .40 caliber or lower handgun, or anything around or lower than a .308 rifle round, and that the meat of the thigh took the bullet. If at a decently close range, that person should survive and most likely walk with a little hitch for most of their lives. Nothing too noticeable, however. There would certainly be scarring, and if nothing happened to bone, and no nerves were injured, there should be no loss in range of motion or use.

Q&A: 19th Century Dueling

Any advice for wiring a 1865 duel scene where someone gets shot in the hand, or for a scene of the same period where someone gets shot in the ear through a window? I really love the blog btw

In both cases, post injury infection is a real risk. And, your characters would run a very real risk of dying.

Not that anyone in your setting would know, but; the bullets themselves are clean, the gunshot generates enough heat to sterilize the bullet. However, the bandages used on the wound wouldn’t, and, historically, these were a common vector for bacterial infection.

Hilariously enough, in both cases, medical treatment would actually be more dangerous than the wounds themselves. But, again, and I can’t stress this enough, your characters would not know this.

Alcohol was viewed as an emergency anesthetic, not an antiseptic.

Also, without access to modern surgical techniques, getting shot through the hand could easily result in a permanent crippling injury.

Now, intentionally shooting someone in the hand, with weapons from that era, wouldn’t be impossible, but it would require an improbable degree of marksmanship.

Even with highly accurate, modern handguns, “disabling shots” like that aren’t really viable in combat. The amount of focus and precision required just aren’t available while someone is fighting through an adrenaline rush.

-Starke