Tag Archives: starke is still not a doctor

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

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

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

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

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

If a knife was laying on the ground for a few seconds, and someone was stabbed/cut with it, would it become infected?

From the very specific way you phrased that? Maybe. The injury could become infected, but the whole thing about it being on the ground is kind of a red herring. That is to say, it doesn’t really matter.

Any knife that hasn’t been fully, carefully, cleaned, can be a potential vector for infection. Post injury, clothing, ambient debris, and even improperly sterilized bandages can result in infections.

There’s actually a small irony in that infections for gunshot wounds come from the stuff being forced into the wound after the injury, not from the bullet itself.

Dropping the knife on the ground, getting dirt or grass smeared on it could result in the blade carrying more bacteria, but, unless it was sterilized before the fight, that would already be the case. I’m not sure how the odds work out on it picking up bacteria, but, it kind of doesn’t matter.

Outside of some specific situations, backtracking and figuring out exactly where an infection came from is wasted energy.

So, you have a character that’s stabbed. The wound could become infected. Without access to proper medical care that could kill them. It doesn’t really mater if the knife has been dropped or not. It doesn’t matter if the bacteria came from the knife, or the victim’s shirt, or their own hand, when they grab the wound because, “surprise, you just got stabbed.”

The one time you do need to track down the source of an infection is when it’s a persistent, recurring issue. Cases where you have a colony of legionnaires’ disease or staph in a hospital, for instance. You see patients getting sick from it regularly, but the vector ends up being in the hospital itself. Another example would be commercial food contamination, such as an E. coli outbreak. But, when it’s a single infection, tracking the vector isn’t usually a priority.

-Starke

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

One of my characters gets pinned to the wall via a knife through her hand. But after that, the only treatment she can get in her situation is to stop the bleeding and wrap the wound up. Would she have somehow been able to coax mobility back into the fingers whose connectors(? don’t know the official name haha) in the palm without professional help? And how long would jarring that area cause pain/numbness?

If the blade penetrates between the metacarpal bones, and doesn’t displace them, then wrapping it will work as emergency first aid… provided she’s getting more help later on. Also, the knife, bandage, and possibly the wall, are all potential vectors for infection, so she’s going to need to treat her bandage with an antiseptic.

Generally speaking, ligaments connect bones to one another, while tendons connect muscles to bone. Severing or tearing either of those is a permanent injury that will require surgery to repair. Though, just taking a knife through the palm (between the metacarpal bones) won’t necessarily nick one.

If I recall correctly there is a string of tendons (juncturae tendinum) that bridge the second through fifth metacarpals for each finger, and that could be injured, but it might be possible to actually miss it, depending on the size and placement of the blade. It can also result in some truly disturbing looking injuries, if torn.

A tendon or ligament injury isn’t one you can just walk off. Anyone who’s experienced a sprained ankle first hand can tell you that. If they’re torn, you can’t “coax mobility” into it. This would be like trying to get a door working after you pulled the pins from the hinges. The pieces are still there, but they aren’t mechanically connected the way they need to be.

…seriously, don’t google these kinds of injuries unless you have a strong stomach or a high tolerance for really disturbing looking hands.

That said, the injuries that are likely to tear ligaments, would also probably amputate the finger, at least partially. So this is a somewhat less likely outcome, unless the blade connects across a knuckle. Fortunately, (thought, it might not feel like it at the time) fingers are one of those very rare cases where you’ve got convenient spares available.

With knife injuries, it’s usually a good idea to avoid moving and stressing the wound. It’s possible to cause more damage. This is also true of bone fractures (which is a real possibility if you’ve just taken a knife through the hand). Also, in a similar vein, if you’ve been stabbed, pulling the knife out is usually a bad idea, because it will further aggravate the wound and result in increased bleeding. (There are situations where this isn’t the case, such as where the blade is interfering with applying aid, but those are the exceptions, not the rule.)

Where I’ve experienced issues, fighting to get finger mobility back, has actually been in staff training. Blows to the knuckles are unavoidable. The staff creates a rough structure that (partially) protects against breaking your fingers when struck, but it does nothing for the bruising, which makes moving them after getting hit, much harder. Also it hurts like hell. Your hands provide absolutely critical tactile information to the brain, unfortunately, this remains true when the information being fed back is how much that hurt.

The stiffness lasts for a few minutes, and it’s actually something you can acclimate to from experience. The pain lasts a bit longer, I want to say 15-30 minutes, but I never actually timed it, and it’s been nearly 20 years since the last time I had someone clock my knuckles with a staff.

A similar injury could be suffered if your character is holding onto a ladder, pipe, or even a D-Cell Maglight, and takes a blow to the hand hard enough to raise a bruise.

-Starke

Hi! Sorry if this is a dumb question but I have a character who is shot at, her head being grazed by the bullet. In order for that to happen as realistically as possible, what would the circumstances have to be? Does the gunshot have to come from a distance? Would she lose consciousness? Would there be lots of blood? What kind of wound would she have and how would it get treated after? That’s more than one question haha. Any information would be of great help!

The circumstances would have to be that the bullet missed. It’s not really any more complicated than that. You put a round in the general vicinity of someone, and didn’t quite connect, but you still tore up some tissue on the way through.

This can just be the result of poor aim, situations where a character is just pointing a gun rather than actually aiming it. Though, someone who doesn’t know what they’re doing and is trying to aim could also result in a glancing blow. Or, if both the shooter and the victim are moving, then hitting a target accurately is a lot harder, and a glancing blow like that is certainly possible. I don’t want to say, “more likely,” because it’s not really a common outcome.

There’s a slightly rarer situation where a shot directed at the head will skate across the skull, it’s one of those “the world is a weird place sometimes” kind of fluke things, but it does happen, rarely.

Range only makes a glancing shot less likely, but it also reduces the chances of getting hit, so, not really a concern.

In general, she probably wouldn’t lose consciousness. At least not from blood loss. Having a panic attack because someone just shot her in across the head isn’t out of the question.

Honestly, I’m not certain about how much blood. Glancing wounds will result in a disproportionate amount of blood for the severity of the wound, but it shouldn’t be life threatening. So, someplace between, “more than you want to see,” and, “not enough to kill you.”

It’s also worth pointing out that this kind of injury is rare enough that my writer’s guide to forensics has nothing on the subject, so I’m kind of flying blind here.

This probably would result in a long, shallow gash and not much else, which means it would need to be treated like any minor open wound. That is to say: disinfect (with peroxide, or alcohol), staunch the bleeding with gauze (ideally with antiseptic ointment added to the bandages, once treatment gets that far), and if the bleeding persists, get someone to sew your character up.

If this happens to you? Go to the ER. This is about as non-lethal as gunshot wounds get, but that doesn’t mean you should mess around with it, also douse whatever you cram in there with either alcohol or peroxide first, you do not want to mess with an infection if you don’t have to, and impromptu bandages are as good a vector as anything.

If the bullet takes off her ear, or part of it, that would probably require reconstructive surgery. Even if it doesn’t, she’ll probably end up with a nasty scar as a result.

Sorry, the wound info is a little more speculative than I’d like, but I don’t have anything solid on hand, so I’m having to do it mostly off the top of my head… so to speak.

-Starke

This may seem a silly question, but I can’t find my answer through online searches. When someone breaks their back (spinal cord broken), will they still be able to scream? Pain-wise, what does someone feel, if anything? My character is healed with magic, but between the time his back is broken and he’s healed is what I’m having problems with figuring out…. I’d prefer this be answered privately, but if you feel this may help someone else, I don’t mind it being publicly answered.

This is actually going to need to be public, because, I’m not a doctor, so there’s a higher chance of me screwing up the medical questions, which means having someone who’s more familiar with the subject checking our work is a bonus.

In general we don’t do private answers beyond a paragraph or two, simply because if the information has the potential of being useful to more than just the person writing the ask. Especially with stuff like this, where it’s not just you.

Also, again, the major disclaimer is, damage to the nervous system is a little more advanced than any of the actual first aid training I got in Scouts.

The basic idea is your nervous system is the means your brain has for relaying information and instruction to your body and back. When you damage it, the information just stops going (both ways). You can no longer instruct parts of your body to function, and they can’t feed back any sensory information. All of this kind of “flows downstream,” so, if you sever the spinal column, everything past that is just gone.

This manifests as numbness, rather than specific pain. This is where the, “I can’t feel my legs/arms/whatever” cliche actually applies. Nerves can get nicked, I knew someone that had a nerve in his arm damaged by an Emerald Tree Boa. The resulting injury left him with a numb patch in the center of his palm.

The brain can interpret no nerve data as painful. However, this tends to happen with phantom limb syndrome, rather than just nerve damage. If you can actually look at the affected area, and confirm that no, nothing’s gone horribly wrong, then the pain dissipates.

But, again, this one’s a little outside my area of expertise, so I could be wrong here.

-Starke