Gut Wounds and Bleeding to Death

Hello! Thanks for running this (very helpful) blog! So, if a character was to loose a decent ammount of blood (enough to make them loose conciousness, etc, but not actually die.) what would the recovery process for that look like? How long would they be unconcious? How soon would they be able to stand/move? The character in quesion is very physically fit, and the blood loss was due to a wound in the side/abdomen area via a sword, if that is relavent. Thanks for answering!

Probably never, barring necromancy.

So, loss of consciousness from blood loss usually means you’ve lost over two liters of blood. That’s about 40% of the blood in your body. If you’re loosing blood fast enough to pass out, chances are, without immediate medical attention, you’re going to die.

Getting stabbed in the abdomen in a really bad wound. There’s a lot of organs in there that are simultaneously vital for keeping you alive and healthy, but also exceptionally adept at killing you when abused. Your kidneys and liver are basically large repositories of blood waiting to end your life from internal hemorrhaging. Your intestines are just waiting to put you into septic shock and kill you if they’re nicked by a blade. Your stomach is something you really don’t want to see ruptured.

Lower abdominal wounds aren’t just really dangerous, they’re actually pretty nasty and graphic. This is a lot of stuff you do not want to damage. And will require some pretty advanced surgery to survive and recover.

So, stepping away from that for a moment, if a character suffers a wound, and is bleeding severely enough for them to lose consciousness at a relatively rapid pace, it will kill them. As mentioned earlier, losing more than about 2 liters will cause you to lose consciousness, but fatal bloodloss ranges from 2.5L to 4L lost (depending on the individual.) At best, they lost consciousness half-way to dying, and they will bleed out in roughly the same amount of time.

There’s some potential situations, where the victim is able to seal off a wound in the field before passing out. For example, if they stabbed through the arm and had been losing blood, but had the presence of mind to cauterize the wound before losing consciousness, they might recover. (Though, this wouldn’t apply to an abdominal wound.)

Multiple (relatively) minor wounds might be able clot, saving their life, even if the cumulative bloodloss would have been fatal eventually. This is especially true if they lose consciousness some time after the injuries. However, this is a somewhat artificial situation, because the character would need to lose enough blood to go into hypovolemic shock, while also managing the rate of bloodloss carefully enough as to avoid killing them. It could happen, I’m almost positive that it has happened, but engineering that situation is tricky.

Beyond that, it’s worth remembering that hypovolemic shock is actually pretty debilitating long before you lose consciousness, slip into a coma and die.

(Keep in mind, these are modern medical terms and wouldn’t apply in a fantasy setting.) Hypovolemia is grouped into 4 stages.

Stage 1 is up to 750mL lost. The victim will appear pale, but otherwise they’re fin. They may feel terrible, and drained, but this is the stage where they’re still functional.

Stage 2 is 750-1500mL, at this point the victim will start to experience anxiety, and they will start to experience mild tachycardia, and their respiration will increase.

Stage 3 is from 1500mL to 2L, and at this point the victim will start suffering serious cognitive impairment, they’ll be confused, their heart rate will be roughly double what it should be, their respiration rate will be significantly increased.

With Stage 4, loss of consciousness, coma, death. Technically, you can be in stage 4 without losing consciousness. Though the mental state is not great. There’s also more severe tachycardia, their skin may appear mottled (with some patches appearing completely drained of blood), breathing will be very rapid and shallow. This is someone who is dying and you can see it.

If you are losing a lot of blood, and you lose consciousness, it’s over, you’re dead. As a result, your body does everything it can to delay that from happening. Even by Stage 2, you’re not going to be in fighting shape. You can’t just keep fighting through that much bloodloss.

When it comes to recovery, there is a trick. Your body can produce plasma pretty quickly. You can recover the loss of 2L of blood in 24 to 48 hours, sort of. The problem is that your body is only producing plasma to bring the volume back up. Actually replacing the lost blood will take a lot longer. Probably 4 to 8 weeks, depending on the individual.

I’m not 100% sure what the symptoms would be for someone having that much plasma in their circulatory system. It wouldn’t be life threatening, but would be unpleasant. I’m pretty sure fatigue, headaches, visual and auditory hallucinations are on the table, but I’d need to do a lot more digging into this specific situation to be completely certain. Regardless, symptoms would drop off pretty quickly over the weeks as their blood plasma levels evened out.

-Starke

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