Q&A: Shot in the Leg

So I read your post on gunshot wounds to the leg and it was very helpful, but what I’m looking for is a little more specific. My character gets shot in the leg, clean, nothing major hit. The wound is bandaged. But immediately after she gets shot, she passes out and isnt aware of anything. Is that believable? If the wound was bandaged right away, would she survive being carried for an hour before even reaching the hospital?

So, what caused her to pass out?

There’s nothing wrong with being able to survive for hours after taking a bullet if it didn’t hit anything vital. Some gunshot wounds can take a long time to kill you. Bandaging it is a good idea, because it will slow the blood loss.

Blood loss can result in losing consciousness. You lose a lot of blood, go into hypovolemic shock, lose consciousness, and bleed to death. If a patient loses consciousness shortly after suffering a gunshot wound, that tells you to look for serious blood loss. You may want to double check and make sure you didn’t miss any internal hemorrhaging.

You know will not cause you to pass out? The pain from getting shot. I feel like I’ve written this recently, but pain does not make you lose consciousness. Pain will keep you awake. While I’m a little less confident of this, I’m pretty sure getting shot will keep you awake. Even if the pain doesn’t, the adrenaline will.

If someone gets shot and passes out, they’re losing blood fast. You lose consciousness when you’re down ~20% of the blood in your body. You die when you lose between 30% and 40%. Napkin math says, if someone gets shot, and it takes 30 minutes for them pass out from blood loss, you’ve got a bit less than 15 to 30 minutes before they’re dead.

So, you have a character who gets shot. Their leg gets bandaged, but they lose consciousness within five minutes of the wound, they’re not going to survive for an hour without medical attention. Even if it takes two hours for them to lose consciousness, taking another hour to get them to a hospital would be an extremely risky decision.

Now, if they’re semi-conscious for most of the ride. Say, the first 50 minutes, and lose consciousness about 10 minutes out, it’s going to be touch and go, they’ve still lost a lot of blood, but that is survivable. If they pass out ten minutes earlier, it’s distinctly possible they’ll be dead on arrival.

If she’s being carried by hand, that carries extra risks because it could aggravate the wound and accelerate blood loss. Especially if they’re carrying her with the gunshot wound at a lower elevation than the heart. The ideal situation would be to lay her out on a vehicle’s bench or a stretcher, with the injured leg elevated above the heart. If you’re bleeding to death, don’t let gravity help finish the job, make your heart work to kill you. It will buy you time.

Also, hand carrying another human being for that long will be exhausting. It’s not impossible, but unless someone’s in excellent physical condition, they might not be able to carry her the distance, and shuffling her between carriers runs the risk of aggravating her wound, making things worse. This is less of an issue if they’ve got her on a stretcher or some other kind of stable platform.

Now, it’s possible she lost consciousness due to some other factor, but I can’t think of any off-hand, that would improve her odds for her survival.

If she lost consciousness shortly after getting shot in the leg, it’s a very bad sign. She’s probably losing blood much faster than anyone realized and would be dead in minutes. My suspicion would be an arterial bleed, which can be managed to a degree by keeping pressure on the artery to reduce blood loss. However, we’re talking about a character having to shove their finger into her wound to stop the bleeding (which requires some fairly specific anatomical knowledge.) Given how fast she lost consciousness, I’m pessimistic about it buying more than a few minutes without serious medical attention.

So, is it believable? No. It’s entirely believable she’d remain conscious, going into shock. It’s entirely believable she’d lose consciousness shortly after the injury, and die a few minutes later. Unfortunately, it’s one or the other.

If she’s bleeding out, her initial symptoms would include a headache, vertigo, nausea, and increased perspiration. These aren’t particularly worrying. She’s loosing blood, but she’ll probably live. However, over time, she’d start manifesting more serious symptoms. These include losing body temperature (and feeling cold), starting to suffer from impaired cognitive function, particularly confusion. Her skin would become cold and clammy, and would get paler as blood pressure dropped. Her pulse would get faster and weaker, also as her pressure dropped. It would become harder for her to remain conscious. Eventually, she would lose consciousness. The faster these symptoms manifest, particularly the more severe ones, the more dire the situation. If she’s going straight to passing out, and help is an hour away, she’s already dead.

I’m sorry, but if she drops after the firefight, you just killed your character.

-Starke

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