I is for information
Feb. 25th, 2013 11:49 am![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
snowynightDisclamier: I don't have a medical background. What I know about medicine I know from Internet research.
Injuries and illness are very important, if not essential to include in a hurt/comfort story, but what happens when you want to hurt your characters, while you don't have a medical background to figure out which bone and nerves may be affected by the gunshot wounds they so beautifully endure for your plot's sake? While the degree of realism in your story's canon may not coincide with that in real life (See: CSI science), it won't hurt to get solid information so you can make an informed choice in this matter. This's an attempt to create a cheat sheet out of the questions and answers about medical issues on the fact finding community on livejournal:![[livejournal.com profile]](https://www.dreamwidth.org/img/external/lj-community.gif)
little_details . Some are direct quote from the answers.
General information about injury
Despite how much it being a cliche, infection and blood loss can and do kill people, especially when your injured person doesn't receive quick medical assistance. "It's just a flesh wound" trope unfortunately doesn't apply in real life.
Extensive bruising is not good news
Bites
Infection from canine bites starts in 24-48 hours, generally. In 24, it would be getting red, more painful. In 48 hours he ought to have grayish discharge (from Pasteurella - most common canine bite pathogen), lots of surrounding redness/streaking, and fever. If he gets significant infection, he's going to be pretty sick-feeling. Many dog bites (especially if washed well) don't get infected, but if the person involved is sicker than the example listed, he'd be likely to become very ill for several days, could honestly even die of it.
Bullet wounds
Gunshot wounds by definition are serious. There're a surprisingly large number of bones, blood vessels and nerves to be affected by a gun shot. Contrary to popular belief, getting shot in the shoulder can screw you up badly. Don't expect getting up several hours after getting shot.
However, there're a lot of places that you can shoot without causing instant death to your victims: the stomach, the lungs, feet, knees, hands, shoulders, probably the lower leg, the upper leg if you don't hit an artery, the arms, the groin. People can survive from amazingly a lot of things. Shock can finally kill you though. Bleeding is the big problem. Getting the bullet out is not (Yeah, a lot of people survive fine with bullets in their bodies, and no, the police can't require the surgeons to get the bullets out during an operation for evidence)
Bullets these days are made to tumble and compress inside the body to increase damage (and ostensibly to prevent the bullet from harming anyone else hapless enough to be behind the intended target, as it usually becomes lodged somewhere inside the body). With that said, through and through wounds are often not as life-threatening as those that get deformed inside the body and displace more energy into the organs. Of course, that's true no matter what course the bullet takes, but surrounding tissue is often damaged more in the case of one that tumbles and deforms. Of course, the caliber of the bullet will also matter, as will distance between the gun and the victim.
Bullets grazing can still cost an eye, ear, finger, toe, nose, nipple or have major damage to genitals.
Burn
Acid burn is burn. Unless skin loss is very bad it can probably be handled without skin grafts. - unless it's hydrofluoric acid, which is a lot nastier and you need aggressive medical treatment (up to and including amputation) to prevent serious poisoning. In order of severity concentrate sulphuric comes say second to hydrofluoric, but it's still pretty serious. After that there's hydrochloric and nitric, neither quite as bad, and after that the organic acids which are weaker but a lot more variable in their effects - some people are VERY allergic to e.g. formic acid, for example. Hydrofluoric acid is extremely dangerous to life but it has nothing to do with being caustic to flesh (it isn't, really). It's a chemical with incredibly low percutaneous (through the skin) toxicity due to its ability to rapidly diffuse through flesh and into the bloodstream.
Everyone heals differently, and every body reacts differently to procedures such as grafting. That said, even with grafts, any of your character could (and probably would) have visible/noticeable scars.
About residual pain: If the grafts are successful and heal well without complications, they would very likely experience a return of subdermal sensation in the affected areas, while potentially having a loss of sensation in the surface scar tissue. If the burns were bad enough to damage muscle, and they didn't heal well, or were never able to be repaired completely, that could be causing him pain.
Broken Bones
If you have broken ribs and a punctured lung, anything strenuous (yes, including penetrative sex) would be out in an approximately six week window, but blow jobs or hand jobs are not out, fortunately.
Compound fractures (especially if they involve the bones rupturing the skin or splintering in a manner that could cause damage to the arteries in the legs) are nasty. Simple bone fracture can do the job too. Don't ignore them.
Coma
People may emerge from a coma with a combination of physical, intellectual and psychological difficulties that need special attention. Recovery usually occurs gradually—patients acquire more and more ability to respond. Some patients never progress beyond very basic responses, but many recover full awareness. Regaining consciousness is not instant: in the first days, patients are only awake for a few minutes, and duration of time awake gradually increases. This is unlike the situation in many movies where people who awake from comas are instantly able to continue their normal lives. In reality, the coma patient awakes sometimes in a profound state of confusion, not knowing how they got there and sometimes suffering from dysarthria, the inability to articulate any speech, and with many other disabilities.
Head Injury
Concussion Is a brain injury/trauma. Particularly a bad one. Effects can last for weeks or months if not indeed permanently. See this link for information about rehabilitation
Hypothermia
Bringing the body temperature up is a very slow process, done by placing warm packs or warmed towels in the armpits and the groin. The patient must be warmed from the core to the extremities, not the other way around. This has to be done super slowly and monitored very carefully, because the body responds to hypothermia by slowing the exchange of blood from the extremities to the core, essentially keeping the cold away from the important internal organs. If the cold blood comes back in too quickly it can stop the heart, so the patient's cardiac status has to be very closely watched as well.
Near Drowning
Except in rare circumstances, drowning people are physiologically unable to call out for help. They also cannot stop drowning and perform voluntary movements such as waving for help, moving toward a rescuer, or reaching out for a piece of rescue equipment.
Water disrupt the critical gas exchange that goes on in the lungs, usually with long-lasting effects--assuming the person survives to be released from the hospital. Patients almost invariably end up on a ventilator for some time, often with a tracheostom. Another common problem is the effects on the brain from lack of oxygen, which can be even more devastating. Either way, recovery isn't as simple as someone relaxing on a couch and watching some television while they get stronger. There can be rehabilitation and there will probably be frequent doctors' visits. And the person will probably never be able to get back to previous levels of cardiopulmonary stamina.
Poisoning
For snake bites, anti-venoms have to applied very soon after the injection of venoms. Otherwise it'll be useless.
Gastric stress is the main symptom of arsenic poisoning. One modern treatment is drinking milk.
Poisons in real life acts slow~ Expect at least hours for it to work.
Full anaphylaxis is terrifying, especially the first time it happens, and you never want it to happen again. Psychological effects are huge.
Stab wounds
General rule: Muscle will recover fairly quickly. nerves could cause permanent damage. Femoral artery would kill very rapidly.
Hand injury: Swelling will be painful and damage function for a while (a lot at first, less over the next week or two). Long-term damage could include numbness, finger weakness, finger spasms or the hand permanently curled up or unable to form a fist...or a complete recovery. A hand is a complicated thing.
Spinal injury: Stab wounds that "missed" the spine could hit nerves just after they emerge from the spinal cord, and could cause more complex motor function and sensation issues. In such case, the survivor's legs might be unable to move, but she could still have partial function or sensation in other ways.
Stomach wounds: Nasty, nasty. It is not required that the survivor die. Depending on where in the abdomen it goes through, it can hit, or miss quite a few organs. But serious infections, including blood poisoning, tetnus, diptheria are lethal without quick application of antibiotics, or even with that.The survivor could have nothing but a scar or all the way to a permanent bag collecting her waste - if a significant portion of her intestine gets necrotic and has to be removed.
Punctured lungs: A collapsed lung in itself is not necessarily fatal, provided it only happens to one of them, losing both might make it difficult to breath. What will kill is when the chest cavity fills with blood courtesy of a stab wound or internal bleeding and is not treated. There is one aspect of a collapsed lung/sucking wound injury which could cause death, and involves only a single lung being involved. It is called a tension pneumothorax, results when the chest cavity is punctured and a lung totally collapses on that side. The shift in internal pressures involved, while not high, is significant. A tension pneumothorax causes everything to shift away from the side of the injury and collapsed lung, placing tension on all the internal structures and compressing the middle section, the mediastinum. That compression causes both a tourniquet effect on the aorta and vena cava, and tamponade or compression that interferes with the heart beating.
This is successfully treated with a chest tube, to remove the air or blood from the affected side
Limb loss
Phantom pains (and non-painful feeling too) are very common. For some people this is very painful and is treated as neurological pain. Rehab specialists will work with him to retrain his brain in hospital, which helps a lot of people, especially younger people.
Stump sensitivity and infections are also common, so the survivor won't probably wear the limb all day every day to reduce this risk.
Further reading:
Body Trauma: A Writer's Guide to Wounds and Injuries
http://www.amazon.com/Body-Trauma-Write
Armed and Dangerous: A Writer's Guide to Weapons
http://www.amazon.com/Armed-Dangerous-W
Jim MacDonald's "Trauma and You" series on Making Light:
http://nielsenhayden.com/makinglight/ar
Trauma and gunshot wounds
http://www.crookedbough.com/manual/Combat_Tactics_Trauma_article.pdf
Wilderness Survival Medicine
http://www.wilderness-survival.net/chp4.php
A User's Guide to PTSD
http://rachelmanija.livejournal.com/541123.html
First Aid
http://www.parasolemt.com.au/
Medical Procedures on the field
http://www.brooksidepress.org/Products/OperationalMedicine/DATA/operationalmed/Procedures/medical_procedures.htm
Living with a disability
http://www.disaboom.com/
How To Kill Your Imaginary Friends: A writer's guide to diseases and injuries, and how to use them effectively in fiction
http://doctorgrasshopper.wordpress.c
Brain Injury
http://www.thedtgroup.org/brain-injury/
Common toxins:
http://www.atsdr.cdc.gov/toxprofiles/index.asp
Injuries and illness are very important, if not essential to include in a hurt/comfort story, but what happens when you want to hurt your characters, while you don't have a medical background to figure out which bone and nerves may be affected by the gunshot wounds they so beautifully endure for your plot's sake? While the degree of realism in your story's canon may not coincide with that in real life (See: CSI science), it won't hurt to get solid information so you can make an informed choice in this matter. This's an attempt to create a cheat sheet out of the questions and answers about medical issues on the fact finding community on livejournal:
little_details . Some are direct quote from the answers.General information about injury
Despite how much it being a cliche, infection and blood loss can and do kill people, especially when your injured person doesn't receive quick medical assistance. "It's just a flesh wound" trope unfortunately doesn't apply in real life.
Extensive bruising is not good news
Bites
Infection from canine bites starts in 24-48 hours, generally. In 24, it would be getting red, more painful. In 48 hours he ought to have grayish discharge (from Pasteurella - most common canine bite pathogen), lots of surrounding redness/streaking, and fever. If he gets significant infection, he's going to be pretty sick-feeling. Many dog bites (especially if washed well) don't get infected, but if the person involved is sicker than the example listed, he'd be likely to become very ill for several days, could honestly even die of it.
Bullet wounds
Gunshot wounds by definition are serious. There're a surprisingly large number of bones, blood vessels and nerves to be affected by a gun shot. Contrary to popular belief, getting shot in the shoulder can screw you up badly. Don't expect getting up several hours after getting shot.
However, there're a lot of places that you can shoot without causing instant death to your victims: the stomach, the lungs, feet, knees, hands, shoulders, probably the lower leg, the upper leg if you don't hit an artery, the arms, the groin. People can survive from amazingly a lot of things. Shock can finally kill you though. Bleeding is the big problem. Getting the bullet out is not (Yeah, a lot of people survive fine with bullets in their bodies, and no, the police can't require the surgeons to get the bullets out during an operation for evidence)
Bullets these days are made to tumble and compress inside the body to increase damage (and ostensibly to prevent the bullet from harming anyone else hapless enough to be behind the intended target, as it usually becomes lodged somewhere inside the body). With that said, through and through wounds are often not as life-threatening as those that get deformed inside the body and displace more energy into the organs. Of course, that's true no matter what course the bullet takes, but surrounding tissue is often damaged more in the case of one that tumbles and deforms. Of course, the caliber of the bullet will also matter, as will distance between the gun and the victim.
Bullets grazing can still cost an eye, ear, finger, toe, nose, nipple or have major damage to genitals.
Burn
Acid burn is burn. Unless skin loss is very bad it can probably be handled without skin grafts. - unless it's hydrofluoric acid, which is a lot nastier and you need aggressive medical treatment (up to and including amputation) to prevent serious poisoning. In order of severity concentrate sulphuric comes say second to hydrofluoric, but it's still pretty serious. After that there's hydrochloric and nitric, neither quite as bad, and after that the organic acids which are weaker but a lot more variable in their effects - some people are VERY allergic to e.g. formic acid, for example. Hydrofluoric acid is extremely dangerous to life but it has nothing to do with being caustic to flesh (it isn't, really). It's a chemical with incredibly low percutaneous (through the skin) toxicity due to its ability to rapidly diffuse through flesh and into the bloodstream.
Everyone heals differently, and every body reacts differently to procedures such as grafting. That said, even with grafts, any of your character could (and probably would) have visible/noticeable scars.
About residual pain: If the grafts are successful and heal well without complications, they would very likely experience a return of subdermal sensation in the affected areas, while potentially having a loss of sensation in the surface scar tissue. If the burns were bad enough to damage muscle, and they didn't heal well, or were never able to be repaired completely, that could be causing him pain.
Broken Bones
If you have broken ribs and a punctured lung, anything strenuous (yes, including penetrative sex) would be out in an approximately six week window, but blow jobs or hand jobs are not out, fortunately.
Compound fractures (especially if they involve the bones rupturing the skin or splintering in a manner that could cause damage to the arteries in the legs) are nasty. Simple bone fracture can do the job too. Don't ignore them.
Coma
People may emerge from a coma with a combination of physical, intellectual and psychological difficulties that need special attention. Recovery usually occurs gradually—patients acquire more and more ability to respond. Some patients never progress beyond very basic responses, but many recover full awareness. Regaining consciousness is not instant: in the first days, patients are only awake for a few minutes, and duration of time awake gradually increases. This is unlike the situation in many movies where people who awake from comas are instantly able to continue their normal lives. In reality, the coma patient awakes sometimes in a profound state of confusion, not knowing how they got there and sometimes suffering from dysarthria, the inability to articulate any speech, and with many other disabilities.
Head Injury
Concussion Is a brain injury/trauma. Particularly a bad one. Effects can last for weeks or months if not indeed permanently. See this link for information about rehabilitation
Hypothermia
Bringing the body temperature up is a very slow process, done by placing warm packs or warmed towels in the armpits and the groin. The patient must be warmed from the core to the extremities, not the other way around. This has to be done super slowly and monitored very carefully, because the body responds to hypothermia by slowing the exchange of blood from the extremities to the core, essentially keeping the cold away from the important internal organs. If the cold blood comes back in too quickly it can stop the heart, so the patient's cardiac status has to be very closely watched as well.
Near Drowning
Except in rare circumstances, drowning people are physiologically unable to call out for help. They also cannot stop drowning and perform voluntary movements such as waving for help, moving toward a rescuer, or reaching out for a piece of rescue equipment.
Water disrupt the critical gas exchange that goes on in the lungs, usually with long-lasting effects--assuming the person survives to be released from the hospital. Patients almost invariably end up on a ventilator for some time, often with a tracheostom. Another common problem is the effects on the brain from lack of oxygen, which can be even more devastating. Either way, recovery isn't as simple as someone relaxing on a couch and watching some television while they get stronger. There can be rehabilitation and there will probably be frequent doctors' visits. And the person will probably never be able to get back to previous levels of cardiopulmonary stamina.
Poisoning
For snake bites, anti-venoms have to applied very soon after the injection of venoms. Otherwise it'll be useless.
Gastric stress is the main symptom of arsenic poisoning. One modern treatment is drinking milk.
Poisons in real life acts slow~ Expect at least hours for it to work.
Full anaphylaxis is terrifying, especially the first time it happens, and you never want it to happen again. Psychological effects are huge.
Stab wounds
General rule: Muscle will recover fairly quickly. nerves could cause permanent damage. Femoral artery would kill very rapidly.
Hand injury: Swelling will be painful and damage function for a while (a lot at first, less over the next week or two). Long-term damage could include numbness, finger weakness, finger spasms or the hand permanently curled up or unable to form a fist...or a complete recovery. A hand is a complicated thing.
Spinal injury: Stab wounds that "missed" the spine could hit nerves just after they emerge from the spinal cord, and could cause more complex motor function and sensation issues. In such case, the survivor's legs might be unable to move, but she could still have partial function or sensation in other ways.
Stomach wounds: Nasty, nasty. It is not required that the survivor die. Depending on where in the abdomen it goes through, it can hit, or miss quite a few organs. But serious infections, including blood poisoning, tetnus, diptheria are lethal without quick application of antibiotics, or even with that.The survivor could have nothing but a scar or all the way to a permanent bag collecting her waste - if a significant portion of her intestine gets necrotic and has to be removed.
Punctured lungs: A collapsed lung in itself is not necessarily fatal, provided it only happens to one of them, losing both might make it difficult to breath. What will kill is when the chest cavity fills with blood courtesy of a stab wound or internal bleeding and is not treated. There is one aspect of a collapsed lung/sucking wound injury which could cause death, and involves only a single lung being involved. It is called a tension pneumothorax, results when the chest cavity is punctured and a lung totally collapses on that side. The shift in internal pressures involved, while not high, is significant. A tension pneumothorax causes everything to shift away from the side of the injury and collapsed lung, placing tension on all the internal structures and compressing the middle section, the mediastinum. That compression causes both a tourniquet effect on the aorta and vena cava, and tamponade or compression that interferes with the heart beating.
This is successfully treated with a chest tube, to remove the air or blood from the affected side
Limb loss
Phantom pains (and non-painful feeling too) are very common. For some people this is very painful and is treated as neurological pain. Rehab specialists will work with him to retrain his brain in hospital, which helps a lot of people, especially younger people.
Stump sensitivity and infections are also common, so the survivor won't probably wear the limb all day every day to reduce this risk.
Further reading:
Body Trauma: A Writer's Guide to Wounds and Injuries
http://www.amazon.com/Body-Trauma-Write
Armed and Dangerous: A Writer's Guide to Weapons
http://www.amazon.com/Armed-Dangerous-W
Jim MacDonald's "Trauma and You" series on Making Light:
http://nielsenhayden.com/makinglight/ar
Trauma and gunshot wounds
http://www.crookedbough.com/manual/Combat_Tactics_Trauma_article.pdf
Wilderness Survival Medicine
http://www.wilderness-survival.net/chp4.php
A User's Guide to PTSD
http://rachelmanija.livejournal.com/541123.html
First Aid
http://www.parasolemt.com.au/
Medical Procedures on the field
http://www.brooksidepress.org/Products/OperationalMedicine/DATA/operationalmed/Procedures/medical_procedures.htm
Living with a disability
http://www.disaboom.com/
How To Kill Your Imaginary Friends: A writer's guide to diseases and injuries, and how to use them effectively in fiction
http://doctorgrasshopper.wordpress.c
Brain Injury
http://www.thedtgroup.org/brain-injury/
Common toxins:
http://www.atsdr.cdc.gov/toxprofiles/index.asp
Hello fandom, what's up ?
Date: 2013-02-25 08:16 am (UTC)I usually write in fandoms where the characters are liable for nasty injuries, and even if they are the goddam Batman, they can't always escapes the sequelas or the recovery time...
I'm bookmarking this one for future use.
Re: Hello fandom, what's up ?
Date: 2013-02-25 11:14 am (UTC)