1. alpacinoutd

    alpacinoutd Senior Member

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    A soldier was hit with shrapnel

    Discussion in 'Research' started by alpacinoutd, May 5, 2022.

    Imagine a soldier is near a blast. His body is peppered with shrapnel but he survives. He's taken to the hospital.

    Would it make sense to say he's put into an MRI machine to make sure there's no shrapnel in his head?
    How long does it take for the results of an emergency MRI to come out?

    What stages would a soldier go through after being injured and being sent to the hospital?

    When would he receive sedatives and painkillers and is it possible to receive them via a syringe? What are the names of some medications he would receive up arrival at the hospital?

    Also, when would he be stitched up for the shrapnel wounds?

    I'm sorry I asked so many questions.:oops:
     
  2. Bruce Johnson

    Bruce Johnson Contributor Contributor Contest Winner 2023

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    You mean a field hospital?
     
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  3. alpacinoutd

    alpacinoutd Senior Member

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    Not necessarily. The battle zone is near a city so it's possible he's taken to a hospital. Is that going to change the way he's treated? I think field hospitals don't have MRI machines so it has be to be a city hospital.
     
  4. Idiosyncratic

    Idiosyncratic Active Member

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    On the matter of the MRI, no. They would most likely use a CT (Computed Tomography) scan, which uses X rays. An MRI machine is a giant super strong magnet and shrapnel is typically metal, bad combo.

    CT scans take about 30 minutes for the scan itself and about 24 hours to get the results of that scan processed.

    Edit to add: It's unlikely that he would receive sedatives at all, unless he was being taken into surgery (and in that case, it would be anesthesia, not sedation). It's unusual for painkillers to be administered directly via syringe, typically they're either given orally or via IV line.

    That's the extent of my knowledge on the topic, but hope that helped.
     
    Last edited: May 5, 2022
  5. big soft moose

    big soft moose An Admoostrator Admin Staff Supporter Contributor Community Volunteer

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    It really depends on

    1) who's army is he in, where is he, and so forth - the conditions and treatment will vary massively. Also where is said hospital, if its close to a combat zone its likely to be overwhelmed with casualties so it won't be a nice quick treatment

    2) how badly is he hit - you don't need a scan to check you don't have metal in your head if you you've got no wounds in your head, also what kind of explosion, what kind of injuries does he sustain ?

    3) if he does have a head wound they won't give him an MRI because you don't want a magnet moving bits of metal about inside the brain

    4) sedatives and painkillers will depend on his other injuries - in my day the medics carried single use injectors of morphine (or other generic opioid which we called morphine) for field use , but there are some kinds of injury that you don't give morphine for.... morphine can slow or suppress your breathing, so you don't give it to anyone with breathing difficulties for a start.
     
    Last edited: May 5, 2022
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  6. Catriona Grace

    Catriona Grace Mind the thorns Contributor Contest Winner 2022

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    My husband was working in the MRI room when they turned the machine on. He said he thought he was far enough away that it wouldn't matter, but then his screwdriver started sliding along the floor toward the magnet. I can imagine what the MRI would do to bits of shrapnel.
     
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  7. big soft moose

    big soft moose An Admoostrator Admin Staff Supporter Contributor Community Volunteer

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    they don't use them for shrapnel wounds ... I've got friends who've got bits of frag metal left inside them who have a 'no MRI' proviso written in their medical records.

    Generally speaking someone with frag wounds will be treated surgically, they'll follow the wound tracks and pull out the big chunks (a lot of the time little bits are left behind because its not expedient to remove them... sometimes they work their way out on their own later which soldiers call 'sweating iron')

    The thing to remember here is that a combat surgeon - or a doctor at a hospital near a combat zone - doesn't have a lot of time to faff about, his interest is in stopping the bleeding, setting any broken bones, getting them stabilised, and then getting them out of the OR as quickly as possible so he can get the next guy in..

    A related point is that someone who's very badly hurt such as with a brain injury from frag may well be left to die so as not to tie up doctors and resources who could be saving other less badly hurt people... this is why it matters who he's with and where he is, the process will be very different if hes say a UK soldier evaced via bastion and then out to Selly oak, than if he's a ukranian stuck in some beseiged town where evac isnt happening and medical supplies are running out
     
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  8. RMBROWN

    RMBROWN Senior Member

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    I have a bullet fragment in my head, behind my left eye. When I went to see about some nerve damage in my feet; they scheduled a myelogram which injects a contrasting dye into your spine and is then viewed as an Xray. The MRI would pull the metal out through the eye socket and would blind me in that eye, using that method is not possible. I have had the bullet in there for 15 years or so. I have never had any problems with it so there was never a reason to remove it. They told me a couple of things would happen years ago, my body would encase the bullet or my body would push it out or even dissolve it.
     
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  9. Xoic

    Xoic Prognosticator of Arcana Ridiculosum Contributor Blogerator

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    Here's a graphic example of what even a tiny amount of metal under the skin can do in an MRI. Apparently prison tattoos have a lot of metal in them—who knew?
     
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  10. MartinM

    MartinM Banned

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    @alpacinoutd

    I think you need to do some more research, like someone suggested about which army. First things first is to have a good understanding of MEDIVAC procedures within your soldier’s army. Then build in the setting and so on. Watch NatGeo programs on the US PJs and understand what priorities are achieved and in what order...

    The stages you ask about, is your first google starting point. Would be interesting to have had more detail about your solider.

    During the build-up prior to the invasion of Ukraine, the Russian troop movements were highly visible. What got everybody worried was the placement of Field Hospitals just at the border. This is a real clue something serious will happen. Time to treat a solider is vital and cannot be too far away from the action. The field hospital is to stabilizes the soldier from immediate risk of deterioration in health. Once stable he’s moved further back behind lines and to a more specific treatment center for his care.

    MRI situations you’re looking at stage three at least. Many wounded in Afghanistan both British and American were shipped to Germany. This would be the MRIs first introduction. It would be irrelevant if an MRI unit was close by when the incident happened as that soldier needs to go through the procedure staging....

    Just my thoughts

    MartinM.
     
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  11. alpacinoutd

    alpacinoutd Senior Member

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    Thank you very much everyone!

    So, is this now medically accurate?

    He had a vague sense he was still alive when he felt the rust-like smell of blood in the back of the ambulance. Dawn had broken when he was taken off it and carried to the ER of the hospital. Through a blurry haze, he saw a woman with short hair, his nurse. As there was a wound in his head, she instructed two soldiers to put him into a CT scan machine, wanting to make sure shrapnel hadn’t pierced his head.

    He was then put on a bed and heard the nurse unzip a medical kit. After she’d finished feeding gauze into his wounds, he felt the jab of a needle and slowly sank into a morphine-induced slumber as the nurse stitched him up.


    For the next few days, he slipped in and out of consciousness as the pain seared through the sedatives. Each time he woke, he wondered how he hadn’t succumbed to his wounds yet.
     
  12. Bruce Johnson

    Bruce Johnson Contributor Contributor Contest Winner 2023

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    I don't know if it's medically accurate, but I have a few suggestions (I know you didn't ask for this, so I'm sort of violating my rule not to give advice if it's not wanted, but one thing stuck out to me a lot):

    ''taken off it" sounds really awkward to me, and probably most native speakers. I don't have any great suggestion other than to start with something like "when his stretcher was pulled from the ambulance" or "when his stretcher was unloaded and carried..." Those may not be best, but I think sound more natural to English speakers.

    I think the sentence with "As there was a wound..." seems like a shift in POV and maybe should be a new paragraph. Personally, I'd probably forgo telling the readers that information through narration and instead through dialogue the POV character would hear:

    That quote of course is probably totally inaccurate, I just made it up, but it's just another way of delivering similar info to the readers. Maybe look at both methods, and see which you think sounds better.

    Hopefully others here can provide some additional insight.
     
  13. big soft moose

    big soft moose An Admoostrator Admin Staff Supporter Contributor Community Volunteer

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    My first thought is why’s he in an ambulance. Most army's medivac their seriously injured with helicopters

    Where that’s not possible you’d expect it to be a truck, keep, or apc

    also if he’s in a civilian hospital why are soldiers putting him on the machine

    why is a nurse giving orders on treatment where are the doctors? And why are they bothering to stitch up minor wounds if they are concerned he’s hit on the head?
     
    Last edited: May 6, 2022
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  14. Thomas Larmore

    Thomas Larmore Senior Member

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    Shrapnel does a number on a human body. Watch episodes of MASH if you want to know more about it.
     
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  15. Alcove Audio

    Alcove Audio Contributor Contributor

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    One veteran I met recently was wounded by an IED. Medic, field hospital, Bagram AFB, Germany, Walter Reed. He's in a wheelchair now, but otherwise okay.

    I have been honored to speak with many veterans. In the early 1970s I worked as the mate on a charter boat taking tourists out fishing. The captain was a Navy WWII Pacific Theater vet with the Kamikaze scars to prove it. We took out lots of veterans groups. Quite a few mistook me for a Viet Nam vet (though I was only 15 at the time), and I got told war stories that aren't usually discussed (even after I corrected their mistake). When I was musical director for the Del Vikings four of the five singers were Viet Nam vets. A spec ops type who worked for a friend of mine was part of the team that found Saddam Hussein.
     
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  16. SapereAude

    SapereAude Contributor Contributor

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    Does this happen in any real country, or is this in a place you made up?

    From my long-ago service in the United States Army, this does not strike me as being at all plausible. In general, while some details may vary depending on the local sitation, the Army tends to treat its own. Wounded are treated first by a combat medic or by a squad-mate at the scene. If they need further care, the injured are medevac'ed by helicopter to a military field hospital, they aren't driven by ambulance to a civilian hospital with a customary, civilian emergency room. As injured and wounded arrive at the field hospital, they are triaged -- sorted into three categories: (1) stable, treatment can wait; (2) too far gone, don't waste any time on this one; and (3) urgent, get him on the table STAT.

    Field hospitals perform emergency surgery. After that, if the patient needs additional surgeries or a lengthy recovery after being stabilized in the field hospital, from Europe and the Middle East American wounded are typically evacuated to a major (military) hospital facility in Germany. The goal of the field hospital is to stabilize. I don't think you'll find CT scanners at a field hospital.
     
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  17. Thomas Larmore

    Thomas Larmore Senior Member

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    From MASH I learned that when a soldier is hit by shrapnel the surgeon must open the body and remove every piece of shrapnel he can find. This is a process that might take a long time and is complicated by the fact that the shrapnel might have damaged organs, might be imbedded in places difficult to get to, and it might be impossible to remove a piece of shrapnel safely. The doctors on MASH were also faced with the limited time they had for each patient since so many soldiers might be coming in after a battle. They called it "meatball surgery" because they had to limit themselves to saving the patient from immediate death so he could be moved to a hospital further away from the front lines and operated on again more thoroughly.
     
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  18. big soft moose

    big soft moose An Admoostrator Admin Staff Supporter Contributor Community Volunteer

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    Yeah, mash is fiction… entertaining as it is it’s not a credible source
     
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  19. Xoic

    Xoic Prognosticator of Arcana Ridiculosum Contributor Blogerator

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    ... which shows that fiction doesn't need to be accurate to a fault on all things, it needs to be relatable and to work in its own context. Of course that doesn't mean anything goes.
     
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  20. big soft moose

    big soft moose An Admoostrator Admin Staff Supporter Contributor Community Volunteer

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    Definitely although in mash the medical dramas were very much window dressing it was mostly a character drama / comedy about the doctors

    I’m not knocking mash it was very good at what it did but it’s not a credible source to use to advise someone on how shrapnel wounds are treated
     
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  21. Xoic

    Xoic Prognosticator of Arcana Ridiculosum Contributor Blogerator

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    Nicely said.
     
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  22. alpacinoutd

    alpacinoutd Senior Member

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    Let's say someone with shrapnel in his body is brought to a civilian hospital. What are the stages of treatment?

    Is this about accurate?

    1. They feed gauze into his wounds and try to stabilize him.

    2. They inject some sedatives and painkillers into his body.

    3. He is given an injection to induce anesthesia. (would it be local anesthesia or general?)

    4. They start the surgery to remove shrapnel. Is it possible for the patient to be awake at this stage and still feel pain irrespective of the sedatives and anesthetics?

    What will happen after the surgery and how long approximately will recovery take?

    ** I understand the circumstance will vary from one patient to another but I need to learn a sort of a general overview of what happens after someone with shrapnel wounds is brought to a hospital.
     
  23. Bruce Johnson

    Bruce Johnson Contributor Contributor Contest Winner 2023

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    You're probably better off seeking this information from a medical related forum, however there are some members that work in this field that can probably give you answers if they follow this thread.

    Only thing I'd say is that if the individual had any dangerous bleeding, gauze/dressing would have already been applied in the field or they probably wouldn't make it to the hospital. My guess is at the hospital these dressings might be removed and new ones applied when appropriate, but not sure the order.

    Also anesthesial awareness is a real thing, but very rare. I'm totally speculating here, but I'd bet you'd have a higher chance of dying while under anesthesia for oral surgery than being in a conscious, locked in state during anesthesia. Probably something between 1 in 100,000 and 1 in a million.

    Edit: I shouldn't have estimated the incident rate of Anesthesia Awareness, partly because I'm no expert but also I never defined it.
    What I was indicating that I thought was very rare was the horror story accounts of anesthesia awareness in that episode of 'Nip/Tuck' and to a lesser degree the movie 'Awake'. Some types of anesthesia awareness occur where the person feels little or no pain but can recall conversations, this is still rare but closer to 1 in 20,000-40,000.
     
    Last edited: May 11, 2022
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  24. big soft moose

    big soft moose An Admoostrator Admin Staff Supporter Contributor Community Volunteer

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    You really needo learn to do actual research instead of asking the membership here all the time.

    i'm not a surgeon but based on what ive heard and my military experience you've got it completely wrong

    e.g Why are they feeding gauze into his wounds if they're about to operate... in the field the medics will have attempted to stop the bleeding with battle dressings, and possibly tourniquets and potentially shot him up with pain killers.

    assuming hes badly hit, when he comes into a hospital he'll go to the O/R (or into the queue for an O/R if there's a lot of casualties coming in)... in the O/r they'll remove the dressings, administer anesthetic, and operate to remove the shrapnel if they can, and stop the bleeding... at the end of the operation they'll suture his wounds and dress them

    course sharpnel wounds can range from 'well thats a bit annoying, i'll pull it out myself and press on, through to jesus, let the poor bastard die
     
    Last edited: May 11, 2022
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  25. big soft moose

    big soft moose An Admoostrator Admin Staff Supporter Contributor Community Volunteer

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