1. Thomas Kitchen
    Offline

    Thomas Kitchen Proofreader in the Making Contributor

    Joined:
    Nov 5, 2012
    Messages:
    1,258
    Likes Received:
    422
    Location:
    I'm Welsh - and proud!

    Stab wounds

    Discussion in 'General Writing' started by Thomas Kitchen, Jun 12, 2013.

    Hi everyone,

    Hope I put this in the right place; I just didn't think 'General Writing' is what this comes under. Anyway, I have a little problem. My main character gets stabbed by a sword (more of a long triangular prism really) in the shoulder. I want readers to think he may die, and he has stated that he's lived his life, and so has lost the will to live, if I can put it like that. He does live with help from a doctor, but as this is post-apocalyptic, resources vary and are limited, but not overly so.

    Therefore, here are my questions:

    1.) Can my MC both possibly live from this shoulder wound or die from it? If not, where would that place on the body be? I want him to sort of have a 50/50 chance.

    2.) What would the doctor need to give the MC in the way of bandages, disinfectant, etc.?

    3.) How long would it take for my MC to die from the wound (if not the shoulder then whatever you said in question 1) if not treated immediately?

    Sorry for the random questions, but obviously I want the situation to be as realistic as possible. Thanks so much. :D
     
  2. T.Trian
    Offline

    T.Trian Overly Pompous Bastard Staff Supporter Contributor

    Joined:
    Mar 12, 2013
    Messages:
    2,246
    Likes Received:
    1,449
    Location:
    Mushroom Land
    I'm definitely not an expert, but a lot depends on how deep and big (wide) the wound is and what damage does the sword do? If it's just the shoulder muscle, the MC would likely survive it if he doesn't have to wait too long for treatment and unless the wound gets infected etc. Then again, I've almost bled out from a bad muscle wound to my tricep (it went untreated for around 15 mins, 20-25 mins would've been fatal according to the paramedics/surgeon), so muscles can bleed a lot too even if no major arteries are severed, but e.g. my situation would've been much better if I'd had anything to use as bandages while I waited for the ambulance to arrive.

    If, for instance, the deltoid gets shredded (sword sinks in and after it has pierced the muscle, cuts it open sideways when the sword is yanked out), and the character doesn't get treated immediately (and doesn't have anything at hand with which to stop/slow the bleeding), you could create a near-death situation, but he's saved once he receives treatment. Those more knowledgeable than me will probably pitch in with more ideas / correct mine if I made mistakes.

    ETA: if you go with my suggestion, the character should have very little on him at the moment, because even a shredded t-shirt would help. I just couldn't take off mine at the time because my arm was riddled with large pieces of glass which would've gotten snagged on the fabric if I'd tried to remove the garment. I also didn't have anything I could've used to cut off the shirt (didn't wear a belt that day either even though I almost always wear one, but I could've used a belt to help with the copious bleeding).
     
    1 person likes this.
  3. huntsman40
    Offline

    huntsman40 Active Member

    Joined:
    May 29, 2013
    Messages:
    102
    Likes Received:
    4
    Some of this will depend on the type of sword, the era of its creation, the metal it’s made from and so on. Also it will depend on where he is struck and how the blow is dealt. Swords can leave utterly brutal wounds that can be fatal just about anywhere on the body as an impact point. This is down to if it is a chopping action or stabbing action and then how deep the blow goes in.

    I would suggest that you have him hit with a thrust rather than a chopping blow if it’s a sharp blade of modern metal as if struck firmly it would go deep and likely cause trauma to vital organs or arteries. And that's just about if they survive it at all, let alone what nerve or muscle damage that would be done that might leave them with lessened function even if they live.

    Some of your choice will depend on how much do you want your doctor to have to do to help him survive? Do you want him to have to do a lot of work like stitching up some organ or vein damage, or have to put in something like a chest drain? Or would you prefer simple would that needs cleaning, stitching and dressing? The latter means you'd have to do less medical research, but would mean you would likely have to go along the lines of infection for your reason his life is in danger. This is not a bad route though if your book is in a post-apocalyptic world and resources are scarce, as you may well have trouble getting antibiotics, which would be pretty much certain to be needed if you've had a dirty sword shoved into your body. It wasn't uncommon in older times for people to survive battles with wounds that were not fatal only to die from infection.
     
    1 person likes this.
  4. Wreybies
    Offline

    Wreybies The Ops Pops Operations Manager Staff Contest Administrator Supporter Contributor

    Joined:
    May 1, 2008
    Messages:
    18,911
    Likes Received:
    10,104
    Location:
    Puerto Rico
    Yup. Infection is your no-questions-asked tool here. Deep, tight wounds, like those had from a smooth stabbing, where it is physically difficult to the get to the very back of the wound to clean it, are a source of difficult to treat infection. If antibiotics are scarce, and they sound like they may be from what you've mentioned so far, infection is an clear ticket. It also keeps you from having to pass A&P to write this section of your story. ;)
     
  5. Thomas Kitchen
    Offline

    Thomas Kitchen Proofreader in the Making Contributor

    Joined:
    Nov 5, 2012
    Messages:
    1,258
    Likes Received:
    422
    Location:
    I'm Welsh - and proud!
    So if I had a shirt on hand for him and he got stabbed in the deltoid, and also got an infection within two or so hours, would that be extremely fatal? The doctor is only 30 mins away, but I can make that time shorter or longer if needs be. Id the infection thing is also too much, I can take that away as well. And if the deltoid did get shredded, what would need to be done to get it "better"? Clean it and stitch the wound back up, or something a little more complex?
     
  6. maskedhero
    Offline

    maskedhero Active Member

    Joined:
    May 4, 2013
    Messages:
    365
    Likes Received:
    32
    Location:
    America
    A shoulder wound, infected, can kill you. He could also cut an arterie, and bleed out.

    Disinfecting is antibiotics, hope, and some surface cleaners. In a world like that, hope.

    He might die quickly, or take a bit longer, depending on the infection. Depends on which method you choose.

    The key, don't stab people. :)
     
  7. Thomas Kitchen
    Offline

    Thomas Kitchen Proofreader in the Making Contributor

    Joined:
    Nov 5, 2012
    Messages:
    1,258
    Likes Received:
    422
    Location:
    I'm Welsh - and proud!
    It is indeed a thrust and not a chop, so no problems there. I would prefer to keep medical attention down to cleaning and stitching, so I don't know if that makes a difference to what the wound is like. Antibiotics would be available, especially where my character would go to see the doctor. Any input would be awesome.
     
  8. Thomas Kitchen
    Offline

    Thomas Kitchen Proofreader in the Making Contributor

    Joined:
    Nov 5, 2012
    Messages:
    1,258
    Likes Received:
    422
    Location:
    I'm Welsh - and proud!
    May I ask what "A and P" means?
     
  9. Garball
    Offline

    Garball Sometimes nothing can be a real cool hand. Supporter Contributor

    Joined:
    Apr 24, 2013
    Messages:
    2,846
    Likes Received:
    1,332
    Location:
    S'port, LA
    Arterial damage in that area could be quite significant if the blade cuts the axillary or brachial arteries. Significant damage to either one of those could easily pose a life or death situation based on time, the damage or retraction of the artery, the skill of the surgeon and his ability to sew them up.
     
  10. Thomas Kitchen
    Offline

    Thomas Kitchen Proofreader in the Making Contributor

    Joined:
    Nov 5, 2012
    Messages:
    1,258
    Likes Received:
    422
    Location:
    I'm Welsh - and proud!
    Great advice there. *Claps hands loudly* Everyone, take heed - stabbing people is bad! :p
     
  11. Wreybies
    Offline

    Wreybies The Ops Pops Operations Manager Staff Contest Administrator Supporter Contributor

    Joined:
    May 1, 2008
    Messages:
    18,911
    Likes Received:
    10,104
    Location:
    Puerto Rico
    Anatomy & Physiology. ;)
     
  12. GingerCoffee
    Offline

    GingerCoffee Web Surfer Girl Contributor

    Joined:
    Mar 3, 2013
    Messages:
    17,605
    Likes Received:
    5,879
    Location:
    Ralph's side of the island.
    You can write the wound to fit any scenario you want.

    A puncture wound doesn't always lead to infection, depends on which organisms and in what quantity they are introduced. A small amount of tetanus bacillis would be fatal if this is not in a vaccinated world, because they grow well in the low oxygen conditions. But there are other organisms that the body's immune system could easily handle. There are millions of people running around with foreign bodies that were left after penetrating wounds that were never treated.

    As for major blood vessels, nerves and debilitating damage to muscle and bone, get a good anatomy book and take your pick of injury locations to hit or miss them.

    BTW, the deltoid muscle lifts the arm, I think of it as outside the shoulder myself when I imagine where this sword is piercing the body, unless the sword is going more through the upper arm than the corner of the torso. The deltoid attaches to the shoulder joint by a tendon. The bulk of the muscle is in the upper arm.

    If one truly hit the shoulder, joint and bone infection, and injury to the joint itself would leave a person with an untreated injury permanently disabled.
     
  13. Pheonix
    Offline

    Pheonix A Singer of Space Operas and The Fourth Mod of RP Staff Contributor

    Joined:
    Jul 24, 2012
    Messages:
    5,716
    Likes Received:
    401
    Location:
    The Windy City
    If he survives, you should also consider the lasting effect it will have on his mobility. If tendons and ligaments were cut, or the joint damaged (there is A LOT packed into the shoulder) he would most likely has at least partial loss of mobility, and total loss if it was sever enough. The movie thing where you get injured in the shoulder and walk away fine is a load of bull crap.
     
  14. Cogito
    Offline

    Cogito Former Mod, Retired Supporter Contributor

    Joined:
    May 19, 2007
    Messages:
    35,935
    Likes Received:
    2,043
    Location:
    Massachusetts, USA
    You might want to ask a mod to move this to Research.
     
  15. huntsman40
    Offline

    huntsman40 Active Member

    Joined:
    May 29, 2013
    Messages:
    102
    Likes Received:
    4
    I'd avoid the deltoid as well, as that might cause loss of the use of that arm possibly, or restricted movement. Sure it's not certain, but if I was going to pick a point to wound in that region I'd maybe go for the point where your upper chest muscle joins your deltoid, and just above your scapula and below the clavicle bone. One issue with that is that the Axillary artery is there, and if that got chopped he would be dead very quickly, but if it’s not a big bladed sword then guess you could just say it missed it. To be honest you could pick many places to stab if you avoid organs and arteries. Check some medical diagrams for ideas, and easy to say it missed tendons etc. if you so wish, as its fiction after all.

    On how to deal with infections you have options. As someone else said getting stabbed is not a certainty to get infection from it, but it is a good method to put your character at risk. How sick you make him is up to you on that front, and he may get better on his own or treatment may be as simple as antibiotics in pill form, or if you want to make him really sick you could have him need IV antibiotics with more powerful drugs. It’s up to you on that.

    Anyway, I will say I'm not a doctor, or have any medical training at all for that matter, but I know a little, just enough to be stupidly dangerous I guess from too much reading. So don't take my advice as fact, do some research on it yourself as well I would suggest. The internet is not just for porn.
     
  16. princessysh_19
    Offline

    princessysh_19 New Member

    Joined:
    Jun 12, 2013
    Messages:
    4
    Likes Received:
    0
    Hope this helps!!! I've given my answers in the quote itself.
     
  17. jazzabel
    Offline

    jazzabel Contributing Member Contributor

    Joined:
    Jan 5, 2012
    Messages:
    4,273
    Likes Received:
    1,666
    Penetrating wound to the shoulder (and the area between the shoulder and base of the neck) can either kill you or it won't, depending what structures were damaged and what treatment was available. These are the options:

    1. Flesh wound only. Knife missed all the vital structures (arteries, veins and nerves) and bleeding can be stopped by applying direct pressure. Once the bleeding stops, the wound should be carefully cleaned and disinfected (can be done with cheap spirits such as vodka, if nothing else is available), skin and or muscle sutured if sutures are needed or available, and bandaged up with bandages or torn strips of cotton fabric. In this scenario, the risk is re-bleeding and infection, which typically develops within 7days. Also, tetanus, so he needs to get a tetanus booster and some antibiotics, plus stitches out if they were used, 7-10 days later.

    2. Knife nicked an artery or a vein ( typically subclavian vascular bundle). This might kill him a lot faster if the bleeding doesn't get controlled. Venous bleed is particularly dangerous, as the veins can't go into spasm (which arteries can and sometimes that can slow down the bleeding). If bad enough, the doctor might have to tie off the bleeding vessel inside. This can get messy, the patient might need blood transfusion plus all the meds from scenario 1. They can still die from complications, or they may take some weeks to recover (provided nothing was permanently damaged).
     
  18. Thomas Kitchen
    Offline

    Thomas Kitchen Proofreader in the Making Contributor

    Joined:
    Nov 5, 2012
    Messages:
    1,258
    Likes Received:
    422
    Location:
    I'm Welsh - and proud!
    As far as limited or no movement in the arm is concerned, it's not a problem, as this stabbing occurs way at the very end of the book, and since a lot of bad thins have happened to the MC beforehand readers will think he'll die. So I'll research it a bit more, but I think the deltoid will be fine. And thanks for all the other info; it has all been extremely helpful :)
     
  19. Thomas Kitchen
    Offline

    Thomas Kitchen Proofreader in the Making Contributor

    Joined:
    Nov 5, 2012
    Messages:
    1,258
    Likes Received:
    422
    Location:
    I'm Welsh - and proud!
    As I don't want to clutter the thread with my individual replies, I will just say thank you all so much for your help - the scene feels far more focused now that I know what's going on. Great work, everyone! :D
     
  20. Mckk
    Offline

    Mckk Moderator Staff Supporter Contributor

    Joined:
    Dec 30, 2010
    Messages:
    4,749
    Likes Received:
    2,534
    Nobody replies in Research though.

    Thomas, can I hijack your thread temporarily? I have a similar question and don't wanna start yet another thread.

    I have a character who's been mauled by something like a Komodo dragon - she suffered a serious bite around her shoulder/chest area. The piece is set in a medieval fantasy world. She's in a forest and her friends are taking her to a healer by horseback, which takes 3 hours. My question is, is it realistic that she survives the journey before she gets to the healer?

    I'm unsure as to how much blood she would lose, what vital organs may have been damaged (never been mauled before, you see) and therefore just how long she has to live without treatment before she dies? Or should I devise some fantasy spell that supernaturally keeps her alive until she reaches the healer? If possible, I don't wanna do that, because she's already gonna be revived magically, don't want to solve everything with magic if possible.
     
  21. TerraIncognita
    Offline

    TerraIncognita Aggressively Nice Person Contributor

    Joined:
    May 28, 2010
    Messages:
    1,339
    Likes Received:
    40
    Location:
    Texas
    In an ideal situation he would get stitches, disinfectant, bandages, antibiotics, and painkillers. I'm guessing he'll be lucky to get disinfectant and painkillers will be some kind of booze, again, if he's lucky. People have survived worse. If he's young and strong the odds are already much more in his favor. Also the recovery would take quite a bit of time. Muscle wounds are no joke. Neither are nerve injuries. Injuries to major nerves can also result in loss of sensation or mobility. So these are also things to consider when you pick a location. It would be a good idea to brush up on anatomy.
     
  22. huntsman40
    Offline

    huntsman40 Active Member

    Joined:
    May 29, 2013
    Messages:
    102
    Likes Received:
    4
    Well Komodo dragon's teeth are like sharks teeth in that they are serrated and about an inch long, and if she is bitten in the shoulder and chest area you shouldn't have to much danger of a vital organ damage, though as I said in other post you do have arteries in that area. I think you can do this without being worried about readers not believing you, and you can decide how bad you want blood loss to be based on how much it bites/tears at her before letting go.

    To be real honest, look at most fantasy novels and you'll see characters have sword fights, or fight monsters and take wounds that leave them bleeding to greater or lesser degrees, but the writers often don't go into major detail about the wound, but instead focus on how the character is feeling instead. So I'd not worry overly about it in the setting you are doing this in due to her going to be cured by magic and just have her worrying about blood loss – be that internally or externally – and losing consciousness etc. That would be my way in your situation rather than go to deeply into what organs inside her are damaged.
     
  23. jazzabel
    Offline

    jazzabel Contributing Member Contributor

    Joined:
    Jan 5, 2012
    Messages:
    4,273
    Likes Received:
    1,666
    [MENTION=23298]Mckk[/MENTION]: Komodo has both extremely toxic mouth with lots of bacteria and a lethal venom, plus, it has a mouth full of serrated teeth and a flexible jaw so it can swallow huge chunks, tear off flesh. Also, there are claws and a very strong, muscular tail which can break a bone when it hits you full force.

    But humans have been known to survive an attack. The main obstacles to survival are 1. blood loss; 2. shock; 3. envenomation; 4. infection. There are fairly simple first aid techniques to manage all of them, and whether a person survives depends on the severity of injury and access to medical care. You can google each of those terms to find out specifics.

    The bottom line is, you are the writer, you can make sure your character survives. Dragons and medieval magic are already not realistic, it shouldn't be hard to make the dragon bite fit in.
     
  24. thewordsmith
    Offline

    thewordsmith Contributing Member Contributor

    Joined:
    Nov 18, 2009
    Messages:
    874
    Likes Received:
    124
    Location:
    State of Confusion
    As Garball already pointed out, there are two major arteries that track through the shoulder and down the arm. As with the carotid artery or jugular vein, if one of these arteries sustains a very large cut, a person can bleed out in a matter of minutes. And since it is, to a large extent, a closed wound, you cannot tell whether the injury is to an artery or a major vein. With either a venous or arterial cut, there will be substantial bleeding and, since a great deal of blood from an arterial injury can be bled out into the body cavity and not through the initial injury, it is not going to be easy to tell just what tissue has been damaged without and MRI or dye scan. And, without access to such technology in your post-apocalyptic world, any doctor would just be guessing as to which of the possibilities is the real injury.

    The first medical response, just as with any arterial injury, would be to apply pressure to the wound area. (NOTE: if this is an arterial injury, it would require some substantial pressure to staunch the internal blood flow and this, in itself, would cause considerable "discomfort" to the victim.) At this point, blood loss is a big worry and can lead to death (or, especially for the untrained civilian, at least the sense of impending death.) Given the restrictions of your scenario, you may or may not want to involve surgery in this treatment but, if it is an artery which has been cut, your doctor will need to open the shoulder to repair the damage. This, too, can be problematic since, as others have already noted, the threat of infection in a non-sterile environment would loom large. The best solution for combating infection is alcohol to sterilize surgical tools as well as the surgical site and, in a supply compromised world, any alcohol will do ... vodka or gin (first preference for their lack of coloring), brandy, rum, whiskey, etc. (I would avoid beer, however, as it has a number impurities which could actually encourage the growth of bacteria.)

    Of course, given the circumstances of such meatball surgery, there will be a question mark for some time after as to the likelihood and degree of recovery. Regular dosing (externally) with the "antiseptic" of choice will keep the threat of infection low but it will still be a consideration. The greater concern would be the patient's ability to bounce back from extreme blood loss as well as the rigors of the surgery itself. Also, the general state of health of the patient prior to the surgery has to be a consideration. Any invasive surgery taxes all of the body's resources. If the patient is not in excellent health or, if they have experienced some illness or trauma prior to the surgery, this can play a part in their ability to recover from both the injury and the surgery. In this case, the traumas of the battle or confrontation which resulted in the stabbing would, to a great degree, have an effect on the ultimate recovery.

    Lastly, patients have been known to succumb, quite unexpectedly, following surgery. The strain of the "combination of ingredients" taxes the heart to the point where it is simply too weak to support the body through recovery. This may not be evident for a few days after surgery as the patient fails to regain energy and strength.

    Hope some of this helps. Good luck.
     
  25. archerfenris
    Offline

    archerfenris Active Member

    Joined:
    Jun 1, 2013
    Messages:
    217
    Likes Received:
    67
    Location:
    Savannah, GA
    This. Injuries are very complex and you can have instances of relatively minor injuries which turn out to be severe and what appear to be severe injuries turning out to be minor. This crap about recieving an injury in places like the hip/arm/leg/shoulder are total bullshit. Just about everytime I hear about a gun shot wound to the arm or leg there is always a fear of said person losing that limb, due to the use of a tourneqet to stop the bleeding.

    If you give the MC a pure muscle wound and have only bleeding concerns then you can get him to the doctor, stitched up, and he should be find. Provided there are no infection issues. This gives a real threat of death but also full recovery, baring any nerve damage.
     

Share This Page