Wednesday, September 5, 2012

Stab wound to the chest

Hello. My hero is in an altercation, and is stabbed in the chest. I know he’ll be bleeding. I want him to need hospitalization, but don’t want him to die. What can my heroine do besides call 911?
911 is a good start. After you get expert help on the way, the heroine needs to do the ABCs: Airway, breathing, circulation. Airway—make sure the hero doesn’t have anything blocking his throat that would prevent breathing. Breathing: is he? If not, she’ll need to give him breaths. Circulation: does he have a pulse? If not, CPR is next. The current method is to do CPR to “Stayin’ Alive,” the old Bee Gees’ song. (oh, oh, oh, oh, stayin, alive… one compression for each word). Giving breaths is appropriate, but the current focus is on circulation. Since he’s been stabbed in the chest, it’s good to move the clothing away from the wound to get a look. Is air coming from the wound? Pink froth? Seal the wound with something occlusive—a palm, a waterproof jacket, latex glove. Go with what you have available. If the hero seems to be getting worse, and his neck veins are standing out, he may have a tension pneumothorax—a big term meaning air from the damaged lung is leaking into the chest cavity and compressing the lung. Letting the air out helps. This is the maneuver you see on TV/in the movies where someone jams a needle/pen case/straw between the ribs, and air whistles out. If you choose to have this scenario, please have the good Samaritan punch through at the top of a rib—blood vessels and nerves run through a groove at the bottom of each rib, and you don’t want your patient to get worse! Shock may set in—he’ll feel cold, shiver, have a thready (weak) pulse, and become pale and sweaty. This would be a great time to have paramedics show up, as the hero is going downhill fast. The next entry will cover what happens to our stabbing victim in the ambulance and the ER. Questions? Comments? Kelly has worked in the medical field for over twenty-five years, mainly at large medical centers. With experience in a variety of settings, chances are Kelly may have seen it. Sometimes truth seems stranger than fiction in medicine, but accurate medicine in fiction is fabulous. Find her fiction at www.kellywhitley.com.

12 comments:

  1. I think this is great, Kelly. Though now I"m gonna be singing Stayin Alive all night :)

    Melinda

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    1. Thanks for stopping by, Melinda.
      I know what you mean about the song.
      Visions of John Travolta on the dance floor... :)
      Kelly

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  2. What a great idea for a blog. I will certainly follow this one and will more than likely be looking for information.

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    1. Thanks for following, Susan.
      I hope the information is useful.

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  3. Nice job Kelly,

    Nice to meet another person whose been in the medical biz for 20 plus years. My background is in ER as well, but not a lot of major trauma these days. Keep them coming!

    Sara

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  4. Kelly, this is excellent. You're my new idol!

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    1. ::Blush::
      Glad you liked it. I aim to please!

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  5. This is great Kelly! It's like the Emotion Thesaurus for Medicine! Will you feature the machine that goes PING!

    Seriously - this is such an awesome resource - nicely done :)

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    1. Of course the machine that goes PING will get some promo! :-)

      Thanks for reading, Killion. More to come...

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  6. So happy to see this I have a question. What if he's stabbed in the shoulder? Can you cover some idea there? Shoulder in the back, he sort of ducked into the injury.

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    1. Hello, CK.
      The extent will depend on whether it's the joint that's hit, the shoulder blade, or the chest.

      If it's the joint, he will likely not be able to use the arm effectively to defend himself. If the blade cuts a nerve, his arm won't work. If a blood vessel is severed, he might have bleeding into the chest cavity; if the lung is hit, all of the above about chest stabbings will apply.

      The shoulder blade is actually a pretty good line of defense of the back. The muscles attached to the shoulder blade could be injured, making it hard for the victim to lift his arm.

      If you need more specifics, please leave your email address, and I'll be happy to get into more specifics that fit your scenario!
      Cheers, Kelly

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