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.