Medical Advice for a Novel

DarkCloud · August 20, 2003, 10:01

Hello, I was just wondering if any of you guys with medical knowledge [maybe Dr. Strangelove :hint: :hint:

]could please help me out.

You see, I am currently working on a novel and in one part of the novel, I have to put in a sort of ‘medical scene’ where the characters are trying to deal with someone who is spurting blood.

The situation is like this:

Earlier, Albior was stabbed in the back and chest with a trident... repeatedly. However, his wounds were wrapped tight with triangular bandages and other cloths.

NOW... About a day-3 days later

Albior is lying down on the ground. He has just overexerted himself speaking to Gilwan and starts sputtering blood. The doctor character rushes in and tries to cure him.

Currently; the scene looks like this:

“Albior's sputtering blood!” Gilwan wavered forward worriedly, her feet tapping nervously against the wood as she steadied herself on the beams.

Diamandet jumped to his feet, throwing the reigns to his nephew. “Here boy, take them.” He ordered, pushing past Gilwan.

Inside the wagon, he rushed towards the sputtering Albior. Gilwan worriedly followed. Diamandet approached the man and bent beside him, watching the blood expel from his mouth. Diamandet cursed and glanced around. “Give him room!” He ordered. Gilwan backed off, worrying her hands.
Diamandet raised Albior’s back, chin and nose, opening a breathing passage.

(NEED SOME MEDICAL KNOWLEDGE FOR WHAT TO DO WHEN SOMEONE IS SPUTTERING BLOOD WITH A CHEST WOUND)

“There.” Diamandet sighed, leaning back on his legs. “He will be all right for a time.” He shook his head. “He should not speak for a time. There is too much danger in speaking.”
---
thanks in advance,
-DarkCloud

BeBro · August 20, 2003, 10:05

Quote:

Originally posted by DarkCloud
(NEED SOME MEDICAL KNOWLEDGE FOR WHAT TO DO WHEN SOMEONE IS SPUTTERING BLOOD WITH A CHEST WOUND)

Sorry, there´s no hope. The poor guy is doomed.

DAVOUT · August 20, 2003, 10:35

Quote:

Originally posted by BeBro

Sorry, there´s no hope. The poor guy is doomed.

Then replace the medical scene by a forensic scene after the wounded guy said : I give my body to the science, and die.

SpencerH · August 20, 2003, 14:12

Heres a link to some basic first aid that may tell you what you need to know.

But AFAIK someone coughing blood like that after a chest puncture wound is very unlikely to survive unless gotten to a hospital or magic worker immediately.

pchang · August 20, 2003, 14:21

If someone is stabbed and then starts coughing up blood, that means that the wound punctured at least 1 lung. This requires immediate surgery to sew up the internal wounds and blood replacement. This is far beyond what could be fixed in a typical "fantasy" setting without the use of "magic" or some other "miraculous means". Perhaps you should change the nature of the symptoms. Instead of coughing up blood, you could have fresh blood appear on the bandages and have him faint or get woozy. This would mean that his wounds have opened up again and would just require some rebinding. He would also need some fluids to replace what he lost.

DarkCloud · August 21, 2003, 15:09

Thank you very much SpencerH... there's more to this type of wound than I had first realized. That site is really helpful!

pchang-

Quote:

If someone is stabbed and then starts coughing up blood, that means that the wound punctured at least 1 lung.

Are there no other reasons for him to be coughing it up... in my scenario, he was OK until he overexerted himself by speaking too much and heaving his chest.

Quote:

This requires immediate surgery to sew up the internal wounds and blood replacement.

Hmm... Any idea how long that sort of surgery might take with a realtively competent doctor in a middle ages-fantasy type setting?

Quote:

Instead of coughing up blood, you could have fresh blood appear on the bandages and have him faint or get woozy.

Maybe I'll have to do this instead.

Quote:

This would mean that his wounds have opened up again and would just require some rebinding. He would also need some fluids to replace what he lost.

Thank you. I can use that advice... I'd like him to be coughing up blood- but if that's logistically impossible, I'll take this suggestion.

I thank you all for your advice.

Guynemer · August 21, 2003, 15:46

Homeboy is dead.

Provost Harrison · August 21, 2003, 17:06

I don't think cardiothoracic surgery is a really a goer for the middle ages DarkCloud

You could get away with him oozing more blood from a chest wound, as has been said, which could be alleviated with pressure and stopping the site of bleeding, but anything internal like repairing punctured lungs or severed arteries is completely unrealistic for the middle ages...

pchang · August 21, 2003, 20:43

If someone is stabbed in the chest and/or back but does not immediately cough up blood, it does not make any sense that he would later cough up blood without further injury. However, coughing up blood could be due to an unrelated cause (like a concurrent TB infection). In general, coughing up blood is a pretty serious symptom that requires immediate medical attention.

Zylka · August 21, 2003, 20:48

Hello Dark,

Thank you for your question. I am delighted and quite intruiged with your desire to bring an accurate medical potrayal to the relm of fiction.

I'm sure in this situation you know who to call

Ghostbusters

-Doc

Urban Ranger · August 22, 2003, 00:10

Quote:

Originally posted by DarkCloud
Are there no other reasons for him to be coughing it up...

Yes. For example, maybe he got open wounds in his windpipe or esophagus due to unrelated causes

Quote:

Originally posted by DarkCloud
Hmm... Any idea how long that sort of surgery might take with a realtively competent doctor in a middle ages-fantasy type setting?

Depends on a lot of things. Do you have magick? If not, this is not the sort of surgery a Middle Ages doctor can perform.

Quote:

Originally posted by DarkCloud
Thank you. I can use that advice... I'd like him to be coughing up blood- but if that's logistically impossible, I'll take this suggestion.

I applaud your attention to details and accuracy. This is rarely seen nowadays. Instead, we would have TV (or movie) scenes where the depicted resembles very little with actuality. Who needs to reseach when they can pull it from their collective posterior?

Skanky Burns · August 22, 2003, 02:00

"His heart has stopped, use the defibrillator!"
* Zaaaaapp *

This annoys me no-end.

Dom Pedro II · August 22, 2003, 02:05

I wish I could be helpful here, but I know absolutely nothing about medicine.

I faint at the sight of TLC programs...

Urban Ranger · August 22, 2003, 04:55

Quote:

Originally posted by Skanky Burns
"His heart has stopped, use the defibrillator!"
* Zaaaaapp *

This annoys me no-end.

"Look, well done!"

Pekka · August 22, 2003, 05:06

Chest wound, blood pumping out? Well I guess you need to cover it pretty fast, and be careful there is no air getting in and the injured getting 'air chest'. I don't know... But I guess that's what you're supposed to do if you're shot in the chest and you have to give first aid so that you can then take it to doctor or further help. I can't exlpain it, I can show it though.. maybe I should draw it?

Urban Ranger · August 22, 2003, 05:37

Quote:

Originally posted by DarkCloud
Earlier, Albior was stabbed in the back and chest with a trident... repeatedly. However, his wounds were wrapped tight with triangular bandages and other cloths.

Trident is a vicious weapon. Those barbed ends make gaping wounds when pulled out.

Ari Rahikkala · August 22, 2003, 06:23

Quote:

Originally posted by DarkCloud
... Albior ... Gilwan ... Diamandet ..

So you're one of those writers...

SpencerH · August 22, 2003, 06:36

Quote:

Originally posted by pchang
If someone is stabbed in the chest and/or back but does not immediately cough up blood, it does not make any sense that he would later cough up blood without further injury.

A broken rib that punctures the lung as the wagon bumps along on the rough terrain?

Whaleboy · August 22, 2003, 06:39

Quote:

Earlier, Albior was stabbed in the back and chest with a trident... repeatedly. However, his wounds were wrapped tight with triangular bandages and other cloths.

Get the shovel

Violence in novels is great, I'm writing one right now, first chapter involves a terrorist bomb going on, then several beatings. Its like playing soldier of fortune in the readers mind!

FrustratedPoet · August 22, 2003, 06:41

Quote:

Originally posted by Zylka
I'm sure in this situation you know who to call

Ghostbusters

Hurricane · August 22, 2003, 06:42

Maybe you should have his wounds get infected, and then describe a nice scene of treating the wound with fresh live maggots. This was (and is) considered a great way of healing infected wounds earlier.

Check out these sites: http://www.md.huji.ac.il/depts/paras...%20therapy.htm
http://www.cnn.com/HEALTH/9710/20/maggot.therapy/

Of course, in the middle ages you don't have stashes of fresh maggots lying around, so what you do is this:
* remove the badages, let flies into the wound. Wait one day
* remove flies and cover wound. Wait until eggs hatch.
* let the maggots eat up the infection. have wound covered, but check every day. When they start on fresh tissue, remove maggots with distillated water (or urine, if no clean water available)

DarkCloud · August 22, 2003, 23:04

Quote:

but anything internal like repairing punctured lungs or severed arteries is completely unrealistic for the middle ages...

Luckily, I'm not going to have any severed lungs, arteries... I think I'll just have his wounds pus or something... he starts coughing, then looks down at his wounds... he's not coughing blood- but he starts freaking out that his wounds have reopened.

Do you think that might work?

Quote:

Trident is a vicious weapon. Those barbed ends make gaping wounds when pulled out.

I forgot they had barbed ends... but now that you mention it- I should make a point of that in my novel!

---And here's something I wrote after I responded to pchang... but didn't have the opportunity to post until now:

(Okay, I've doublechecked what I've written and catalogued it as such)
LIST OF WOUNDS: (4 Trident Wounds in the back; Punched in nose; knocked into wall "Spurting fluid from both his back and his mouth"; kicked in kneecap; repeatedly kicked in the side)

When Diamandet first gets Albior- he has to first rip the clothes off the wounds, exposing them; then he needs to put the herbs on the wounds (herbs which act as an antiseptic. Thus stop the blood poisoning.); then he needs to dress the wounds (applying pressure) [air must not enter under the wounds]; then to stitch up the wounds with string and needles, covering them over and sealing them so that they cannot bleed.

"If the casualty's condition (for example, difficulty breathing, shortness of breath, restlessness, or grayness of skin in a dark-skinned individual [or blueness in an individual with light skin]) worsens after placing the dressing, quickly lift or remove, then replace the airtight dressing. "

(Do I need to do field dressing if the wound is going to be sewed up? And should that be done before or after the wound is sewn up?)

Hmm... I'll try to work with this suggestion: (it would be
much easier to work and believe it if he took one primary
torso shot and a wider variety of non-vital/non-lethal shots
due to his skills etc. - even if he lost use of an arm due to
a bicep pierce - which he would or took a shot in the upper
back/shoulder breaking his scapula(shoulder blade). He could
still be pretty messed up without making it difficult to
believe he would even survive 3 days to sputter blood.)

I guess I need to put specifics on the placements, or just make Diamandet remark that it was lucky the shots only just barely pierced the skin?
Do you think that might work... I'm trying for some believablity here- not too much, but just enough so that a doctor wouldn't read my book and say (Oh, this guy's just making up sh**)

And as for the coughing up blood- that's been cut... I'm doing waht I posted above- his wounds start pussing and reopening and bleeding again and he starts freaking out, coughing (NO BLOOD THOUGH)... I think that might work.

---
thank you again pchang.
--
URBAN RANGER-

Quote:

Depends on a lot of things. Do you have magick? If not, this is not the sort of surgery a Middle Ages doctor can perform.

Hmm... Not in this scene- no magic here. This is pure medical... What if the doctor merely sewed up the surface wounds... thus tying the body so that the bleeding stops?

Could there plausibly not be too much internal bleeding? Could Diamandet plausibly seal him up and preserve him for a time... about 8 days, so that he can be conscious and recovering strength by the 8th-12th day- where some sort of magic thing happens and heals him?

Quote:

I applaud your attention to details and accuracy. This is rarely seen nowadays

Thank you Urban Ranger. I'm trying to do the best I can.

---
Ari (aka LightEning)

Quote:

So you're one of those writers...

What's wrong with that

each of their names means something. Gilwan's full name "Gilwan Illwan" describes her appearance; 'Gilwan' meaning green-eyed and 'Illwan' meaning that her birth was an ill omen.
The other's names have similar origins

They're not just 'pulled out of thin air'

Ah Hurricane, thanks for the situation, but I don't think that much graphic detail is quite needed

---
Thank you everyone

Dr Strangelove · August 22, 2003, 23:50

If the fellow is coughing up blood after being stabbed then he may have sustained a pulmonary laceration that involves a major airway in addition to the lung itself, though I can't quite see why the hemoptysis would have been delayed until 3 days later, since his blood should have completed clotting. If he were to bleed for 3 days then surely he would have bled out by then. I suppose he might have developed pneumonia. It is possible that a secondary infection could cause bleeding to begin again, and might even open a connection between the bleeding within the lung and the airways.

A stab wound to the chest puncturing the lung would likely cause bleeding into the pleural space, the space between the lung and the chest wall. It might also allow ari to enter the space. As blood and air fill a larger volume within that half of the chest the lung on that side becomes more and more compressed. If the wound is deep enough it might also cut one of the bronchial branches. The bronchi are the airways that bring air into the lung. If a bronchus is lacerated then blood may get into the airway and be coughed up.

DarkCloud · August 25, 2003, 21:10

Thank you all for your help.

Since you were so helpful, I feel that it is your right to see the results of your aid.

Here's the revised scene. (Hopefully much improved and as correct as it can be.)

Thank you again!

------

“I-” Albior wavered. He blinked. He brought up a hand to his head, clutching it tight. He coughed once, then collapsed, head lolling to one side. He moaned in pain.

“Ohno.” Gilwan closed her hand on the dagger and drew back. Albior continued spurting blood.

“Get Diamandet, quickly.” Callendor leaned over Albior grabbing his back and trying to prop him upright. Gilwan fled for the wagon’s front cabin.

“You must help! Please! Hurry!” She exclaimed, bursting out into the open air, squinting her eyes as the sand rushed past abrasively.

“What’s the problem?” Diamandet turned to her, one hand holding the reins, another on his sword, now kept close after Henriik’s night assault on the Monks.

“Albior’s sputtering blood!” Gilwan wavered forward worriedly, her feet tapping nervously against the wood as she steadied herself on the beams.

Diamandet jumped to his feet, throwing the reigns to his nephew. “Here boy, take them.” He ordered, pushing past Gilwan.

Inside the wagon, he rushed towards the sputtering Albior. Gilwan worriedly followed. Diamandet approached the man and bent beside him, watching the blood expel from his mouth. Diamandet cursed and glanced around. “Give him room!” He ordered. Gilwan backed off, worrying her hands.

Diamandet looked at Albior’s wheezing, then at his bloody back. He cursed. Turning, he gestured with his hand. “Dagger. I need a dagger.” He urged.

Callendor reached into his robes and drew one out. He slapped it into Diamandet’s hand. Diamandet’s fingers curled around its hilt. He bent forward, leaning over Albior, biting his lower lip. Thrusting aside Albior’s robe, he cut through the undertunic, Diamandet’s sole spare one, gifted to the man after Diamandet had been forced to destroy the first. Ripping through the fabric, Diamandet severed the cloth cords. The blood ran freely. Albior’s wounds had reopened. Diamandet rose and hurried toward his shelves. Rummaging on them, he grabbed the herbal pouch and needle and string. He raced over toward Albior, who had faded into unconsciousness. Muttering oaths about opened wounds and air getting into them, spoiling any good the herbs could do, Diamandet went to work.

Gilwan, watching from a few paces off, put a hand to her mouth. Internally, she cursed herself for encouraging him to strain himself. If he could cast magic, then the Monks needed him. If he had saved them, then he was greater than most. She had been foolish for causing him to strain himself when he was injured. She had not acted rationally. She cursed herself.

Some time later, Diamandet leaned back on his haunches and sighed in relief, setting the unused string and needle to a side. “There.” He wheezed, rising to his feet, grabbing the dagger and returning it to an urgent Callendor. “He will be all right for a time.” He shook his head. “He should not speak for a time. There is too much danger in speaking.”

Gilwan’s face greened as she stared at the unconscious Albior.

“Was he overexerting himself at the time of his relapse?” Diamandet demanded, growling the words while he glared at Gilwan.

Gilwan looked worriedly to Callendor, who had, after recieving his knife, slunk away to a far corner of the wagon. Kharman and Tarman’s eyes drifted toward her, watching her with shocked dismay. “It was my fault.” She lowered her eyes. “I don’t quite know what I was thinking. I merely thought I needed to know an answer. But I did not need to know it. My fault. All my fault.” She pointed at Albior, tears welling in her eyes.

Diamandet snorted. “Don’t do it again.” He shot Gilwan an admonishing glare, then stormed past her, headed for the front cabin.

Gilwan’s arms hung listlessly at her shoulders. Her hands worried at her waist, anxiously closing around her trusted dagger. Running her fingers over its embedded jewels, she wept.