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Thu Jun 21, 2018 4:28 am
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StellaThomas says...



Hey @shaniac! Thanks for your question.

Unfortunately I don't remember a lot about cyanide because it doesn't come up so much in practice as you might imagine xD but I did have a lecture from an Agatha Christie loving pharmacologist about it who reminded us that one of the initial signs of cyanide poisoning is that the person's breath smells like almonds. Don't know if that's useful to you. What's probably more useful for you is that cyanide kills you instantly or within minutes. There are antidotes - Vitamin B12 being a popular one, but unlikely that anyone would be carrying them around unless they suspected that someone was trying to poison them. Remember that the Nazis all carried cyanide capsules so they could die quickly before anyone noticed.

So. Cyanide kills you fast. As I say I'm not a hundred percent up on my poisons - but check out thallium for a slow and painful death (and can be passed on by skin contact, unclear if cyanide can). I just read up on a spate of murders in Australia in the 1950s - mainly by women - with thallium poisoning and here is an interesting list of signs and symptoms: https://www.dermnetnz.org/topics/thallium-poisoning/ mainly severe stomach cramps and vomiting/diarrhoea and loss of nerve endings starting in your fingers and toes which can be really really painful. Your poisoner would just have to be careful to not be exposed themselves.

That's just one suggestion. If you go with cyanide, the cyanide will kill them before the stab wound.

Here's the thing about stabbing someone once: it's surprisingly difficult to kill someone, especially with a kitchen knife. Multiple wounds will do it but really unless you hit their heart or a big artery, it's unlikely that they'll bleed to death. A gut wound would open you up to infection... A hit to a kidney would maybe have you bleeding internally enough to die. But basically as long as it isn't heart or abdomen... it's tough to kill someone straight away.

Beyond your aorta which runs right down the centre of your body, most likely places that you would bleed out from are:

- femoral artery coming our of your groin and running down your leg deep in the middle of your thigh - awkward to reach with a knife
- brachial artery- emerges from your thorax under your arm and runs down to the medial edge of your elbow (with your palm facing forward, the edge closer to your torso. You should be able to feel a pulse there)
- carotid artery- in your neck.

So other than your neck... it's almost like humans evolved to not have major arteries in unprotected places! Which is great for us as a species but not great as writers who love blood and guts....

What I'm saying, long, awkwardly and tangentially is this: stabbing someone in the shoulder won't cause too much blood or too much permanent damage. There is a chance you might puncture the very top of someone's lung but assuming they're going and fit this will heal over (putting them on high flow oxygen helps the lung to reinflate and seal itself off). Other than that, the majority of your blood vessels and nerves run under your arm along the inside edge, so you wouldn't get too much nerve damage either. The same can be said for most of your leg. What you'll really hit is muscle which will hurt like heck. But muscle grows back. Nerves don't.

Skin also is good at regenerating. What type of damage is done depends on the knife, a serrated knife and sloppy cut make for a worse wound that may be more difficult to sew up and is more likely to cause skin tightening and maybe even be keloid when it heals. A knife with a smooth edge and a single stab wound is more easily sewn up, and as long as it's not over a skin flexure (like over a joint where the skin has to be supple and mobile), a scar wouldn't cause any permanent disability.

So if you're looking for places to stab your character that won't cause chronic damage, the shoulder is still a good call, as is the leg. The abdomen is maybe a bit more dangerous... in the sides and back they run the risk of losing a kidney, elsewhere if they get a gut wound they can become profoundly septic and may need surgery ICU to get over the infection... but if they survive that they'll be flying. Same can be said for being stabbed in a lung. But honestly, limbs seem your best bet, particularly if your murderer is relying on poison and isn't fussed about a fatal wound.

I hope that that helps! Sorry I rambled a lot. Need to get more practice ;)
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Thu Jun 21, 2018 9:04 pm
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zaminami says...



In my story, at the end, my MC kills one of the other MCs. She attempts to kill the third MC, but it doesn't work. Where would you stab someone (with a knife) to kill someone but with a chance that the person could live?

For reference, MC 1 (the guy who dies) is extremely fit but has a few brain issues and MC 2 (the one who doesn't) is extremely smart but can't run for his life.
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Fri Jun 22, 2018 5:15 am
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StellaThomas says...



@izanami - I hate answering questions with more questions but I suppose what this really depends on is what your setting is and how quickly they can access medical care, and how good that medical care is.

With modern care, almost anything is survivable. To me, if I were going to stab to kill I would probably try for the chest. Again, it depends on your setting and, I suppose, how much your people know about anatomy and biology. It's been fairly well recognised for centuries that the heart is important which is why it's called the heart. With modern technology you *can* survive a knife to the heart but only just about.

To me, aiming for the heart seems the most likely thing for your MC to do. Because of your ribs and sternum being a tough bone and cartilage cage, unless she is incredibly strong the best place for her to try and reach the heart is by thrusting up from below the xiphisternum, in an area medics call the epigastrium but you may know as the solar plexus. With a long enough knife, you'll puncture the pericardium at least (the lining of the heart) which would fill up with blood until it compresses your heart and stops it beating (known as a cardiac tamponade), or else even puncture the myocardium (the actual muscle of your heart). Obviously a myocardial rupture spells death quite quickly but it is thick and tough. Anyway it doesn't matter so much. Even if it misses the myocardium, they're probably dead.

Otherwise were she to stab the other person in that area, she'll most likely just hit stomach, which would need emergency surgery but would unlikely be fatal.

The other option that would work, to me, is if she just makes a stab between the ribs. This can be fatal if you get close enough to the centre, but if not, you would probably just cause a pneumothorax (a pocket of air in your chest that blocks your lung from expanding) or a haemothorax (the same but with blood). Once they're stable and not bleeding these need to be drained out but he'll probably survive. By the way when I say young and fit, I mean like, under 65, not a smoker and not suffering from any major chronic disease! I have low standards.

Of course the other very easy way to kill someone with a knife is a stab in the neck, but it's a fairly brutal thing to do.

So basically, a lot of this is down to your setting and your character. To me, the idea of stabbing two people - I presume who were once friends? - suggests it's going to be haphazard and inexpert, and luck of the draw can easily explain who lives and who dies.
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Fri Jun 22, 2018 1:42 pm
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zaminami says...



So basically she is extremely skilled with knives and tends to use longer ones, so I believe that the first one would be best.

Throughout the book, she becomes more and more violent as it goes along so she gets better and better at fighting and stabbing. She also is knowledgeable of human anatomy as well as MC 2, which might explain why he would live and MC 1 would die...?

There is good medical care nearby, but I was having the MC slash the car tires so they wouldn't be able to go to the hospital, so I guess that there isn't actually good medical care. MC 2 does have basic knowledge of medical care and what to do in certain possibly deadly situations, just in case. This could be one of them?

Idk the planning stage for this scene is a bit all over the place: P
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Fri Jun 22, 2018 9:05 pm
StellaThomas says...



@izanami - as I say, pure dumb luck can also explain these things to an extent, and also plays into survivor's guilt for MC 2 if that's something you would like to explore. To me it sounds like the first option is best for sure, and you can just explain away the reason he lives - maybe something distracted her, maybe he twisted away from the knife so it punctured a lung instead of heart, maybe she just knows the angle is wrong.

The other thing to take into account is does she take the knife out? Leaving a knife in a wound can slow bleeding and may also be a make or break it thing to consider.

So as I say, there are lots of ways to explain how even an expert killer might not deal a fatal blow, and if he survives long enough to get to the hospital that's all he needs :)
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Fri Jun 22, 2018 11:46 pm
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zaminami says...



I'm still working that detail out, but I think hat helped a lot! Thanks!
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Sun Jun 24, 2018 2:37 am
rebelpilot says...



I asked a question before you decided to come back to this. Do you want me to repost it?
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Sun Jun 24, 2018 6:36 am
StellaThomas says...



rebelpilot wrote:Ok well later on in my story then one of the characters gets their neck broken and I was wondering if they would be able to survive. They are Human and it is star wars fan fiction and they receive medical attention pretty quickly.


Hey @rebelpilot! Sorry I was on hiatus. Anyway I can answer now if it's helpful to you for sure :)

The Star Wars universe is fairly forgiving... Padme was "perfectly healthy but dying" for goodness sake. Finn is put into a pod for weeks and recovers. They have amazing robotic prosthetics. Darth Maul *got chopped in half and came back from the dead*. So yeah, I would say that it's possible for them to be healed quick enough.

In the real world, a broken neck - which refers to a severed spinal cord between the levels of C2 and C8 - means either death (C5 and above) or serious injury and quadriplegia (C6 and below). C3-5 innervate your diaphragm and without them you can't breathe and there is no solution to this.

This is important to consider full stop when writing spinal injuries: in the real world, as yet, there is no cure. It's something I talk about a lot about how I really dislike "miracle cures" And paralysis being a passing thing for characters - the only type of transient paralysis that I know of is Guillain-Barré Syndrome which is very cool and worth a read. I'm not going to go too far into this as I'm pretty vocal about my feelings on miracle cures. What I would recommend is deciding why a broken neck is the injury you're going for, and what long-lasting residual effects it will have. Will they be weak in all 4 limbs? Sensory deficits, coordination, ongoing chronic pain? Because getting your neck snapped is a big deal, and I personally think it's better for character development if there's consequences.

Anyway - Yes as it's Star Wars, anything goes! Just write responsibly :)
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Sun Jun 24, 2018 7:14 am
rebelpilot says...



Thanks. I have another question. About how much blood would a some one around ten years old have?
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Sun Jun 24, 2018 7:52 am
StellaThomas says...



Depending on their size and weight, but roughly about 2.5 to 3 litres. Remember that bleeding out isn't losing all of your blood but just losing about 40% (so in this case probably about a litre), because you can't perfuse your organs quick enough after that. Kids are more resilient and should be able to last a little bit longer than an adult but keep it in mind that not a lot of blood can be a huge loss to a little person.
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Sun Jun 24, 2018 7:57 am
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rebelpilot says...



I know, it's that one of the characters is literally made of magic so they can lose all of theor blood without dying and I just wanted to know around how much that would be. But thanks again.
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Tue Jun 26, 2018 7:52 pm
occymay says...



Hiya, I was wondering if you could help shed some light on a possible problem in my novel.

Okay, so one of my characters passes out from smoke inhalation but what I need to know is if they would have to be treated at a hospital? Also, what would likely be the symptoms of smoke inhalation and how long would those symptoms last? To give some details, there isn't a lot of smoke and she only spends enough time inhaling it to pass out.
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Wed Jun 27, 2018 12:37 pm
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StellaThomas says...



Hi @occymay!

The short answer is: yes. She needs to go to hospital.

Smoke inhalation is a lot more dangerous than people think, and if you're in a bad enough state to lose consciousness then it's definitely bad. People in novels pass out a lot more than people in real life! Usually loss of consciousness is a pretty big deal to us.

When someone comes into hospital: our priorities are ABC, in order of how quickly you're going to die.

A is for Airway, because if your away is blocked or "Not patent" as we would say, or even just "unprotected, that's the first thing that's going to kill you, in less than a minute.

B is for breathing. If your lungs are damaged or not working properly, or if you've inhaled a lot of something that isn't oxygen (like this gal), that'll start killing you pretty quickly as well, though not as fast as Airway obstruction.

And C is for Circulation. This accounts for bleeding, shock and dehydration of any kind, including from burns. Burns are so dangerous because you can lose so much fluid through them so quickly. There's a formula to decide how much fluid to give a burns patient and... it's a lot. It's a lot of fluid.

So. Assuming your character has survived with no or just superficial burns, we can put Circulation to one side for the moment. But that's not what would kill you quickest. A and B are.

Her airway is under threat for two reasons:

1) smoke causes irritation to your nose, mouth, larynx, larynx and trachea. When mucosa (the lining of those body parts) gets irritated, it gets red, it gets angry and it swells. Your trachea is roughly the size of a euro coin, and your larynx- which is your voicebox- only has a tiny space between your vocal cords. If they get irritated, and swell, they can block off your airway. This is the biggest cause of death in fires.

2) she's already unconscious. When we're conscious, Or even just asleep, we are in control of all the muscles around our airway - the back of our tongue, our epiglottis etc. When we are unconscious- not just sleeping - we are unable to protect our airway in the same way. In hospitals we rate people on something called the Glasgow Coma Scale based on how responsive they are, if their eyes are open and moving and if their limbs are moving. The scale goes from a low of 3 to a max of 15. If you score 8 or lower, your airway is considered unprotected.

So what do we do for people whose airways are swollen or on their way to swelling up? What do we do to unconscious people?

We intubate.

This means putting a breathing tube down and putting her on a ventilator. This might only be for a few hours to wait for the swelling to go down. She'd be sedated too, because having a tube down your throat is absolutely awful and it's the natural human instinct to fight it.

Now maybe she's awake enough by the time she gets to hospital (or when the paramedics arrived) that she's not intubated, they look down her throat and they decide "let's just wait and see". A very reasonable decision especially if you have a well staffed hospital and a nurse who can continuously supervise her.

That leaves us with the other Big Issue: breathing.

People pass out from smoke inhalation largely from one thing: carbon monoxide poisoning. I'm sure you've heard of it - the silent killer. Here's the thing: our blood likes CO 200 times more than it likes oxygen.

There follows some complicated binding stuff that I don't fully understand but basically what happens is that we flood people with 100% oxygen (normal air is 21%) to get it to try and push some of the CO out of the way. Sometimes this in itself is reason for intubation as it's more reliable than oxygen masks. And we would just keep going probably for around 24 to 48 hours I'm not 100% sure. Overall it'll take 90 days - the life cycle of your red blood cells - to completely remove the CO from your bloodstream because it's well and truly stuck in there.

Look. It's your story. Is it plausible that she gets by without any of this intervention? It's certainly possible. If your characters are working to a schedule and they need to take the risk, then maybe they just take the risk. But in a real life frame of reference, we would be keeping her in hospital until the worst of the danger was past.
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Wed Jun 27, 2018 1:43 pm
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occymay says...



Wow, I never realised smoke inhalation was that bad :O I wrote this section of the story when I was 15 and I'm currently editing it so I'll probably cut that out because it's not that important. Thank you so much for your information, it was really helpful ^_^
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Mon Jul 02, 2018 10:29 am
bluewaterlily says...



Hi Stella! I've been following this thread since you put it up and I love all the helpful and detailed responses your provide. I've been waiting for an excuse to finally use this thread. I have so many possible medical scenarios I want to write so I'll probably be using this thread a lot from now on :O since I am a huge medical nerd.

Now onto the question! I have some addiction questions to ask. So I have this character who's started smoking as a way to cope with personal and marital problems and he's smoking about 10 cigarettes a day (which I this is half a pack at least according to Google?). How long would it take him to become addicted? Or is he considered addicted?

Also, a month after he starts, he tries to quit smoking and starts wearing Nicotine patches. Would one month be enough time to suffer from Nicotine withdrawal? How would you recommend portraying Nicotine withdrawal if it even applies and what would be the symptoms and side-effects he'd experience? For his addition or emerging addiction?, how would this be t be treated from a physical health and mental health stand point?

Thanks! And sorry for all the questions.
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