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Tue Sep 04, 2018 8:34 pm
StellaThomas says...



Hi again @rebelpilot!

I can't imagine that being thrown by another human would cause much damage other than some bruising at the point of impact, which would likely be a shoulder or hip as those are the bits that stick out the most!

As for broken ribs - it would really depend on the mechanism of injury, but usually broken ribs are isolated - unless the rib floats and pops open an organ, like a pneumothorax or a haemothorax as described above, or damages the liver or spleen which are the two organs fitted most snugly into your lower ribcage. Beyond that, it would really depend on how they broke them! Most people don't even know that they've broken ribs, they're hard to see on Xray and the treatment is the same as bruised ribs - rest, take some painkillers, and don't do it again.
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Tue Sep 18, 2018 12:13 am
rebelpilot says...



I have decided that the character that gets their neck broken might get paralyzed and I was wondering what affects that would have on them? Like what things would they be able to do and what things wouldn't they be able to do?
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Sun Oct 07, 2018 1:47 pm
DauntlessDagger says...



I have a character who gets shot in the head. The bullet only grazes the side, but I know even a small injury to the head can be dangerous, and she doesn't go to the hospital for a few weeks and also those few weeks are VERY Physically exhausting.
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Fri Oct 19, 2018 4:44 pm
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StellaThomas says...



Hi guys, I'm sorry for the delay in getting back to you!

@rebelpilot - as I've said before, I am by no means an expert on spinal injuries, they're a really specialised area of medicine. However, I had a look for you and here's a good resource on what a injury can do at any particular level. Remember, the higher up, the more impaired they might be. And don't forget about things like bowel and bladder control, because obviously these can be pretty humiliating for people in real life and often get glossed over in fiction.

There are also autonomic changes in how a person regulates their temperature and their blood pressure, but again, I really am pretty inexpert in this field, so maybe take a look elsewhere and see what you can find. Neurosurgery is complicated!

@DauntlessDagger - so I suppose if it only grazed her head, I can't see there being too much damage. The only question is did she fall/hit her head somehow else, which could have caused a concussion. I can't see how a bullet could cause a skull fracture without being a direct hit. I assume you mean that it skimmed the side of her head and presumably took a rather lot of hair and scalp with it. Which. Ouch. It's worth mentioning that scalps bleed a lot. The bleeding will die down but for whatever reason we are blessed with a really rich network of capillaries supplying our scalp, so there's always a lot of blood with head wounds, more than you might expect. So it's possible she loses some blood and feels a bit woozy from that.

If she were to fall and hit her head, or whack it against something, you'd be worried about concussion or a bleed. Concussion is kind of complicated. Essentially it's your brain getting bruised from shaking around inside the confines of your skull. Effects can be different for different people but usually include some form of confusion, exhaustion, inability to concentrate. And again, this can go on for a day or two, or for several months. It really all depends and is poorly predictable. It's possible that that's what is making her so exhausted over the next few weeks?

A brain haemorrhage is another option for you, but honestly I don't think it's a good call. She would need immediate attention.
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Mon Oct 29, 2018 9:51 pm
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Messenger says...



Alright, so my MC's are out on a mountain in the middle of winter with just a few furry jackets. How much time do they have? Winds up to 25mph, snowy, and sunny. They are on the move, and two of them are taking turns with a jacket.
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Mon Oct 29, 2018 10:16 pm
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ChieRynn says...



OK. So I sort of stabbed one of my characters but I want to make sure it's possible that he lives. I've already written the scene but it's been bugging me for a while.

I stabbed him in the ribs. The entry was from the side, not the front. I think it was between his 8th and 9th ribs?? There is magic involved that helps heal him, but I don't want it to be one of those incredibly miraculous recoveries. How it happened was like this. He gets stabbed in the middle of a fight and it takes a second for it to register that he's been hit. Then he looks down and sort of freaks a little bit and pulls the blade out (no no). Not sure how deep the blade went into him, but the knife was about 8 inches long. It didn't go all the way up to the hilt. He's injured enough that he goes still and the others believe him dead (then again they are running for their lives at this point and couldn't do the most thorough examination). They did get the chance to somewhat bandage him, but then he "died" and they had to escape. So what little they did would somewhat slow the bleeding but not too much.

I'm just wondering, what's the internal damage and recovery going to look like? I can change how/where he was hit if between the ribs doesn't work.
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Tue Oct 30, 2018 5:16 pm
StellaThomas says...



Hey guys! Thanks for the questions!

So @Messenger - a few things - you haven't actually mentioned how cold it is, just that there's a lot of wind chill. But also snow + sun means that it can sometimes be warmer.

Hypothermia isn't my strongpoint, tbh, it's not something that we see that often (or I mean, when someone comes to hospital, you see that their temperature is low and you give them warmed IV fluids and a "warming blanket" - the preferred brand is literally called a Bair Hugger xDD) But when I was in New Zealand this year, there were lots of warning signs up about hypothermia and its signs that they liked to call the "'umbles":

- mumbling (slurred speech)
- stumbling (falling/legs getting stiff/losing balance)
- fumbling (not being able to do small motor movements with hands, being clumsy, reacting slowly)
- grumbling (change in mood, becoming irritable out of keeping with the situation).

How long they last depends on their own constitution. Someone who is bigger, with more body mass and in particular more subcutaneous fat will last longer before succumbing - so a woman might do better than a man, unless she's very small and slight. So it's really up to you, but I would say that somewhere between a few hours and a day, I wouldn't leave it much longer than that.

It sounds like what they'll really need to do is find shelter against the wind and cuddle up to get warm. It's such a cliché but seeing that we run at 37C, if everything else is below zero, your fellow human is like a nice hot water bottle.

It doesn't have to be absolutely freezing for people to get hypothermic either. Particularly consider the scenario that their clothes are wet, leaving them unable to get dry.

Also consider what altitude they're at, and if they're having problems with altitude sickness. Again, it's not something I know much about and any knowledge I have is from travelling rather than medicine (Ireland literally doesn't have mountains high enough for it to be a problem for us), but they might be headache-y, easily exhausted, and unable to draw breath the way they usually do.

As I say, I don't know much about hypothermia, but hopefully I've given you a little bit of guidance so you know which way you're going with your research. But it isn't so complicated - just get them warmed up!

@ChieRynn - okay! So I've answered quite a few stabbing questions elsewhere in the thread so feel free to look around.

8 inches is quite long - how big is your character? Just because, like, on me, that would probably go the whole way through back-to-front, and right to the centre (with your aorta and heart, big nope) from the side. So yeah, make sure it isn't the whole way up to the hilt - but then consider how it actually *sticks* in him enough to draw it out? Or maybe the person pulls it out? Or it falls? Do you see what I mean, if it were four inches deep, then the weight of the hilt would cause it to pull out of the wound and drop to the ground. So just have a thought about that! Of course, if he's big then it doesn't matter so much.

Right so here we are. Eighth/ninth rib is kind of a funny spot, almost directly on the diaphragm. It depends on if he's breathing in or not at the time and how full his lungs are. Given that he's in a fight, he's probably not breathing that deeply.

So if the knife goes in below the diaphragm - say at the ninth/tenth rib, on the left side he will hit stomach, maybe spleen, and maybe large bowel. On the right side he will hit liver and probably large bowel.

I suppose that given your magic system what you want to decide is this: do you want to protect him from bleeding or from infection? Honestly, if you have a magic system that is able to protect him from infection, I think you'd be pretty golden. Liver, spleen and stomach will all bleed a lot, but if he's young and healthy he could conceivably recover from a knife to his stomach or liver quite quickly (spleens really really bleed, they're the 'Macbeth' of surgery, you literally aren't allowed to say the word in theatre, but also, you can live without a spleen). The main issue that troubles me is large bowel. To nick large bowel means poo in your abdomen, means faecal peritonitis, means death in a scenario with no antibiotics. Now, he could be lucky and not get hit on his bowel. Or you could choose to make his magic protection against infection, meaning the only thing he has to worry about is bleeding.

The other option is you go a little higher, like eighth/ninth rib and you stab him in the lung. This would have to be right hand side though and, when you think about the mechanics of the fight, he would have to have his elbow raised high enough long enough for someone to get a knife in there. Possible if he is, for instance, thrusting a sword elsewhere. This could result in a haemothorax or pneumothorax, (explained in depth a few posts back if you're interested), shortness of breath but actually, bizarre as it sounds, getting stabbed in the lung is probably a better outcome for him than getting stabbed in the abdomen.

So, I think that with these kind of injuries, you need your reader to suspend disbelief a bit and make sure that it's made out that he's been "lucky", and also that magic plays a role.

Regarding recovery, I presume that someone will be able to stitch him up eventually. Skin heals pretty quick, about ten days. If stabbed in the stomach he won't be able to eat much for the following few days. He may be vomiting up blood - and this could be a good mechanism by which his friends think he's dead. People can vomit up their whole blood volume in minutes, so maybe they saw him vomit blood and thought that that was the end. But the body has ways of blocking off bleeds, so it is possible that he vomited, was weak, but didn't actually die, and eventually someone found him and fed and watered him. So regarding recovery consider:

- pain
- appetite
- limited mobility to make sure wound doesn't reopen for the first week or so
- anaemia. This means low energy, getting short of breath easily, dizzy, fainting. It can take three months to replace all of your blood, but he'd be gradually getting better.

Anaemia probably only if he gets stabbed in the stomach since it's the one that's going to bleed the most - but would also give him, to my mind, the most convincing 'death'.

Hope that helps, sorry I'm super unstructured in my response, so feel free to ask for any clarification :)

- Stella x
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Tue Oct 30, 2018 5:24 pm
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Messenger says...



thanks so much, @StellaThomas. I'm glad you brought up the being wet part because I completely forgot about one of my characters having been knocked in the water! I will definitely need to edit that. Do you know much about head wounds? I have a character who hit his head against the wall, and I had him get up and have a headache/blurry vision, but I didn't really specify where he got hit. I need him to be able to move around (it's okay if he struggles a bit) so what parts of the head can receive some battery without going to mush?
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Tue Oct 30, 2018 5:38 pm
StellaThomas says...



Hey @Messenger!

Head wounds are funny in that they're really unpredictable. What I think you are probably looking for is a concussion, rather than a brain haemorrhage. Concussion is actually caused by the brain itself knocking against the skull. In that way, it's quite unpredictable what parts of the brain are going to be affected by what injury, and what the effects are going to be.

Most common things that happen with a head injury:

- people often vomit initially (but I would limit that to just once, which is our clinical cut-off for "when do we need to start worrying that their brain is swelling and about to herniate out of their skull?" If they only vomited once, almost immediately after the head injury, it's usually not of much concern, but if they keep vomiting it's a big red flag)
- initial dizziness
- blurriness of vision - I suppose this depends on the mechanism of injury, if their optic nerves got sheared by the force or if something is pressing down on them. Patterns of visual loss are funny that way. All of our visual-processing stuff is done by the occipital lobe - that's like at the back bottom bit of your brain where your skull pokes out over the back of your neck. Blurriness, double-vision/diplopia are probably your best bets. Losing vision entirely in parts of the visual field suggests an optic nerve injury which is harder to fix, so I'd stick with vague blurriness.
- confusion, not paying attention, not able to commit things to memory, not knowing where/who/when he is, disinhibition - all this good stuff can come out of a concussion and again, depending on the injury, can last anything from a few hours or days to the rest of his life. People can often get very sleepy, and find that they can't actually concentrate on anything for more than a minute or two, that they can't focus on conversations, and because of the inattention, can't remember much either.

I would avoid movement stuff the same way I would avoid specific eye signs. So I suppose the places where he gets a bit of a beating are his frontal and occipital lobes - so at the front and back of his brain. These are the places most commonly injured anyway because they can crash into the skull, particularly in what we call acceleration-deceleration injuries. So consider a mechanism of injury where he either hits the front or the back of his head, and his brain sort of jerks a bit like you do when a car suddenly stops - see what I mean?

The other thing to consider that in an awful lot of head injuries - like something like 80% of acquired brain injuries, people lose their sense of smell. The olfactory nerve that manages smell is a long, thin nerve running over the ridges on the base of the skull. A concussion might have no other lasting effects - but their sense of smell is gone, or partly gone, forever. And it's something they mightn't notice for weeks afterwards. Just food for thought if you're worried that your characters are going to make it off scotch-free after all their ordeals.
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Tue Oct 30, 2018 5:46 pm
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Messenger says...



okay, great! He hit head lower skull against a wall and passed out, and I had him wake up with blurry vision and a headache, slight pain at loud noises. I didn't know about the olfactory nerve, but that's really cool and I might work it in. :D :wink: I think I should go back and focus more on him being a bit slow to think through things. I do have him kind of lookin around, not reacting quickly, but it wasn't for that reason so maybe it all works out in the end? haha but I'll double-check. Thanks so much for the quick answers. Guarantee I'll be back soon :P
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Tue Oct 30, 2018 6:42 pm
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ChieRynn says...



@StellaThomas he actually DID get stabbed in the right side. I was doing some research and knew that he could get hit in his lower lung. What would be someone's chances of natural recovery (guessing not too good?) from getting hit there (if the blade hits no other organs)? And would it be enough to make him appear dead? If he's hit in the lung wouldn't he be coughing up blood? If so how much?
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Sat Dec 01, 2018 6:14 am
DauntlessDagger says...



How much time would it take to recover from two gun wounds (one in the hand, another in the upper arm)? Also, if you knew first aid could you just fix yourself up at home? The character is a seventeen year old girl, who is breastfeeding two babies. She has a fake ID and visa so she doesn’t want to go to the hospital. And yes, I know this sounds really weird.
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Thu Jan 24, 2019 2:43 pm
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SirenCymbaline says...



I'm writing about a character who dies from a laudanum overdose. I was able to get some information on side effects and how it kills you,
Spoiler! :
Life-threatening overdose of opium tincture owes to the preparation's morphine content. Morphine produces a dose-dependent depressive effect on the respiratory system, which can lead to profound respiratory depression, hypoxia, coma and finally respiratory arrest and death.
but I also want to know how long those stages might take, how long it takes to die, and how it might feel.

I'll understand if you don't know, it's a Victorian drug.

But I would be happy to settle for information on what respiratory arrest is like.
  





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Thu Jan 24, 2019 8:24 pm
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Etteim says...



I have a character who is hit by a pickup truck and dies from it. I was wondering if you could help with what types of injuries the character would be suffering from that would result in their death (preferably an instant or fast one), and what the body would look like.

The truck was traveling at a high speed, 70 to 75 mph, and the character was hit at their side. He's also an average and healthy thirty-year-old, if that helps.
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Fri Jan 25, 2019 5:40 pm
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StellaThomas says...



Hi guys, wow, sorry for not updating in a while!!

@DauntlessDagger - it depends on what she got shot with! The upper arm wound I wouldn't worry about too much, wrap it up tight and she should recover, but the hand wound could have life-changing effects - remember just how important hands are, and that all the movements in your fingers are controlled by muscles whose bellies are in your forearms and whose tendons run the full length of your hand. So that's a much more serious wound than something in her biceps or deltoid which she can easily grow more of, keep that in mind. Then you have to decide if it was a bullet or shot/pellets that she got shot with, at what range etc etc etc.

Largely, it won't be life-threatening to get shot in the arm, unless it breaks her humerus or hits her in the armpit where your precious arteries run. But it can be life-limiting and that's just as important. She cannot realistically spontaneously recover all function of that hand afterwards if she doesn't seek medical assistance. So the arm - fine, bind it up, grit your teeth and get on with things. But the hand is going to make handling two babies tricky!!

Regarding breastfeeding, as long as the bullets aren't retained (less likely with bullets but with shotgun pellets it's possible), allowing heavy metal to potentially seep into breastmilk, or should she get antibiotics to prevent infection which are also expressed in breastmilk, her main issue is staying hydrated, and vitamin- and iron-replete after losing a considerable amount of blood - 17 year old girls don't have that much of it, and if she's breastfeeding she has presumably given birth recently, and then is sharing everything she has with two tiny humans. So anaemia would be my main concern out of that one.

@SirenCymbaline!

Don't worry, I know what laudanum is! However, I did a quick google to see its equivalent morphine dose (opioid conversion charts are a daily part of life for me), and it's only 1% morphine, which means one of two things:

1) they had to drink a *lot* of laudanum
2) it was literally their first time ever using it

to achieve overdose levels. Remember that tolerance is a thing, and the more you use opiates, the harder it is to overdose on them - and the less of an effect they can arouse from you.

Good news for you, though! Respiratory depression is a very calm, peaceful death. Here's what usually happens: you have receptors that register your oxygen levels, and send a message to your brain, which send a message back to your lungs telling you to breathe. As an example, try holding your breath. For as long as you can. You know that panicked feeling you get until you absolutely have to take a breath in? That's your respiratory drive, responding to the fact that you've been holding your breath for too long and your oxygen levels are getting too low - the technical word for low oxygen is hypoxia.

So what usually happens is:

oxygen levels get too low -- respiratory rate goes up.

That's why we will often talk about people getting short of breath - normally we breathe between 12 and 20 times a minute, and above that is abnormal, and usually indicates someone is sick - unless they've just done lots of exercise, of course! And breathlessness is an absolutely horrible feeling for people. And potentially the medical interventions we do for it are even worse, but I digress.

So here's the thing about opiate overdoses: they depress your respiratory drive. What that means is you start to breath more slowly, less than 12 breaths a minute, usually between 6 and 8, maybe even less. So your oxygen levels begin to drop. So usually, that would make your respiratory rate go up. But because your respiratory drive is depressed, it doesn't. Your breathing stays very slow, shallow, and calm. Your oxygen levels continue to go down. Your breathing doesn't speed up, you don't get panicked, but because your oxygen levels are low, you begin to get groggy and ultimately lose consciousness. Either you die because you stop breathing all together, or because your brain is starved of oxygen for too long. But as for the sensation - I mean, I've never done it. But it's a very peaceful, calm way to die, as far as methods of death go.

As for how long it would take, a quick Google tells me the effects of laudanum are between 6 and 8 hours, so less than that (otherwise it would start to wear off). It depends how much has been taken. Probably earlier rather than later - say in the first 2 hours or so of taking it.

@Etteim

most likely, it would be a severed spinal cord in the neck that would kill him from the force of his head being thrown faster than his body, and hitting the ground. Either that, or a head injury, but the broken neck seems the best way for you to go for a very instant death for the poor guy.

As for what the body would look like, I imagine there would be a bit of blood and gore on his head and the side of his face that hit the floor, and probably over his ribs and shoulder on the side that hit the ground as well. Honestly it's not a very predictable thing and not something that I particularly would have a lot of expertise with! I suppose it depends on what you want, if you want it to be bloody or not - it depends on the road surface as well (though I assume tarmac for the truck to be travelling at that speed!) I doubt there would be much by abdominal or leg injuries though if you imagine the trajectory of getting hit at ? shoulder/chest height (I don't know lol we don't have enough pick up trucks in Ireland apparently, how big are they?!) and getting thrown forward (because at that speed you would probably be thrown quite a distance, rather than just getting knocked down as you might by a slower moving vehicle). Sorry I'm not much help!
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