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Sat Aug 06, 2016 8:17 pm
StellaThomas says...



@Rosendorn I think I need a little more information to go on there - there are lots of different types of scars, and scars in different areas affect people different ways. If your character has a scar that they find particularly disfiguring I would look into keloid and hypertrophic scars. Let me know a bit about the situation and I'll try go from there - the range of measures for scars go from Vitamin E oils that you can buy in the chemists all the way up to skin grafting and surgery. In between there's a lot of dermatological treatments that are probably only available in private dermatology/cosmetic centres, I had a quick glance just there and, being trained exclusively in public hospitals, I had never heard of a lot of them!
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Sat Aug 06, 2016 9:04 pm
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soundofmind says...



Ok so I've been putting off asking this question because I don't want to sound super silly and like I don't know what I'm talking about, but... at the same time, haha, that's why I'm asking of course. A quick and sincere thank you to being available and open to answer questions, btw! (Since I assume we can still ask stuff aa).

OK SO. Question: How necessary is it to cauterize a wound? And of course, to help answer, I'll give a bit of context... and, well, follow up questions too I guess. Pff they all connect in a stream of thought.

Said character is a young dude. Early 20's, he's an ex-soldier and fit and all that, and he gets stabbed in the shoulder... or, the softer tissue/part right next to it (I regret never taking anatomy... is it the deltoid? Somewhere around there?). It's not supposed to be a fatal injury, but after getting stabbed, the knife gets pulled out quickly after, and he's kinda left bleeding. He's kind of tied up so he has to way to ,, fix it at the moment. I guess here I ask... how much blood loss is too much/how much can a dude lose after being left with an unattended stab wound in a the shoulder for like 2 or 3 hours. And can he... die? Like, I don't THINK so but I genuinely don't know much at all so please forgive me, aaa.

BUT ANYWAY ABOUT THE whole cauterization thing. If he gets found said 3ish hours later, would it still be bleeding and would cauterization even help? Like, they don't have a lot of modern medicine tools or much of anything. Think cowboys. Old west. They're out in the good 'ol nature and gotta tough it out. So like, would burning it help the wound to seal, stop bleeding, and maybe lessen any risk of infection and all that?

Also... can a wound re-open after being cauterized if over-exerted/ a lot of stress if put onto it?

I HOPE I MAKE SENSE. If I don't, you can ask for more specifics??

BUT yeah, thank you again for offering your knowledge and YEAH.
  





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Sat Aug 06, 2016 11:05 pm
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StellaThomas says...



Hey @soundofmind! Don't worry, there's no such thing as a silly question ;)

So. Cautery. First things first, before I forget:

It smells.

I kind of never realised how much it's used in current times until my first time in the operating theatre and the smell of burning flesh first greeted me. They obviously have very high tech, precise ways of doing it now - such as diathermy and variations of electrical methods. But it still smells. So if you write a cauterising scene, mention the smell.

I digress.

Okay so the reasons for cauterising a wound back in the good old days were two fold:

A- stop bleeding
B- prevent infection.

Obviously we have better methods of preventing infection now but in theatre for example it's good for stopping capillary bed bleeding. And this would also be the reason for doing it in your book's setting.

But that said there are other ways to try and stop bleeding too. Putting pressure on capillaries shuts them down and stops them bleeding similar to the way burning them does. The issue is that if you are unattended and losing a lot of blood, you might be too weak/out of it to put such pressure on the wound.


You're completely correct that that muscle is the deltoid. Regarding how much it's going to bleed - all your major vessels run down the inside of your arm from your armpit for the most part, so up at the deltoid the only blood supply is what is going locally to that area. What I'm getting at is that it's not like getting stabbed in the femoral artery or the stomach or something where you get loads and loads of bleeding. But you will get some.

As you know your average human has about five litres of blood in their system. We class haemorrhage by how much blood volume they lose, or the percentage of blood - obviously it varies, a little old lady will have maybe three or four litres, The Mountain from Game of Thrones probably has about 8. Class IV - the most severe class, is 2 litres or over 40%. Just think about how incredible it is that we can still survive with that much blood gone. You'll be really sick - but if someone stops the bleeding you stand a good chance of surviving.

What I'm rambling on at is that I don't think your character is likely to lose more than a litre total, probably less. So when they find him, his heart rate will be up, he'll be cool and clammy and probably a little confused. But he should be alive.

Now. Cautery. Honestly, it's up to you. If you think it'd be fun to write a cauterising scene, go for it. As you say they don't know a lot about medicine so the method they choose is up to them. But if you want to avoid it, there's alternatives such as cleaning the wound, stitching and bandaging it. They can use alcohol to clean it, and try sterilise a needle and thread for stitches, then bandage it tightly. The only thing is that stitches can get infected, in which case they might need to burn off necrotic/dead tissue. So you could always do both!

Regarding reopening the wound, what you need to think about wounds is that you need to strain the muscles underneath it. Any wound big enough and not well healed enough - say in the first few weeks - is prone to opening again - this is why people aren't allowed to lift anything for six weeks after abdominal surgery, and are barely allowed to do anything at all after open heart surgery. The cauterisation won't stop that happening, and neither will stitches. But you need him doing something - I don't know, hanging out of a tree or something - that stresses his shoulder and stretches the skin hard enough for it to tug the edges of the wound apart like that.

Hope that wasn't too rambly, happy to clarify!
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Sun Aug 07, 2016 1:23 am
Rosendorn says...



It's a burn scar, fantasy setting so assume skin grafts don't exist (surgery does, but grafts are a little out of the realm of technology). It was a third degree burn and it took a very long time to heal.
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Sun Aug 07, 2016 9:10 am
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StellaThomas says...



@Rosendorn - third degree burns take an immensely long time to heal. How big was the burn? There's an old adage that you calculate the mortality of a burn by adding the percentage of skin burnt to the person's age. This isn't so true anymore with modern burns units - I've seen people with over 60 and 70% burns make a good recovery. But it is something to keep in mind that they are really incredibly serious life threatening injuries, so don't get too eager about giving your character a big scar without considering how deadly burns are.

Other than that, all of those measures that I was talking about are modern day advances. The only thing I can think of is Vitamin E - you know like BioOil for scars and stretch marks? Vitamin E is a key component in your skin so the theory is that it helps with the elasticity and healing of your normal skin rather than scar. I'm sure you could find substitutes in a fantasy world.

But realistically if they've had a third degree burn they're always going to have some type of scar, though the visibility of it will depend, it may fade over time.

Remember as well about hiding scars which is something that is often considered when giving people iatrogenic scars - we have Caesarean lines below the bikini line, thyroid surgery is done in the crease of the neck and people are given advice about scarves etc should they wish to hide it while it's still the most visible. AV fistulae for dialysis are done at various points up the arm and one of the considerations is how well someone can hide the fistula with their sleeve if they find it unsightly. And then there's make up. Just practical stuff for if a character finds a scar ugly and wants to hide it - it may seem obvious but I think sometimes people forget about it!

As I still don't know where on the body the scar is, I can't help about contractures or further complications.
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Sun Aug 07, 2016 4:16 pm
Rosendorn says...



This fantasy world has a slight edge over at-the-time tech— magic can and does act as life support, so long as you have enough healers dedicated to it. She also got immediate care that removed some of the corrosive substance from delicate areas, so the burn isn't as bad as it could be. Also, it's based on the Arab world, and Arabs were just a bit more advanced in medicine and surgery than Europe in the 1600s.

Basically, she gets acid poured over her face and arm (... long story short, she killed a demon with a slash to the neck, he was taller than her, and their blood is acidic) and the magic in the world is such that the fact she could die is built right into the magic system. She's got a track history of surviving wounds nobody could/should, which turns her into a very powerful (and very dangerous) type of mage known as a Resister. Aka, one who resisted death.

The immediate care she got saved her eyelid and the thin skin around her eye, therefore saving her eye itself. The magic of the world does allow for faster healing by speeding the body's natural healing processes, so in theory it could be possible something similar-ish to skin grafts exists in the world? Basically it would force the burn skin to copy her regular skin.

She does grow her hair out to cover the side of her face, wears gloves to hide the mark on her hand, and wears long sleeves to cover the marks on her forearm.

So you could say I'm dealing with two medical things here xD One is how much blood is realistically going to flow out of a neck wound if you're slashing it while a person is standing over you, and the other is the acid burn.
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Sun Aug 07, 2016 7:13 pm
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StellaThomas says...



Hey @Rosendorn, thanks for giving me some more information.

Unfortunately I'm not au fait with old Arab medicine, I know they discovered the circulatory system long before Europe did, which was basically our only advance in the sixteenth century so I'm not sure what other comparisons there are. Other than that basically all my knowledge is based on things that were discovered from 1850 onwards. So you'll have to do your own reading for that.

Regarding how much blood you'll lose from a neck wound, as I explained above to soundofmind it depends on your body mass, but you will eventually exsanguinate, and probably fall forwards while doing so. So the blood would go everywhere.

Regarding acid attacks, there are lots of very emotive, very detailed, very horrible accounts of the recovery from these directly from the victims - the case I know best as it was well publicised here and in the UK is Katie Piper, but as I'm sure you're aware it's a much more common hate crime against Asian women. It's an area that I would feel uncomfortable recommending any type of "miracle cure" for as it permanently affects lives in the real world - like paralysis, for which I also don't think fiction should provide miracle cures - more than anything it's lazy writing. But sorry tangent.

In terms of what would happen in an acid attack, she would likely permanently lose in their entirety if her face is covered with acid:

- eyelids
- eyelashes
- eyebrows
- tip of nose
- lips

If her neck and mouth are affected it will also have an impact on her airway, so she won't be able to breathe by herself. In terms of her eyes - even cleaning something off very quickly would still likely leave her with corneal abrasions and blurred vision in that eye - assuming the eyeball itself isn't lost completely.

The scars from acid attacks, no matter how much surgery and treatment people have in the modern day, are always present.

It's a fairly brutal injury, and I have limited experience in the burns unit but the majority of people end up having more than twenty, sometimes more than fifty, sometimes more than a hundred, sometimes more than two hundred surgeries to reconstruct their faces. And that's in the modern day. So you'd better hope your world's magic can work miracles!
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Sun Aug 07, 2016 7:32 pm
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soundofmind says...



Thank you so much for answering!! That was SUPER super helpful!! :)
  





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Thu Aug 11, 2016 7:23 pm
Rosendorn says...



You know, it hadn't actually occurred to me I'd have acid attack parallels. That is something I'd rather... not touch. Especially since I've been getting the sense I'd be forcing the extra info of "demons have acidic blood" the way the plot's going and my own personal writing style.

I think I'll just leave it to the wounds she got from the knife/claw fight— but she did have some wounds on her face, that would get covered in blood. Do I have anything about blood contamination to worry about?
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Thu Aug 11, 2016 7:43 pm
StellaThomas says...



@Rosendorn - unlikely presuming her wounds are cleaned out and she's given antibiotics or whatever the magical equivalent. Unless you want to go for blood borne virus style effects - think hepatitis/HIV. So she gets an infection from the blood that way. Obviously you could change it to magical equivalents again. For reference, the seroconversion rate of HIV is about 0.4% - much lower than people think, that is for every time blood is transferred from person to person there's only that much of a risk, but that for hepatitis is higher, I'm not sure of the percentages.

Without the viral component, blood from one organism isn't just going to flow into another one (because it would have to go straight into her bloodstream, like into a patent vein or artery), it would just lie on top of the wound bed, the way normal dirt would.
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Thu Aug 11, 2016 8:16 pm
Rosendorn says...



... Viral infections gives me an idea. Because the blood is supposed to impact her— there is a belief that if you touch "live" blood, aka the blood of a living person or the blood of somebody who has recently died, you must be purified in order to not absorb magic/personality traits from the other person— I can work in the origins of that superstition a lot easier than a full mythological working. Nothing might actually end up serious, but the principle.

Grain of truth to religion, my favourite.

Thanks!
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Wed Oct 19, 2016 3:02 am
Wolfi says...



I don't know if this can be answered, but here we go ~

If a person were to wear an eyepatch over a good eye from the age of one to twenty (and perhaps only took it off briefly at nighttime), would there be any hope of that eye being of any use again?
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Wed Oct 19, 2016 4:53 am
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Pinkratgirl says...



Wolfical wrote:I don't know if this can be answered, but here we go ~

If a person were to wear an eyepatch over a good eye from the age of one to twenty (and perhaps only took it off briefly at nighttime), would there be any hope of that eye being of any use again?

I think it could be used again, but it would take a long time for it to "heal" and it would probably be a bit smaller than the other. Seeing light with that eye would probably hurt very badly for a while since it would've been so adjusted to the dark. I'm not certain on this stuff though.
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Wed Oct 19, 2016 3:09 pm
ChieRynn says...



I have a couple questions. I'm usually able to figure most of this stuff out (because Mom's a PTA who did wound care stuff or whatever) but here's some more serious injuries I need some advice with.

So a character kind of ends up in a nasty torture situation and gets burns slashed down her back...(I don't usually write dark/violent/scary stuff but this is an exception) They were cuts with an energy sword that produces an extreme amount of heat as well as acting like a sword. The burns were 3rd degree- I googled types of burns for research and 4th degree burns are a thing? 3rd and 4th then. She also had quite a few broken bones and some sustained nerve injury.

Here's a couple questions:

1. What would it take for someone to be under temporary paralysis from the waist down, using the injuries I mentioned before? (a) Can burns do that?

2. How weak would it make a person who went through those injuries? I mean, she almost died in the story.

3. How would sedatives/anesthetics affect that? In order to be submerged in a healing substance, (it's Sci-Fi stuff) she needed to be lightly sedated and (a) how would that work if she was in such a weak state? (b) Would it be safe to sedate someone who was that weak?

4. How long does it take to recover from temporary paralysis? She was unable to move her legs for around 3 - 4 weeks, and (a) how would one go about the recovery process? (b) How does someone slowly begin to recover from that? (c) Where would she first begin to regain feeling?

I think that's all, but I may think of more. Thanks.
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Sun Oct 23, 2016 9:54 pm
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StellaThomas says...



Sorry for the delay in getting back to you guys!

@Wolfical - you know, I don't actually know. So the main reason we would patch a good eye is in kids with amblyopia/lazy eye. By patching the good eye we reinforce the connections between the lazy eye and the brain. Nothing happens to the good eye during that time. But for an extended period of time... hm.

I think, to me, the most likely thing to happen would be that the brain has rewired to work with just one eye, it doesn't do binocular vision anymore. So then when the second eye is reintroduced, bam! Double vision. The eyes don't connect and communicate with each other and they mightn't be aligned - ie. the person may have strabismus/a squint or amblyopia. The brain, in particular the occipital lobe which controls our vision is remarkably plastic. You know how when people go blind their other senses get heightened? It's not psychological, that part of the brain is literally rewritten for the other senses. So I think that the effects would be temporary. So strabismus and diplopia originally, but I think there's potential for that to fade.

@ChieRynn - fourth degree burns are not technically a thing, but it's what we kind of call burns that go through the skin and burn the muscle/bone underneath.

1. What would it take for someone to be under temporary paralysis from the waist down, using the injuries I mentioned before? (a) Can burns do that?


So to paralyse someone you need to damage the spinal cord. Now, there are ways of causing temporary paralysis, mainly by bruising/shocking the spine into not working anymore. I wouldn't be confident that burns could do that though, because the amazing thing is that the spinal cord is enveloped in strong hard bone.

Causing trauma to the vertebrae and a big bruise or haematoma could cause temporary paralysis... so you would want to use the "sword" aspect of the weapon more than the "burn" aspect... but use the sword as blunt force. Any sharp cutting force or burning force is going to more permanently damage the spinal cord... I personally have a pet peeve of paralysis being reversed, so if you're planning on using a temporary version, make sure they know it's temporary from the start to stay in my good books. But obviously this is your story, you can do what you like...

2. How weak would it make a person who went through those injuries? I mean, she almost died in the story.


Burns are really debilitating. Twenty years ago there used to be an algorithm: percentage of body surface area burnt + patient's age = percentage chance of dying. So if you had a fifty year old man with 60% burns, they'd have a 110% chance of dying... Not great.

We're getting better at treating things all the time though. The main issue with burns is dehydration, they just let all the moisture in your body leak out into the atmosphere. She'd also be in incredible pain, which does weaken you physically obviously. And if she's paralysed, she can go into what's called spinal shock - this is where you lose the ability to control your fluid levels beneath the level of the paralysis. So normally when you're injured/sick, blood is redistributed from your muscles and limbs to your vital organs. You lose this ability with paralysis, and in the immediate setting it can send someone into shock. Shock is our medical term for "really sick" ;)

3. How would sedatives/anesthetics affect that? In order to be submerged in a healing substance, (it's Sci-Fi stuff) she needed to be lightly sedated and (a) how would that work if she was in such a weak state? (b) Would it be safe to sedate someone who was that weak?


So, the worry about anaesthetics is people dropping their consciousness level so much that they can't protect their own airway (they relax all the muscles in their throat/back of their tongue so much that their airway collapses and they choke) and that we depress their respiratory drive - that is, we make them forget that they need to breathe to live.

So it depends on what situation you're sedating her in. If you're going to stick a tube down her lungs and connect her to a ventilator, she'll do just fine. Otherwise, you need to worry about her not being able to breathe anymore.

4. How long does it take to recover from temporary paralysis? She was unable to move her legs for around 3 - 4 weeks, and (a) how would one go about the recovery process? (b) How does someone slowly begin to recover from that? (c) Where would she first begin to regain feeling?


So this is the kind of stuff that makes me feel a bit uncomfortable because in the real world, there isn't much by way of temporary paralysis, except for things like Guillain-Barré Syndrome (ascending paralysis caused by an infection, it's super cool but super scary). There really isn't much real-world scope for it. We use spinal blocks to temporarily make people lose feeling and movement during procedures like Caesarean sections and hip replacements. The only other thing I can think of as a real world analogy is ICU myoneuropathy - when people are really sick and ventilated/hooked up to lots of machines in the ICU, it causes all their muscles and nerves to waste away and they essentially have to learn to walk again.

Obviously this is a sci-fi world and you can kind of create your own versions of things. Where she would begin to feel again would depend on the type of neuropathy - in Guillain-Barré Syndrome for instance, you lose feeling first in your toes and they're the last place to come back as well. Anything caused by shocking the spine/bruising/haematoma - the feeling would come back in a matter of hours to days rather than weeks.
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