Monday, August 15, 2011

Author Beware: Arterial Bleeding vs. Venous Bleeding

I'm going to start doing these "Author Beware" posts every now and then. When you see that heading, it signals I'm doing a post on something a published author has written that medically is questionable. Now, I won't name the author or book, just the situation. So, if you know the book and/or author, please keep it close to the vest. This is merely for learning purposes.

geology.com
In two novels recently, I've come across inaccurate descriptions of venous versus arterial bleeding. One novel in which a character had slit his wrists clearly described arterial bleeding but called in venous bleeding. Another novel described a puncture wound to the neck and a "geyser" of blood from the wound yet the character made it to the hospital with a dressing around his neck.

First, what is the difference between arterial and venous bleeding? A short anatomy lesson first. Arteries are on the forward side meaning this is blood that has just left the heart. In order for your heart to get blood through the body, it has to pump. The heart's pumping is something you can feel... it's called your pulse. Whereever you feel your pulse is an artery.

Venous blood is on the return side. This is blood that has off loaded its oxygen and is on its way back to the lungs. There's not as much pressure, per se, in those vessels.

When you puncture an artery, it spurts, pretty dramatically, with each heartbeat. I saw a demonstration once of how long it would take someone to "bleed out" from an untreated arterial bleed to the knee which houses the popliteal artery. Now compared to some, this would be a smaller sized artery compared to your aorta. Any guesses?

About three minutes.

Venous bleeding doesn't have the characteristic spurting with each heartbeat. It generally oozes though it can ooze quite a bit. Venous bleeding can also be deadly if there is enough of it left untreated.

Arterial bleeding is generally harder to control than venous bleeding. You have to apply a lot of pressure to get it to stop. Hence, my dismay at how a character who sustained an injury to his neck, likely the carotid artery, could have made it to the hospital with a simple dressing in place.

What do you think?

13 comments:

  1. Reminds me of the first day of my ENT residency. A patient with an infected neck wound after cancer surgery ruptured his carotid artery. I was the nearest doctor, and I went to the operating room with him, kneeling beside him on his bed, with my thumb pressed onto the artery to stem the bleeding until we could tie it off. Go to the hospital with a blown carotid? Yeah, right!

    ReplyDelete
  2. I confess, I'm something of a medical info addict, ever since I read "In the Blink of an Eye" about Pediatric Trauma. If I'm writing about a character bleeding, the first question I ask my medical informants is 'how long to bleed out?'. Most of the time the bleeding is venous, because arterial gives me the willies, even when writing. If I want drama, I'll explore a slow leak (and possibly make it internal). OTOH, I just killed off a bad guy with a perforated abdominal aorta, which was rather interesting in a gruesome sort of way. (shudder)

    Thanks for another very interesting (and much-needed) post!

    ReplyDelete
    Replies
    1. Can I ask something? How long do you take to bleed out from a perforated abdominal aorta? I want to use that particular death in a war scene, too.

      Delete
    2. Your abdominal aorta is a major blood vessel so a major perforation would cause death in a matter of minutes (like two or three) and the patient would probably lose consciousness before onset of death from falling blood pressure.

      Thanks for you comment and hope this helps!

      Delete
    3. Yay, thanks!

      Delete
    4. Is it ok if I email you 2 other questions about this subject (feel free to post them publicly as a blog post) ?

      Delete
    5. Sure. My e-mail is under the contact tabs. Just FYI-- it might be a week or so before you hear anything as I will be off social media/e-mail this coming week.

      Delete
  3. Thanks for stopping by, Richard!

    Shandiss-- be sure to stop in on Sept 9th. Dr. Edwards is doing a two part series on abdominal injuries. Maybe it will help add detail for your story.

    ReplyDelete
  4. Sept 9th has been duly entered into my calendar. Thanks--I'm looking forward to it!

    ReplyDelete
  5. Just found this. Although I've worked in an animal clinic for years, I wasn't sure how much of what I'd seen there translated to the human side. I'm currently editing someone's manuscript, and the injuries in a couple of scenes struck me wrong enough to do some digging before revision.
    A couple of things I'm still looking for is how long a person remains conscious with arterial or venous bleeding (in one scene, this is from femoral injury) and whether/how much accelerated heart rate from exertion speeds bleeding (either kind).
    Thanks so much for posting this!!

    ReplyDelete
    Replies
    1. Hi, Clayfoot 2!

      I'm posting a response to your question on my April 6, 2016 blog. Hope you'll be able to check it out!

      Delete
    2. Hi, Clayfoot 2!

      I'm posting a response to your question on my April 6, 2016 blog. Hope you'll be able to check it out!

      Delete