Author Question: Delayed Death by Crossbow

Ben Asks:

Here's my scenario that I would appreciate some advice on:

I've got a 25 year old woman that is shot through the left calf and the upper torso (I was thinking, maybe having the upper body shot piercing her shoulder) by crossbow bolts made of wood in my fantasy novel. The weapons that shoot her are each one-hand-held, meaning that they can be aimed and fired with only one hand.

What I need to know is this:

1. Would this outright kill the character?

2. If yes, where on the average human female body can I have two crossbow bolts made of wood puncture that body in such a way as to negate instant death, but still leave months of recovery time for that character, if she gets the proper medical help fast enough?

For background information, the science level of the world I am writing is roughly the same level we have today in America and Europe, the same with this world's medical tech and knowledge.

Jordyn Says:

Thanks for sending me your questions.

1. A wound to the calf is unlikely to outright kill someone immediately. Any bleeding that's not controlled if brisk enough can lead to death. Infection is a risk with any wound-- particularly those that are caused from things (like arrows) that penetrate the body deep into its tissues leaving bacteria and other microorganisms behind.

The shot to the torso has more likelihood to cause death if it hits the right structure. On the left side of your chest are your heart, great blood vessels, and lungs. If the shot was more to the shoulder then an outright kill would be less likely and the risks above would be more prominent (bleeding and infection).

2. A shot to the calf and the shoulder have the potential to set your character back several months. If you don't want the character to die-- I would avoid having a shot to the torso. A projectile to any extremity can cause the bone underneath to fracture. Fractures typically take 6-8 weeks to heal.

If you didn't want to go with a fracture of the bone from the projectile-- you could have onset of infection (depending on how sick you'd want her to be for those months). Systemic infection can easily cause death. Local infection to the wounds can be problematic as well. You could also go with tendon damage to the arm or leg which would inhibit movement of the extremity. Healing and rehab of tendon and/or ligament damage can take months as well. Whenever an extremity isn't used because it's immobilized you always get muscle atrophy (muscle wasting) which causes weakness of the arm/leg, etc. It takes time to rehab that as well.

Good luck with your novel!

New Medical Device: X-STAT

As a medical nerd, I'm always a little fascinated by new medical devices and what they can do. I was alerted to this device by Mike H. via Facebook (Thanks, Mike!) and found it worthy to post upon to keep all your medical treatment scenes in those novels up to date.

The Blaze

It is true that not all bleeding can be controlled by direct pressure. It is also true that bleeding is the leading cause of death when it comes to bullet wounds (unless you have suffered a direct hit to either your heart, brain, and/or spinal cord which is likely the end of your life here on earth.) Uncontrolled bleeding from limbs is one thing that harkened back the use of the tourniquet. First by the military and now by civilian EMS agencies. They found the concern over tissue damage didn't pan out in the research.

For those other folks who get shot in the chest and/or abdomen, it's always a race to the hospital where definitive control of bleeding can happen-- which usually necessitates a trip to the OR-- which takes time. You may have heard the term "Golden Hour" which is generally the preferred window to get the patient to definitive treatment before they die.

Rapid control of bleeding could actually extend this hour in my opinion.

Enter the X-STAT.  For lack of a better term, the X-STAT is a tampon shaped (sorry, guys) device that is filled with dime-sized medical grade sponges that are coated with a hemostatic (stops bleeding) agent. It is inserted into the wound and the plunger places these sponges deep into the wound where they expand (like the firework snakes) and stem bleeding without direct pressure. The expansion of the sponges prevents them from being forced out of the wound.

Genius.

Thus far it seems to be listed as an investigational device and its use is limited but if it does what it says it does I think this could mean a big difference for trauma patients.

You can read more about the X-STAT here. 

What do you think of the X-STAT? Would you use it in a novel? You can bet I'll find a way to.

Author Question: Exsanguination

Heather S. asks:

I came across your website while browsing for some information for a project. I am currently a nursing student and am doing a project on arterial bleeding. I am trying to find specific exsanguination times for the major artieries in the body. I have had no luck after searching online and multiple medical books. I just need a simple answer, i.e carotid artery 2-20 minutes. I have a few times, however, I feel that they are inaccurate. Please see below:

I-stock Photo

Carotid - 2-20 min

Brachial - 5-60 min

Femoral - 5-60 min

Aorta - 1-2 min

Popliteal - 5-60 min

I would greatly appreciate your help as it seems you are extremely interested in medicine. This might go on to help your other readers as I came across the questions dated January 12, 2012 where you discuss exsanguination. Thank you!

Jordyn Says:

Your question is not an easy one.

Any major artery (and the ones listed are major) that is completely severed will likely lead to the patient's death in less than five minutes. I saw a demonstration once where a physician simulated this happening.

He took a 2 Liter bottle (an empty pop bottle) and filled it with water. He drilled a hole into it (to simulate arterial severing) and then squeezed it at a regular rate to simulate the heart pumping. That bottle was empty in a matter of three minutes. Yes, we timed it.He said the diameter of the hole he drilled equated to the popliteal artery which is behind your knee.

However, the injury may not be a complete separation which is why you have the varying time lengths. Of course, if the person gets some type of medical treatment (like a pressure dressing that stems the bleeding) they may last a lot longer as well.

I know this answer isn't a clear cut answer but in medicine . . . they usually aren't.

Heather's Follow-up Question:

Could I say the smallest time is the fastest time to bleed out without medical attention and the longest time is a small bleed from an artery?

Jordyn Says: Yes, this is reasonable. 

Author Question: Bleeding to Death

S.W. asks: This is the scenario: A woman has given birth attended only by her partner. After an exhausting long labor, the birth goes reasonably well, but a couple of hours later, she hemorrhages. My question is, would it be possible for her to bleed to death while sleeping?

My plot needs her partner to be in the same room, under the influence of alcohol or drugs which he takes to 'celebrate' after the birth. I need him to not realize what's happening until it's too late to save her.

Jordyn Says:

I do think this scenario is plausible on a couple of levels.

When a woman has bleeding complications related to delivery-- she's obviously losing blood. Simply, blood carries oxygen to each of your organs.

When there has been significant blood loss-- the woman will lose consciousness because of two aspects: not enough blood to carry the oxygen to her brain and/or low blood pressure. You have to have a certain blood pressure to perfuse your brain-- and therefore stay conscious.

She would go unconscious and could appear just to be sleeping to the one who's under the influence of all those meds/alcohol.

The pregnant woman would continue to bleed and never regain consciousness. She would die from exsanguination.

Medical Question: Exsanguination

Dee asks: How long would it take a character to bleed out if they were shot in the arm and the back? What organs can be hit to bleed but not be lethal?

Jordyn says:

If an artery is hit, bleeding out (exsanguination) can happen very quickly. Like a matter of minutes. So, if you want these people alive, I wouldn't have the bullet hit any artery. You have several major arteries in your chest (aorta, pulmonary artery, etc) and the brachial artery in your arm that lies under your bicep. A truly severed artery will pump blood out with each heart beat and the bleeding is hard to control. So, I would go for venous bleeding which can also be dangerous but will allow more time and can be easier to stop.

Dee asks: I’d like the character to be in the hospital for a few days. What is the option there?

Jordyn says:

You’d asked what organ could be hit but not be lethal. I would personally go with a lung injury if there is a bullet to the chest/back. The lung could collapse and cause bleeding as well. This would require placement of a chest tube to resolve so they’d be hospitalized for 3-5 days depending on how the lung re-inflated.

Keep in mind, venous bleeding can be deadly as well. If some of the larger veins are hit like the subclavian vein which is up by your clavicle-- bleeding could be swift enough if not stopped to cause death. All bleeding can lead to death if it's not stemmed (either by your blood clotting or by someone applying pressure to keep the blood in place until the blood clots). I once heard a coroner give a talk about a man who was drunk and on Coumadin which is a blood thinner. He dropped a knife onto his foot and happened to cut an artery. Well, in his drunken state, he didn't realize how serious it was and he bled to death. Sad but true.

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?