Wounds Part 2
Taner tore through the underbrush, making her way to the howling ripping through the forest air. “Oi!” She called out. “Oi, I’m here! I’m almost near you!”
She rounded a tree and almost tripped over her patient. They were a soldier, clad in armor and on their back in the mud, moss, and branches. They were screaming and clutching their thigh. Taner immediately unstrapped their armor for a closer look.
They seemed to have no major injuries… except for the femur fracture. Taner cursed and pulled out as much rope and twine as she could. She carefully wrapped cloth around the solder’s foot on their wounded leg. From there, she slipped a thin rope through the cloth at the foot arch and then attached that to a tree. As she pulled on the rope, the leg straightened out and the soldier’s screams lessened to whimpers.
“It’s alright,” Taner said as she hurried to the solder again. “I got you. That should help a little bit while I make an improvised traction splint.” Normally, her partner would be keeping traction on the leg, but she had heard the screaming when she was, of course, off duty and alone. Just her luck.
“Okay, this branch should work—”
A low, guttural growl came out from the beneath the underbrush. Taner scrambled back to her patient. A black paw stepped out into view. “Sorry sorry!” She unsheathed her patient’s sword; her superior would give her an earful later. “Sorry! I need this!”
Diving Right In, and Content Warnings!
At last! The second part of the “Wounds” series! What could actually happen when a fictional character gets hurt! If you missed the previous post and are wondering why I am looking into wounds in fiction, I highly recommend reviewing at least the intro, because we’re heading right into the content, folks!
This time around, I am going to talk about three injuries: those of the chest, the head, and the bones! I wanted to add spinal injuries, but the post got a little too long and clinical. (And it’s already pretty clinical.)
Alas, I was unable to find my EMT study notes for this post… but I did find a ton of my wilderness first responder notes! From these, we’ll go through some of my favorite injuries I learned about in my classes. Most of what I am talking about here is taken directly from this book (well, one of two books) right here:
(…”Favorite injuries”? Why does that make me sound so evil as I write that?)
I also had a physician read through and fact check this post. Thanks mom!
Content Warning: we are going to keep going down the rabbit hole of “wounds,” I just want to remind everyone that we are going to be discussing bodily harm. Mainly broken bones and head injuries, but there is some mention of vomiting and bruising during the “head injury” section, we mention bones in places they should not be (aka outside of the body) , pain, and I do write about holes in the body in the “chest injury” section.
Also, same rules as last time: do not use this as a “how to care for someone IRL.” If you find yourself in need of medical assistance, this is not the place to find that!
CW: This is the “holes in the body where they shouldn’t be” section. Readers, be wary!
The most obvious result from a character being wacked in the chest is the breaking of ribs and some bruising. Anything goes for being bruised: your chest can bruise, your lungs can bruise, and even your heart can bruise if hit hard enough. Heart contusions (bruises) could lead to heart issues later on, but for the most part, these bruises are going to put your character into a world of pain.
But what if a character is hit in the chest and suddenly struggles to breathe? They may not just have the wind knocked out of them, they may also have a pneumothorax. A pneumothorax is a fancy way of saying a “collapsed lung.” There are many flavors of a collapsed lung: caused by blood filling up the chest space, air filling up the chest space, blood AND air filling up the chest space. The end result is the same: pain, and difficulty breathing. Not only that, but if this is the type of collapsed lung that lets air in but not out (causing the lungs to just inflate like a balloon), the character’s main vein on the side of their neck can start to bulge out and their windpipe may be pushed to one side of the neck.
That’s what we would call in clinical terms: “gnarly and not good.”
What kind of wound can cause a collapsed lung? A lot of things: broken ribs, the act of crushing the chest, or something poking into the chest.
I know I discussed “pokey things” in the previous post, but I’m bringing it up again because we honestly see “being stabbed” as a common injury in both sci-fi and fantasy. And if one is stabbed in the chest, occasionally it can create a “sucking chest wound.” And yes, it really sucks both metaphorically and literally. If a character is poked by, say, a sword or a knife in the chest and it pokes a hole into the chest and lungs, air starts to escape from the lungs through the hole. This causes a sucking sound when the character breaths. To transport the hurt character, one needs to put an occlusive (plastic-like) dressing over it, taping 3 of the 4 sides down so that air can escape during exhales, but stay in during inhalation.
What if the character managed to only get a few ribs cracked here and there? Painful, but manageable, right? Well, there is one instance where a “few cracked ribs” can lead to “OH NO OH CRAP,” and that is where the cracks in the ribs detach a section of the ribs from the rest of the bones.
This is where things get cool.
Imagine your ribs for a moment and imagine drawing a circle on a section of your rib cage. You’ll need to go over about three ribs as you draw it in your head. The edge of that circle is where the cracks are. So, what we have here is a section of the ribcage that is detached from the rest of the rib structure. This doesn’t seem like a huge deal (after all, it’s just broken ribs, right?) until you realize that the detached bit of ribs is now moving with every breath since they’re kind of free-floating on top of the lungs. And what’s cool about it is that this causes paradoxical respiration.
Paradoxical respiration happens because animals breathe by negative pressure system— Ok, we’re getting a bit off topic! What you need to know is that when the chest fills with air, the section of the detached ribs get sucked in. When the chest pushes the air out of the lungs, the section of ribs bulges out because air presses against the lungs. And that, my friends, is a flail chest. Neat, huh?
And how do we deal with all these injuries? Get that character to a hospital, stat! (Or at the very least, healing stat!)
CW: This is the vomiting section. We don’t go into that much detail, but read at your own risk.
This is where the fun begins!
…You know, as I type that, I can see how unnerving my enthusiasm for brain trauma can be to others… Especially under my “content warning.” The irony is high here, folks.
But brain injuries are quite fascinating, especially since we downplay them in popular culture. Yeah, the classic “hit them in the head with the frying pan” is super dangerous and if the person becomes unconscious from the hit, they may be in serious trouble.
Let’s say a character gets a good thwack to the head. What are some things to look for?
There’s a whole checklist to go through, so here we go! Blood in the mouth/ears/nose/eyes; blurred vision; Bruising under the eyes (racoon eyes) and behind the ears (battle’s signs); pupils unequal in size; clear liquid in eyes/ears/nose that’s probably cerebrospinal fluid; a tender head. TL;DR… a thwack to the head is not pretty.
If conscious, the character will most likely be concussed, their brain having been rattled inside their skull. They’ll be a little dizzy and may have the urge to vomit. They will seem a little out of it and may have lost some memory of the event leading up to the head injury. I must stress here, if a character has a concussion, the inability to concentrate can be debilitating and is not something to simply shake off (having known cyclist friends who have dealt with concussion).
That “mild” head injury can quickly develop into a more severe head injury. The pressure inside the skull can build up (because, you know, swelling and internal bleeding) and starts inducing the character to start projectile vomiting. This same swelling can lead to your pupils not responding to light and begin to have one increase in size while the other decreases. The character may become disoriented and can start trying to pick a fight with the folks trying to help them. Their heart rate and breathing rate skyrockets. They can start repeating the same five questions over and over again.
And then they’ll drop unconscious.
If unconscious, the injured character could start doing Cheyne-Stokes respirations where the character starts to breathe super rapidly, followed by a period of slow breathing. The reason for this can be due to increased pressure within a person’s skull (because, you know, swelling) which puts pressure on the parts of the brain that controls breathing (for my neuro-science folk, we’re talking about the medulla oblongata and the pons.).
But wait, there’s more! There’s decorticate posture, and decerebrate posture. The former is where the unconscious patient seizes up and curls their hands into their chest while the latter is where the individual’s body seizes up with their head and neck arched backwards, and the arms are curled away from the arms. Both are signs of severe brain damage.
Yeah, long story short: if your character takes a substantial hit to the head, they aren’t going to do so well without a helmet. Granted, not every single one of these symptoms are going to show up with a head injury, but I can guarantee that said character is not just “walking away” from it.
(At the very least, they’re going to be dazed for a LONG while)
CW: Broken bones and bones out of body. Stay safe, folks!
Broken bones can be life threatening if they manage to sever a major artery/vein (and the character bleeds out), but there are many a way to break a bone that doesn’t involve quite as life-threatening a symptom.
The best thing to do with a broken bone is, if possible, realign the parts and then splint the limb above and below the break. You can’t really do this with ribs (see above). The character will naturally self-splint and will hold the broken limb in a way that takes away the most pain.
What if the bone…uh… does poke out of the skin? That can happen, and it’s called (to no one’s surprise) an “open fracture.” My notes here say to clean the wounds, and then attempt to re-align the bone and slide it under the skin. Then, one immobilizes the joins above and below the break with something like a brace (whether or not one uses a sling is dependent on where the break is).
The outlier bone for this type of treatment, though, is the broken femur, or your thigh bone. See, that bone is massive, and breaking it is not like breaking an arm. No no… if that baby breaks, your thigh muscles begin to spasm. The character will be in extreme agony. You don’t just realign that baby, you put it in a traction splint which pulls the femur taught and realigns the bone parts. This can bring immediate relief.
Quick Storytime about broken bones!
A few years ago, I broke my knee cap. For the first half hour, I was in the most pain I have ever experience, but after that, I had so many hormones pumping through my body that I could walk: aclassic “endorphin and adrenaline rush.” Endorphins were released to dampen my pain response, while adrenaline was released to pump blood to my muscles. For one hour, I noticed almost no pain in my knee, and I could have walked for an hour. I even apologized to the ski patrol for wasting their time when they came to pick me up.
That would have been a horrible idea, but I could have done it. I also saw it after a cycling crash, where someone broke multiple ribs, but felt so fine that they convinced the group to let them ride back to the cars (they then turned out to have a punctured lung).
What I want to stress here is that for many injuries, a character may feel intense pain for a moment, and then the pain can go away… briefly. It’s not just for broken bones, either; many other injuries (like puncture wounds) can be drowned out by your brain’s response for a brief amount of time. This does not mean the injury is suddenly healed, it just means the brain is giving the character time to haul their butt to safety.
Will people always get enough of a rush of adrenaline and endorphins to drown out the pain? Not always. And this isn’t to discuss how adrenaline and endorphins work (that’s a whole other post), but I bring it up to say that a character could walk out of a physically traumatic experience feeling fine and then collapse from blood loss. Or have the pain of all their injuries creep into their body as they become aware of how many bones they’ve broken. Or sit down and realize they can’t stand back up due to pain.
Do with that information what you will!
I am a little disappointed I could not add spinal injuries to this one, but luckily, that will be a topic for the third wounds post of the series. Yes, you heard me right; even with our two posts, we still haven’t gone through all the ways we can hurt our characters… accurately!
Third part incoming!