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Old 02-10-2011, 06:47 PM
elfkin477 elfkin477 is offline
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Help me realistically injure this character (bad cut)

Jeremy, a naughty and hyperactive boy, is five and a half. Yesterday he accidentally kicked a soccer ball through the sliding glass doors, and his overwhelmed Dad thoughtlessly threw the broken glass into the garbage can. Today, while wearing a tee-shirt and shorts, Jeremy tripped over the bag containing the glass while bringing it the curb and cut himself.

Dad has a little first-aid knowledge, so he wrapped up the cut(s) the best he could before hustling Jeremy and his siblings into the car and driving to the ER or waits for an ambulance. It's possible that the hospital is near enough by that it only takes 20-30 minutes from the time Jeremy's sister wails to dad that Jeremy is hurt to arriving at the hospital, but it could take a lot longer if necessary considering Dad's wrangling four kids solo while Mom is out of town.

Jeremy lost enough blood that doctors are concerned (and Dad is terrified to lose him, which really is the point of the injury) but after being given some blood and being stitched up Jeremy will be fine.

So, how badly (how deep and long a cut) should Jeremy cut himself, and to what body part(s), exactly? I could guess, but odds are pretty good I'd over-estimate and suggest a wound that'd have him bleed out before getting to the hospital, or under-estimate and give him a wound that wouldn't be severe enough to worry Dad as badly as I'd like. Suggestions from the medically knowledgeable, please?

Oh, what happens after a blood transfusion, anyway? I've cut myself badly enough for the ER twice and was let go immediately after getting stitches, but I imagine there's some sort of observation time after getting blood. Hours? Over night?

Thanks!!!

Last edited by elfkin477; 02-10-2011 at 06:49 PM.
  #2  
Old 02-10-2011, 11:00 PM
Chronos Chronos is online now
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Don't worry about making the cut too severe, given that Dad applied prompt first aid. You can survive the most extreme cuts, if someone bandages you up well right away.

Actually, don't worry about describing the wounds at all. Long before it's bad enough to be life-threatening, it'll be bad enough to basically cover him in blood. Just think how bad a mess a nosebleed can make, and this is assumed to be much worse. Dad probably won't really get a good view of the cuts before the doctors have cleaned the kid up.
  #3  
Old 02-11-2011, 01:16 AM
Crepitus Fremitus Crepitus Fremitus is offline
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Based on your description of events, I'd say he cut himself on the palm side of the forearm, about five inches down from the elbow, about three inches wide, and no more than half an inch deep. Look there. Most people have a prominent vein just under the skin. It would ooze blood nonstop. Not immediately life threatening, but surely so if not treated properly. Elevating the arm over the head would reduce blood loss, but not everyone would think of that.

If a person lost enough blood to earn a transfusion, I'd say they'd deserve a night in the hospital. But practices vary.
  #4  
Old 02-11-2011, 03:13 AM
outlierrn outlierrn is offline
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ER nurse here.

Scalp lacs are famously bloody without being very dangerous, scare the bejeezus out of parents but rarely amount to much.

A forearm lac should respond well to direct pressure, I'd be surprised if you lost enough blood to require a transfusion unless you had a major arterial bleed, which would probably scare you enough to call 911.

Truth is, we don't transfuse at the drop of a hat, can't tell you how many times I've heard someone say 'oh he'll need surgery for sure,' and the docs like 'pfft, I'm not even going to check an H&H, strickly sew and go.'

I think your best bet would be multiple lacs, say a nasty looking one to the scalp, and something to the base of the bicep. You could give the kid a piece of glass there, and a wound that doesn't look too bad initially, but after bouncing around over some pothole opens up the brachial artery enough to gush. That would give the added guilt of the kid almost dying from a survivable injury because dad was paying attention to the wrong wound.

That scenario would likely buy you a trip to the OR, and an overnight stay.

Have fun
  #5  
Old 02-11-2011, 03:50 AM
Blake Blake is offline
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Quote:
Originally Posted by Chronos View Post
Don't worry about making the cut too severe, given that Dad applied prompt first aid. You can survive the most extreme cuts, if someone bandages you up well right away.

Actually, don't worry about describing the wounds at all. Long before it's bad enough to be life-threatening, it'll be bad enough to basically cover him in blood. Just think how bad a mess a nosebleed can make, and this is assumed to be much worse. Dad probably won't really get a good view of the cuts before the doctors have cleaned the kid up.
I'll second this.

Don't worry too much about details, injuries are naturally variable. You can have two injuries that look identical to external examination, and one will result in death from blood loss within minutes and one will heal without a scar with no medical treatment at all. Injuries really are that variable.

It all depends on how deep the injury is and what angle it entered at and hence which blood vessels were severed. Nick a major artery and you can be unconscious within seconds and dead within minutes. Sever a minor vein and it can bleed like a sonofabitch for for 20 minutes and then spontaneously stop. As Chronos notes, there will be more than enough blood to cover half the child's body without being life threatening.

All you really need to describe is a cut to a limb. It doesn't even need to be very big, just a few inches. That is probably all Dad will ever know too. Doctors don't go into much detail about the extent of wounds with patients who are laymen. In fact they mostly don't do with each other. "x cm laceration to left the forearm significant with blood loss" is normal, rather than excruciating detail on which muscles and vessels were severed and where precisely the wound is.

When Dad sees the doctor the most likely thing he'll hear is"We've stopped the bleeding and there is no injury to any tendons, but he has lost a lot of blood and we recommend a transfusion. If he gets the transfusion he should be fine in a few days. Can we go ahead?". AFAIK most places won't give transfusions without consent unless it is an absolute emergency, which is unlikely in this instance. Dad is unlikely to ever know more than that, and there's no reason your readers should either.

And as Chronos also notes, cuts that only affect veins are usually fairly simple to quell. So Jeremy could cut himself and bleed profusely for 5 minutes or half an hour, and once dad applies pressure the bleeding will mostly stop. It will still soak through the bandage and make Dad panic, but but it won't be serious blood loss at that stage.

As for time period, IANAD, but at at least 72 hours in my experience. If blood volume is low enough to require a transfusion then you really need to observe the patient for at least the next 12 hours. After that there are issues of immune reactions etc.
  #6  
Old 02-11-2011, 09:46 AM
gotpasswords gotpasswords is offline
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He'd just about have to roll around in the Bag O' Glass - patio doors are made of safety glass that shatters into a billion or so little chunks.

He'll have something more like road rash than any deep penetrating lacerations.

For the scenario to work, Junior would need to break a regular window, mirror or large framed painting/poster, any of which will break into huge jagged pieces that can slice into a person.
  #7  
Old 02-11-2011, 11:26 AM
Blake Blake is offline
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Originally Posted by gotpasswords View Post
...patio doors are made of safety glass that shatters into a billion or so little chunks.
Maybe in some jurisdictions where that is required by law. Not most doors in most places.
  #8  
Old 02-11-2011, 11:34 AM
Munch Munch is offline
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Quote:
Originally Posted by gotpasswords View Post
He'd just about have to roll around in the Bag O' Glass - patio doors are made of safety glass that shatters into a billion or so little chunks.

He'll have something more like road rash than any deep penetrating lacerations.

For the scenario to work, Junior would need to break a regular window, mirror or large framed painting/poster, any of which will break into huge jagged pieces that can slice into a person.
Yeah - and there's no way he'd break a sliding glass door with a soccer ball. Especially a 5.5 year old. Maybe there was a large glass-framed painting that he hit.
  #9  
Old 02-11-2011, 02:13 PM
gotpasswords gotpasswords is offline
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Quote:
Originally Posted by Blake
Maybe in some jurisdictions where that is required by law. Not most doors in most places.
Nope. It's been required pretty much globally since 1977. Whether or not it's enforced is a different issue.

Safety glass guidelines are set by the Consumer Products Safety Commission (CPSC). CPSC Standard 16 CFR Part 1201 addresses architectural glazing safety in residential and commercial structures. This standard was adopted into the International Building Code (IBC) in 1977, and has since been added to most local and regional building codes.
  #10  
Old 02-14-2011, 01:08 PM
elfkin477 elfkin477 is offline
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Quote:
Originally Posted by gotpasswords View Post
Nope. It's been required pretty much globally since 1977. Whether or not it's enforced is a different issue.

Safety glass guidelines are set by the Consumer Products Safety Commission (CPSC). CPSC Standard 16 CFR Part 1201 addresses architectural glazing safety in residential and commercial structures. This standard was adopted into the International Building Code (IBC) in 1977, and has since been added to most local and regional building codes.
Correct me if I'm wrong, though - they don't force homeowners to update to the new regulations, do they? As far as I know the standards only apply to new construction/replacement fixtures. My aunt's sliding glass doors were installed in the early to mid 70s, and as far as I know no one's knocked on the door to tell her she needs to update them to be to code.
  #11  
Old 02-15-2011, 09:18 AM
GoodOmens GoodOmens is online now
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Originally Posted by outlierrn View Post
ER nurse here.

Scalp lacs are famously bloody without being very dangerous, scare the bejeezus out of parents but rarely amount to much.
That was my first thought. This is why they're so commonly used in pro wrestling (or used to be anyway): very dramatic but not all that dangerous. And, if you're so inclined, you can give the kid a prominent scar that will remind him of his naughty ways or that he survived Voldemort.
  #12  
Old 02-15-2011, 11:23 PM
Silver Fire Silver Fire is offline
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Quote:
Originally Posted by Blake View Post
As for time period, IANAD, but at at least 72 hours in my experience. If blood volume is low enough to require a transfusion then you really need to observe the patient for at least the next 12 hours. After that there are issues of immune reactions etc.
Incompatibility reactions generally will occur way, way before the 12 hour mark. While it probably varies wildly from facility to facility, a blood transfusion all by itself may not (IME, does not) require an overnight stay. If the boy has to spend the night, it's probably best to make it because of the extent of his injury, the need for surgical repair, etc. A penetrating wound, rather than a simple cut, would be best for that, I think. Stabbed in the abdomen, maybe, with the glass still protruding. If Dad's stupid enough to pull it out, the scene could have a lot of gore.
  #13  
Old 02-15-2011, 11:48 PM
jellyblue jellyblue is offline
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[obligatory adjacent nitpick] My thought was that 5 1/2 is too small to have lugging the trash to the curb be your chore. [/o.a.n]
  #14  
Old 02-16-2011, 11:25 AM
drachillix drachillix is offline
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Quote:
Originally Posted by elfkin477 View Post
So, how badly (how deep and long a cut) should Jeremy cut himself, and to what body part(s), exactly? I could guess, but odds are pretty good I'd over-estimate and suggest a wound that'd have him bleed out before getting to the hospital, or under-estimate and give him a wound that wouldn't be severe enough to worry Dad as badly as I'd like. Suggestions from the medically knowledgeable, please?

Oh, what happens after a blood transfusion, anyway? I've cut myself badly enough for the ER twice and was let go immediately after getting stitches, but I imagine there's some sort of observation time after getting blood. Hours? Over night?

Thanks!!!
IANAD but I used to be an EMT, so i will take a "stab" at it.

The obvious answer to me for a trip/fall cut is going to be hands/forearms. A good solid slash to a wrist/forearm could clip the radial and or ulnar arteries and or the associated veins in the area. It does not have to cut all the way through or get them all for there to be some impressive bleeding to a layperson. Even a 5 year old could probably dribble blood from a serious laceration for the better part of an hour before being in real danger but it will need intervention. Dad making a decent effort to bind such a wound will extend that time to 2-3 hours.

If you wanted something more dramatic kid could fall on the bag and end up getting stabbed in the chest or abdomen with a chunk of glass. Depending on depth and location you could end up with a variety of impressive but not immediately life threatening bleeding with other potential issues like punctures to lungs or other internal organs.

Just as a side note, little kids can be shockingly tough to kill. They do not have the reserves that an adult does, but given quick intervention, they are surprisingly resilient.
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Old 02-16-2011, 03:52 PM
HeadNinja HeadNinja is offline
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Originally Posted by drachillix View Post
Just as a side note, little kids can be shockingly tough to kill. They do not have the reserves that an adult does, but given quick intervention, they are surprisingly resilient.
This may be why people no longer ask you to babysit.
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Old 02-16-2011, 04:40 PM
Lasciel Lasciel is offline
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Jumping in on the glass issue, as that's what bothered me.

There are very few 5 year olds who can break a safety-glass sliding door with anything - let alone a kicked soccer ball.

Options:

If it's a newer house with one would assume up-to-code installations (ie, there's no explicit mention in the story of the doors being sentimental heirlooms from gramma's old house) then I'd rather it be a decorative glass panel or picture glazing which gets smashed. Same effect, same glass shards, more realistic.

If you're willing, or the house in the story is older, make it obvious that the door in question is old - possibly have someone warn Jr about it because it's old/fragile. Simply changing it from a sliding glass door to a set of french doors are a good option - those are often old, and often have very large panes of good old non-safety glass, and I've broken several, as have my brothers. They shatter really nicely!

Additional (yay new household tech) option - have Jr shatter one of those newfangled mercury lightbulbs, and have to be kept overnight at the hospital because of the mercury poisoning rather than the cut itself - Dad will be all sorts of guilt-ridden because he never even thought about the mercury when he was agonizing over the bloody cuts.

  #17  
Old 02-16-2011, 04:56 PM
Jonathan Chance Jonathan Chance is offline
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Just another writing issue:

This screams 911 to me. And I'd be surprised if the dad didn't make the call. I think, if he does drive the kids to the ER on his own there'd better be a sentence or two where he explains that decision to someone.

Get me, having covered my share of accidents and injuries EMTs can get just about anywhere in one HELL of a hurry. And they know it, too. I once reported that a fire truck and squad arrived at the scene of an auto accident in 7 minutes and they called me with data to indicate that is was less than six. I got an education there.

So it might take the dad 20-30 minutes to make his way through traffic but somewhere within 5-10 minutes are pros who do this fairly often.

Also, when I was young (11 or so) I was home along and was making models. I slipped with an Xacto knife and opened my left index finger down to the bone about halfway around. I called 911 and they dispatched a squad and then the dispatcher advised me on dealing with it until the squad arrived (hold it vertical, apply pressure with a washcloth and so forth).

Heck, that scar is still there.

So there's going to be A) no reason for the dad to drive himself and B) no reason for him not to be able to do basic 'until the pros get there' first aid.
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