Getting shot in the stomach

Once again, this is for a story I’m writing. I want to describe a medically accurate gunshot wound, preferably in the lower torso, whereby the character:

(1) Nearly bleeds to death, due to a severed artery (like in the movie “MAS*H”: “We’ve got a gusher!”)
(2) Undergoes surgery, where he wakes up and can feel every bit of pain, but can’t call out to anyone, so he wills his heart to stop until the doctors “shock” him and that puts him under again…oh okay, this part is pure Creative License. :wink:
(3) Recovers quickly enough to be mobile within 2 weeks, and eventually able to perform strenuous tasks like hiking 5 miles, climbing over fences & crawling through gutters, making stabbing motions with a knife…yeah, it’s that kind of story.

If a five-mile hike causes him to reinjure himself, that’s fine.

At first I was thinking a “flesh wound” that doesn’t pierce the abdominal wall, but that doesn’t sound gooshy enough…how about a bullet to the spleen? Or the liver?

spleens not bad, it can bleed like stink, but it’s relatively small and non-essential so your recovery time could plausibly be quicker than a major artery or the liver. I’m an ER nurse so post op course is not my area, two weeks maybe pretty optimistic. nitpick/ we don’t shock a stopped heart, only a fibrillating one, ie disorganized movement/nitpick

KGS, you again?! :smiley:
Gut shots are very painful, often have very long recovery times, because of the massive infections they are prone to. When what belongs inside the gut, wanders into better neighborhoods, everything can and often does, hitch a ride in the proverbial hand basket.
The gut shot itself can cause major bleeding, without involving other organs. The mesentery is the covering that holds the intestine together. It is extrordinarily vascular. A shot ripping through the mesentery and the bowel is a bloody, stinky, life threatening emergency. The Mesenteric arteries come directly off the Aorta.
BTW, a severed artery in the abdomen would be, if not fatal, life changing. Better the artey is damaged, and repairable.

As far as the waking up thing, often, with big abdominal trauma, the patient would remain intubated after surgery. Likely, he would be given a paralytic agent to prevent movement, which could cause more injury. Paralytic agents are not sedative, nor do they relieve pain. If a sloppy anesthesiologist were to neglect to order sufficient analgesia and sedation, your patient would experience massive pain and be unable to tell anyone. He it’s very doubtful his heart would stop, although, pain can cause multiple symptoms. It actually will increase heart rate to an alarming level. It can cause blood pressure spikes or it may cause the blood pressure to drop to such a profound level as to required the support of vasopressors.
Any untoward symptoms would be “discovered” by a nurse, never a doctor. The nurse does an assessment at least once an hour. In very critical patients it could be as often as every 5-10 minutes.
The surgeon visits once, maybe twice a day. He does an abreviated assessment, because he relies on the nurse to be alert to any changes. In most ICUs if a patient has a terminal event, the nurses start the rescusitation. The doctor runs the show once he’s on scene, but, prompt action by the nursing staff save the life.
The ICU nursing staff would never allow a chemically paralyzed patient to go unmedicated. I have, however, recieved patients from anesthesia that have only paralytic recorded on the flow chart. ( In the hospitals where I’ve seen that happen the anesthesiologist has been immediately suspended, one was fired, one was not.)
The only action that would be taken would be to immediately give a dose of narcotic and sedation intravenously. They act nearly instantly.

Two weeks is a very optimistic recovery time. They invariably have stubborn peritonitis, so the surgeon often wouldn’t even close the wound for 3or 4 weeks. When it finally is closed, they need to be watched it be sure the infection is truly clear.

As far are the extent of recovery, if the person was young and in good health prior to being wounded, they should make a full recovery. But realisticly it would take 3 weeks to many months.
Once the skin of the abdomen is healed, normal exercise shouldn’t cause a problem.

Being shot or stabbed in the liver or spleen would be serious, but a surgical repair would bring him back to 100% fairly fast. He wouldn’t be intubated, paralyzed, or even in the ICU after surgery.
A damaged spleen would be, as outlierrn said, removed. It’s not ideal, but life without a spleen is livable.
Livers, on the other hand, have to be repaired. Life just ain’t worth livin’ without it. Or even possible. The liver will regenerate to some degree. Controlling bleeding is often the biggest problem. A severe liver lac can require upwards of 40 units of blood during surgery. Once repaired, the person may or may not be in the ICU. Just the fact of receiving that much banked blood might buy a ticket. The person would likely not be intubated, or paralyzed. They also have a hightened possibility of breaking loose a clot that can cause stroke, heart attack, or other eschemic injury.

Hey, picunurse. I just want to say I have always enjoyed your replies.

I’m no great shakes on the “recovery” mode (my patients are always stable after my procedures, aside from a slow ongoing decomposition), but I sure can give you a lot of places a person can get shot that are life-threatening.

How quickly after the shot does he/she receive medical care? Moments? Because when I was a surgery intern, we occasionally saved someone who was aorta-shot, by clamping it off. Never any inferior vena cava shots - the blood would just keep puddling up from the depths, there was nothing you could clamp. Course a rescued aorta-shot person would likely not bounce back in two weeks.

But that suggests you could go through any medium-sized artery and not die so long as the ambulance gets there inside of two minutes. How about the external iliac artery? Or, crossing the inguinal ligament, the femoral artery, close enough to the peritoneal cavity to bleed inside rather than outside? You could get either of those with a tangential shot through the abdominal wall that would almost look like a flesh wound. If the shot missed the guts, I would think two weeks would be a reasonable recovery time.

Or how about a shot that hits the mesentery tracking right to left, goes below the colon and stomach and just above the pancreas (I know it sounds miraculous, but I see weirder things all the time), and hits the splenic artery, just before heading out beneath the twelfth rib? You could either leave the bullet in the body, or have a nice little exit on the back. Big operation (you do realize most of the pain your character is experiencing will be from the operation - the surgeons’ cuts. GSW itself not terribly painful), probable splenectomy, clamp it off for a quick repair. If no pancreatitis, two weeks not impossible for bounceback.

Just remember, after splenectomy, big risk of pneumonia from encapsulated organisms.

Do you need any descriptions for a gunshot wound entrance or exit?

I remember seeing an ex-mobster being interviewd a couple of years ago. He said there was a hit on a guy who was eating a big bowl of pasta with is wife in his apartment. The hitman came in and killed the guy.

One of the shots hit him in the stomach. He said the pasta spewed out of the bullet hole.

A few years ago I had a sigmoidoscopy*( bowl rescetion).; I was given general anethisa, an epidural, and was not intubated. While they where moving me off the operating table after the surgery, I woke up. They gave me another epidural before sending me to my room. When I woke up, while being moved, I could not talk due to all the drugs, and it was very “foggy”, I was like “Mmmm!..MMMmmm!”
I have always had a high restience to anethesiacs, my mom too. You could angle your story along these lines.

I relize I was not intubated because I was preped for surgery, and it was not an emergency. May be you could have the bullet clip the colon, lots of blood, not bad enough for same day surgery; have the surgery a couple of days later. Or something like that.

  • not sure if I have the right medical term.

A sigmoidoscopy is a test similar to a colonoscopy, it isn’t as long and they use a rigid tube rather than the flexible fiberoptic. You may have been sedated for that.
A bowel resection is an operation, where in, part of the intestine is removed and the ends sewn back together. That can be done as a minimal invasive surgery, as long as they’re not looking for cancer. In that case, you might not be intubated. You wouldn’t be under general anesthesia, either.
For elective surgeries, the endotracheal tube is inserted after onset of anesthesia, and ideally, removed before reversal.
So most people may not even know they were intubated. The chance of something going terribly wrong while under general anesthesia are too great to not intubate.

gabriela, thank you for the compliment. I could tell you some “war” stories about surprising saves with major bleeding, but I’ve promised not to go over the gross line on the board. I’ve been known to make grown men cry. :cool: (or worse)

I will give one example. Not a gunshot wound, but a motorcycle accident. The young man was riding at a high rate, (by his own admission) at midnight on the four lane that runs past the hospital I worked in at the time. Another vehicle hit him and left the scene. His right leg was disarticulated at the hip. The femoral artery was torn, but not completely separated. That type of breach holds the vessel open, unlike a total severing, when the vessel will actually snap back into the surrounding tissue, bringing some hemostasis.
The accident happened 20 feet from the hospital entrance. One of the medic units going back out after a drop off found him, maybe seconds after it happened. Not only did he live, we were able to reattach the leg. He got 85 units of blood in OR, and other blood products too numerous to count. The trauma team had to stay in the OR to give blood products while 3 surgeons worked on him. I was from the ICU, the other trauma nurse was from ER and the two trauma docs were from the ER as well.
We were in the OR for 14 hours. There was a mix up, the next shift didn’t know they were supposed to relieve us, so we had no choice but to stay.
He was in the ICU for three weeks. He had a completely uneventful ICU stay. He went home, and a week later, threw a clot, and died at home from a stroke.

Everyone else:
Please tell me if that was over the line. I don’t want to frighten anyone or make anyone feel ill.
You’re a pathologist, correct?
(I hope I can get this right. I heard it years ago…)
An internist knows everything and does nothing.
A surgeon Knows nothing and does everything.
A pathologist knows everything, and does everything, but a day too late. :smiley:

Thanks for the replies! Once again, the SDMB is an invaluable wealth of information.

The shooting takes place at a high school, so there should be someone immediately available with at least basic first aid. EMTs arrive in 3-5 minutes. The victim is taken by LifeFlight to a metro area trauma center (anyone know a likely place in the San Fernando Valley?) – exsanguination is a big problem, and his vitals are basically in “crash” mode before he even reaches the hospital.

(I’m basing this part on an actual shooting from several years ago. The victim’s condition was described as “extremely critical” and “moment-to-moment” all afternoon long. Yes, he did survive…the doctors called him “a real fighter.”)

Yes, the writer should always know these things, whether it makes the story or not. :wink: I haven’t given much thought about the exit wound, or if there will even be one…exit wounds tend to be messy, don’t they?

I’m a bit confused as to why intubation/ICU would be used for some injuries but not others. Would the patient be intubated before surgery, if his vitals were in “crash” mode? If so, how long would the intubation last?

AHA…I like this one! You see, the character suffers what appears to be a petit mal seizure in the presence of a doctor who knows of his gunshot injury. (This takes place 1-2 months later, still working on the time frame.) However, the REAL cause is supernatural…which means, I can make up any symptoms I want! :smiley: I’m thinking cold/clammy skin, labored pulse, dilated pupils…what other symptoms would possibly indicate a stroke?

Also look for not just dialated pupils but pupils dialated different amounts.

Hemiparesis (sp) - partial paralysis usually of one side of the body or ther other

Pulsus differansus - Expansion of difference between systolic and diastolic blood pressure ex first vitals show BP 130 over 80, 5 min later 135 over 75, 5 min later 140 over 70.

Be careful on your terminology and physiology…having someone in a medical background give it a once over before you call it good to avoid any major rolleyes from the medical community. Terms like stable but serious, extremely critical condition, etc are news shorthand for “we have no fucking clue and couldn’t pronounce it right if we did know what was, but its gonna leave a mark”

Most sigmoidoscopies these days are done with a flexible fiberoptic sigmoidoscope. I haven’t seen a rigid one done since the early 1980’s.

I have no medical qualifications. :frowning:

But I have had a sigmoidoscopy recently! :cool:

It was expertly done.

The admitting nurse (excuse me if I get the titles wrong) explained that they would basically insert a camera up my bottom to check the bowel for any problems.
I wouldn’t need an anaesthetic and it wouldn’t take long.

I was invited to lie down on a table and pick a side to lie on. I could either watch the camera monitor or not. :dubious:
I decided not to watch. I confess to being influenced because the consultant had asked my permission for a student to observe the procedure. This turned out to be a young gorgeous blonde female, who was opposite the monitor…

Anyway the tube went in and then they explained that they would pump air in to help keep my passage open. This felt strange. :confused:

Finally the consultant pronounced me all clear and left me in the hands of the student (so to speak). I was just deciding how to ask her for a date when she mentioned that removing the tube would release the pressure.
I promptly farted for well over a minute. :eek:

(No, I didn’t ask her out…)

I had 10 " of my largintestin removed. Diverticulitus, preferatied colon due to an infection in the little sac things; resulting in a larg absess. Absess removed, bowl recection, with a bag for 4 mounths. Thank god that was reversed. If I was intubated, they never told me. They explain the whole procdure; but I guess they concentrait on the surgery and stuff; they did tell me they where doing an epidural, thhey should have mentioned the intubation.

Not over. Rather mild and quite interesting, IMNSHO.

lets see:

Intubation is one of the first things to do with a “crashing” pt, even if their problem isn’t primarily respitory. Post op intubation can last for days or weeks. In a previously healthy pt it depends a lot on the surgery. It’s not unusual to chemically paralyze a pt post op if a chest or belly wound hasn’t been closed due to swelling or contamination, movement could be fatal, such a pt will be intubated and on a ventilator.

stroke: acute mental status changes, slurred speech, facial droop on one side with weakness of one or both extremities on the same side are the BIG symtoms we see in the ER. I have seen a strokes cause siezures and generalyed changes instead of the usu one side or the other, but that’s less common. It all about location, whatever portion of the brain is blood deprived, that’s the function that will be lost. There are two types of stroke, occlusive ie blood clot, or hemorrhagic ie ruptured vessel, both present the same, but are treated differently. Basically there’s nothing we can do for a bleeder except wait and see, maybe bring their blood pressure down if they are hypertensive. Surgery to evacuate blood from the skull is possible, but that’s after a massive event and your character is not going to get back up and fight. With a clot, you can have a dramatic event and a dramatic recovery, at least it’s medically possible, even if it doesn’t work out that way IRL as often as on TV. Rapid administration of clot dissolving drugs is the key here.

I’ll match you story for story anytime you want, let’s party :slight_smile:

Picunurse, that was not over the line. Well, at least my line. Well, um, that is to say, I lost track of the normal human line long ago.

I find war stories fascinating, and hope to tempt you across the line to more of them.

I’m a forensic pathologist, and I think I have successfully pushed the line a foot or six farther out in only a hundred or so posts.

Why don’t we start a thread entitled “War Stories Known to Make Grown Men Cry”, and alternate until somebody reports crying?

and they dared threaten me with the goat…

Ooh ooh ooh. Ooh ooh ooh. Can I play?

Those’re bad. You have to be young, and a fighter, to come back from those.

Entrances are a quarter inch wide, look like neat, punched out ovals with a continuous trickle of blood from them, and have a thin dark ring at the edge of the raw flesh (the “abrasion ring”). Exits are a quarter inch to a half inch wide, look like slits or torn slits with v-shaped ends, and have a thinner trickle of blood from them, and no abrasion ring.

The exit is only messy when you are shot with a rifle or other high velocity gun. Those exits are the classic ones which most people think of - the famous exits that are larger than the entrances. They are not typical. By no means. At all. The exit from the average handgun looks a bit like what you would get if you were playing around with a broom handle inside a pup tent, and you accidentally poked it through the top of the tent. A slit with tears at the ends.

Plus the trickle of blood, of course.

Intubation is used whenever we can’t count on the patient to handle his breathing himself. Absolutely, anyone who’s crashing will be intubated. Anyone with a flesh wound will not be intubated. In betwen, judgement call, erring on the side of intubate.

If you have elective surgery, you will be put under and then intubated. There is a danger moment right between “going under” and “intubated”, which all anesthesia personnel I have ever watched handle with professional smoothness. You are extubated before you wake up. You are hoarse afterwards for a day, and may not know why.

If you have elective or emergency surgery, and you are too ill afterwards to be relied on to breathe on your own, you will remain intubated, awake or not, until you can be trusted to breathe without help. You may find this process very difficult and annoying. Picunurse, have you had many people who were awake and alert but ventilator dependent, who tore out their own ETT and died from it? I will never forget one of mine… I gave her my Sunday paper to read in the ICU and my last sight of her was reading it intently in the morning, then off to the morgue in the afternoon. Brr.

Of course that was from before I was a pathologist.

Along the same lines, any truth to the notion that a gut-shot leads reflexively to a bowel dump?

Death leads reflexively to a bowel dump.

The cases I have seen strongly suggest to me that all peristalsis ceases completely the moment the bowels are injured. Ugh, that week-old pastrami, in half-chewed bites, still motionless in his stomach a week after he was shot in the belly.

Makes sense, I remember from my surgery training that even handling the bowel made it go insulted and stop processing for a few days.

Picunurse? Ever seen gutshot lead to bowel dumping? Hunters?

I have but it was not via normal channels. Shotgun slug left to right through the abdominal cavity pretty thoroughly eviscerating him in the process, wasn’t much of his intestines left inside. Guy didn’t make it.