Ellis sent in this week's medical question.
A man has been shot in the chest and is lying face-down. The bloody exit wound is visible on his back. Should the witness turn him over and try to stop the bleeding in front? She can place a wad of cloth over the hole in his back, but would that help? Paramedics are maybe ten minutes away. What should she do? I want him seriously hurt, but he should live to recover.
A second man has been hit over the head with a china lamp as he stuck his head inside a doorway. He’s unconscious, but I don’t want him dead either. Would a head wound bleed a lot? Is he likely to be unconscious for a while or could he recover enough to get to his feet and possibly fire a gun?
Here's my answer.
The important thing in your case, Ellis, is to keep your victim breathing, so yes, the witness should turn him face up, and she can use a wad of cloth to help put pressure on the exit wound when he's on his back. Gravity will then cause most of the blood to flow downward towards the exit wound. There will still be some blood flow from the entrance point, so yes, the witness can cover that wound also. The victim's biggest problem will be a traumatic pneumothorax and/or hemothorax on the affected side of the chest. (Thorax means chest, pneumo refers to air, hemo refers to blood.)
I'm assuming the bullet missed the heart and only hit the lung. A traumatic pneumothorax is a collapsed lung due to trauma, in this case the bullet passing through the lung. A collapsed lung occurs when air escapes from the lung and fills up the space outside of the lung, inside the chest. The lung more or less folds in on itself, making it difficult for the victim to breath.
A hemothorax occurs when the bullet tears the inner lining of the chest wall or the lining covering the lung. Blood flows out into the space between the chest wall and the lung, and again we have pressure on the lung causing collapse and extreme difficulty breathing.
Blood loss is generally massive in gunshot wounds to the chest because each side of the thorax (chest) can hold 30-40% of a person's blood volume. The blood will leak out from the wounds, but it will also build up inside the chest cavity around the lungs and the heart and put so much pressure on the heart that it can't pump blood to the brain or the rest of the body and will eventually stop beating. Your witness will see frothy blood flow from the chest wound which indicates air bubbles mixed with the blood. She may also see blood coming from the victim's mouth.
The witness will mainly want to keep the victim breathing, and may have to assist breathing with mouth-to-mouth resuscitation. Your victim may be conscious when first shot, but shock due to rapid blood loss will render him unconscious within a minute or two. Even if conscious, he'll be too busy trying to breathe to be able to speak.
Ten minutes is a long time to have to wait for your paramedics. If you want this guy to survive for that long, I'd shoot him in the lower right chest so that the affected area is the lower lobe of the right lung. The right lung has three lobes, or sections, so if you shoot him in the third lobe -- the lowest and smallest lobe -- the upper part of the lung has a better chance of staying inflated and helping him breathe. Also, the blood will drain down and away from the heart causing less chance of pressure on the heart from accumulated blood in the chest. I'd have the witness turn him over and apply a wad of cloth to the back, then cover the chest wound with a cloth, then turn the victim on his affected side so the wound opening is down and the good lung is up (helps with breathing and keeping blood from putting pressure on the heart). Then have the witness apply pressure to both the chest and the back wounds using one hand for each wound. Take pressure off the wounds every 4-5 minutes to let air escape from the chest, then apply pressure again.
http://www.primary-surgery.org/ps/vol2/html/sect0247.html You can check this site for pictures that may help you understand what happens to the lung.
As for the guy hit over the head with a china lamp, unless the lamp is really heavy, it's unlikely he'd be more than stunned by the blow. So yes, he could easily get up and fire a gun. If the lamp broke and cut his head, yes, he'd have a lot of bleeding. Head wounds bleed like mad. Even a one inch long cut will bleed enough to mat the hair, cause blood to run down the face and neck and reach the shoulders. I saw plenty of patients in the ER who looked like somebody threw a bucket of blood on them, and it turned out they had cuts that only required a few stitches. Of course, the deeper the cut, the more it bleeds, so if you want the guy to fire the gun and miss, a good whack on the head should stun him enough to throw off his aim while also messing with his vision by having blood pour down over his forehead into his eyes.
Do you have a question concerning medical procedures in the ER, medical care given by paramedics, or first aid hints for use by your sleuth? Send your questions to me at firstname.lastname@example.org and I'll do my best to answer them.