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joycewritesjournals  asked:

Hi Auntie. My 25-30 year old character is shot in the arm, then immediently glanced by/partly run over at speed by a very large truck. His leg is crushed under the knee and he has to have it amputated. Does that seem like a realistic injury to need amputation? How quickly would he die without medical care? What would happen on his arrival to the hospital, as far as what treatment he would receive immediently to keep from dying? Sorry if these are stupid questions, Thanks loads for what you do.

Hey @joycewritesjournals ! Thanks for your ask. Absolutely none of this is a stupid question. 

I would believe this story if the kid was running away from the shooter and into the truck, particularly if he actually ran into the side of the truck and got his leg caught underneath. 

A BKA (below-the-knee-amputation) for a crush injury like this is absolutely a realistic outcome, especially if pulses in the foot are lost. Damage to the leg tends to be catastrophic from crush injuries, and outcomes may be better with amputation than with surgery to try and fix the demolished tissue. 

First things first: You asked how quickly this character will die. The answer is, if there’s an arterial bleed, about 5-15 minutes; however, truckers do not want people they have run over to die, and will likely stop and apply a touriquet made out of some material or other. Shirt sleeves work well, belts work poorly, but something. It’s also likely that there isn’t an arterial bleed, so your character has basically infinite time if that’s the case. 

Your character is going to get scooped up by EMS, have anything that’s bleeding intensely treated, and, if there’s time, have that leg splinted. Next stop is a trauma center, where the character will be stripped naked and inspected for injuries. Doctors will touch his head, his neck, his chest, his abdomen. Depending on the trauma team, he may have a finger inserted into his rectum (with a glove and lube) to check for rectal tone, though this is falling out of fashion. 

He’ll get IVs and pain medication, and the team will work from there. Treatment will be dictated by a single maxim: what will kill him first? 

Assuming there’s no arterial bleed from the crushed leg – and often times there won’t be, but often times there will – the team actually has some time to call down orthopedics and get a consult about that leg. Even if there was an arterial bleed, it’s already been stopped, either by the trucker or by EMS, so the ER will just have to manage the blood values, likely with what’s called a massive transfusion protocol, where the character is given 1:1:1 units of packed red blood cells (PRBCs), fresh frozen plasma (FFP), and platelets. He may also receive an injection of a medication called tranexamic acid, or TXA, which promotes clotting. 

The surgery isn’t going to have to be immediate, as in get this the fuck out of my ER; the leg can wait to make sure that they have a good sense of what else is going on. Ultimately, the leg is going to go, and it will go in the first few hours, but the team has time to organize, make a plan, get consent, allow the character to make some phone calls, etc. 

One other thought: expect some significant damage to the knee in all of this. A lot of force has been applied to the lower leg, probably not in an “ideal” position, and the knee will have some twisting. ACL issues, tendon repairs, dislocated kneecap… any of these would be realistic and would actually add to the realism. 

Since you asked about immediate care, that about covers it! Hope this was what you needed :) 

xoxo, Aunt Scripty

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Ich habe dich verloren.
Erst schleichend. Langsam.
Und dann mit voller Wucht.
Das ist jetzt fast vier Wochen her.
Ich habe nicht geschrien.
Ich habe nicht geweint.
Ich bin leer.
Einfach nur leer.
Es müsste mir das Herz brechen.
Vielleicht tut es das auch.
Ich weiß es nicht.
Ich fühle nämlich nichts.
Rein. Gar. Nichts.
Das ist nicht gut.
Weil das kann nur eins heißen.
Dass es irgendwann über mir zusammenbrechen wird.
Wenn ich nicht damit rechne.
Und dann werde ich zusammenbrechen.
Ich habe dich verloren.
Vor vier Wochen.
Fünfundzwanzig Tagen.
Und ich werde es wahrscheinlich nie verstehen.
Das ist das schlimmste.
Denke ich.
Dass ich nicht weiß warum.
Dass ich es nie wissen werde.
Weil du einfach aufgehört hast, ehrlich zu mir zu sein.
Vielleicht auch zu dir selbst.
Ich denke daran.
An deine letzten Worte zu mir.
Und an die letzten zwei Jahre.
Wie das alles nicht zusammenpasst.
Ich denke permanent daran.
Und fühle nichts.
Und genau das macht mir Angst.
—  21.07.2017
Wenn ich dir sage: “Pass auf dich auf.” “Fahr vorsichtig.” Dann meine ich eigentlich damit: Ich liebe dich zu sehr und könnte es nicht ertragen, wenn dir irgendwas passiert.