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Thursday, January 9, 2014

Medfacts #3: Stabbed in the chest part 3: Lung laceration and hemothorax

As always, we're dissecting health realism for writers—what really happens when your heroine gets stabbed in the lower right side of the chest? We've dissected puncture wounds, and now we're talking full-scale broadsword or spaceship-accident lung laceration. This goes in more than 4 cm and leaves a long gash, not a puncture, in her lung.

Now you can't save her life by just draining out the air in her chest. We're now talking surgery to remove a damaged lobe or sew the lung back together, and that's a whole 'nother ballpark. That's not going to happen on your fantasy battlefield. Maybe in your scifi story. You'll need super-fine surgical thread, for one thing, and in addition to getting air out of the pleural space now we have the added problem of having to open her up to sew up her lung (which of course lets more air in).

Where's the line between the puncture wound and the wider laceration? You'll know partly because most likely your heroine won't just have air in her thorax—she'll have lots and lots of blood filling it up, too. Don't all cuts bleed? Sure, but usually you bleed outside, not inside your body, and the small stealthy puncture we've dealt with previously probably won't gush blood. But now? That diamond-studded space-sword will have cut intercostal (between ribs) blood vessels on its way in--it's too big to have missed these big vessels--and you'll start filling her chest with blood. That blood build-up's called hemothorax. It also pushes on the lungs and sucks. A heroine with hemothorax will feel kind of like her chest is burning: the blood is so warm, both as it's gushing into the cavity and onto her skin outside of the wound, that it actually feels distractingly hot, like boiling.

If she's been stabbed with a large sword like this—or say a surprisingly solid shard of glass from a bar-fight—it's likely you'll also have lacerated or damaged the intercostal nerves just below each rib. That means that, in addition to the heavy pressure pain she feels all over her chest, she'll have a very intense, specific, stinging, stabbing pain near the stab wound. “Won't a stab wound always hurt, even if you don't nick a nerve?” Sure, but not like this. Our original scenario--knife between the ribs 4 cm in, just enough to puncture a lung—could even happen in a crowded bar, stealthily, where she feels a nick in her side and doesn't really know she's been stabbed until she starts dying. Pain fibers are the slowest nerves in your body, you know. But the giant sword-thing we're talking about now? Oh, she'll know right away. Partly because of the GIANT SWORD in her face, but partly because this will sting, burn, and ache all at the same time. Maybe if she's lucky the sword lacerated the nerve completely, in which case she won't feel the rib pain as much as she feels the crushing in her chest. 

This unsalvagable scenario doesn't give your heroine much time, but it's a good way to do a choking, suffocating goodbye, if you're the kind of meanie who kills off characters. Survival after this injury takes intensive recuperation, so it's probably not the most realistic injury choice for your MC leading up to another mission, battle, or story climax; this needs to be THE climax injury of the story, unless your story's about recovering in a hospital for a long time.

So I think we've covered the most common lung trauma you get in a typical novel adventure; we're gonna finish up thorax next time with the left side of the chest (hint: your heart's over there!), and then do a quick special on getting shot. We're making your novel a little more realistic with each knowledge tidbit!

Go back to the previous post, or the next post, in this series.

All information from Grant's Atlas of Anatomy, Lippincott's Illustrated Q&A of Anatomy & Embryology, Moore's Essential Clinical Anatomy Third Edition, and the January 2010 article by Nishiumi N., et al, on pulmonary laceration in the Annal of Thoracic Surgery.

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