Internal Bleeding: How long without treatment will one survive.

[mooeypoo]

Hi,

 

Well. This is for a story I'm writing. Sorry to be so "scientifically-shallow" in my motives

 

If a person gets stabbed, concidering the fact most abdomen stab dangers are internal bleeding, how long can he survive without someone taking him to a hospital? What can that person do in order to prolong that survival time?

 

I'd appreciate responses, even if it does sound a bit weird of a question..

 

Thanks guys

 

~moo

[Genecks]

Yes, how long can he survive.

[mooeypoo]

well, my character is a female. Story, remember?

 

Now answer and stop nitpicking!

 

~moo

[Nevermore]

It depends on what the stab wound hits. Anywhere from 30 seconds, if it hits the aorta, or indefinitly, if it hits no major blood vessles. But, on average, I'd say a few hours.

[Glider]

It's impossible to say. With an abdominal stab wound there will always be internal bleeding. The result can be anything from the wound healing (i.e. no real damage and the body's own mechanisms stopping the heamorrhage) to death in well under a minute (puncture to the left ventricle or ascending aorta) although they would be more thoracic wounds.

 

So survival times are directly related to which area/organs are damaged. If the liver is damaged there will be serious bleeding. If it is badly damaged you might live for a couple of hours. If the hepatic artery is hit, you will live for minutes only. The same for kidneys or renal arteries. If you hit the pancreas, bleeding will be severe and could kill you in anything from a few hours to minutes depending on the severity of the injury.

 

GI (gastro-intestinal) wounds including any section of the colon result in less severe bleeding, but then the main risk is peritonitis; serious infection caused by leakage of the contents of the illium or colon into the peritoneum. This can kill you in days if left untreated.

 

Punctures to the vena cava (the venous analogue to the aorta) will also kill you, but more slowly than punctures to the aorta as the blood pressure in that vessel is a lot less.

 

So, the short answer is that it depends entirely on the severity of the injury and what structures are damaged.

[gcol]

Short answer: How long is a piece of string?

[mooeypoo]

Woah Glider THANKS!!!

 

That was an awsome response, now I know how to sort out the condition of my currently dying character without rewriting my story! Awsome, thanks!!

 

If I may, only last subquestion: What are the physical conditions, or "stages" that accompany that type of bloodloss?

From my time in the military, I remember learning that bloodloss is accompanied, first, by numbness of the limbs, and that the action of "fainting" - falling to the ground - is the body's defense mechanism, allowing blood to reach the brain without the interference of gravity.

 

What are the following physical stages / "signs" of bloodloss, or internal bleeding?

 

And another thing. In movies, we seem to always see someone spitting blood when injured in the abdomen. From what I could read, this is not true for abdominal injuries, but only for chest injuries -- the blood entering the lungs.

Is this true, or am I wrong?

 

 

I am trying to do what some movies (and stories) fail to do, and make this situation realistic. My character is currently lying on a floor, stabbed in the stomach 4 times. I want her to end up alive, but I also want her physical state, throughout the story, until she is found at least, to be realistic

 

Thanks!!!!

 

~moo

[cpwmatthews]

It would depend on how large the implement that did the damage was and therefore the amount of blood loss, We have 8 pints of blood in our system, approx. so the calculation can be done.

[mooeypoo]

How much blood can one lose without dying?

 

I once heard something about a third.. that sounds WAAAAAY too much though...

 

~moo

[cpwmatthews]

a 3rd sounds about right although I have heard of more I think, It would also depend on how hot or cold you were and the rate at which the heart was pumping, being active or not.

[mooeypoo]

The character I'm writing about is extremely fit, in great shape in fact.

 

Would that help her survival odds?

 

Plus, please, for the sake of realism, what are the symptoms she should have as her condition degrades? What does one experiences with loss of blood and internal bleeding?

 

~moo

[cpwmatthews]

If someone was fit then their heart rate should be lower but as i said depending on the temperature and when they last excercised. the symptoms I believe would be tierdness, dizzyness, coldness, then into unconsiousness then death

[Glider]

If I may' date=' only last subquestion: What are the physical conditions, or "stages" that accompany that type of bloodloss?

From my time in the military, I remember learning that bloodloss is accompanied, first, by numbness of the limbs, and that the action of "fainting" - falling to the ground - is the body's defense mechanism, allowing blood to reach the brain without the interference of gravity.

 

What are the following physical stages / "signs" of bloodloss, or internal bleeding?[/quote']There are several symptoms your character would suffer as a result of internal bleeding. Abdominal swelling and discolouration would be one (particularly if bleeding from the liver). The main symptoms of internal bleeding are those of hypovolemia (an overall reduction in blood volume). However, some are related to reduced haemaglobin (Hb) which reduces the oxygen carrying capacity of the blood.

 

The speed at which these stages progress depend upon the severity of the bleeding, but essentially they are as follows:

 

1) Peripheral shutdown. The hands and feet go cold and pale as the body shuts down peripheral vessels to maintain pressure in the central compartment. The skin goes pale and clammy.

 

2) Postural hypotension/syncope. The person if prone, would feel dizzy or faint if moved to a more upright posture.

 

3) Elevated pulse/breathlessness. As the Hb drops, the body compensates by elevating heart rate. The pulse is often described as 'thready', fast and weak.

 

4) Loss of vision/greying out. The retina is very sensitive to oxygen deprivation. A comparitively small reduction leads to greying out if vision. The vision goes grey from the peripheral field (i.e. tunnel vision) and then fades completely. By contrast, the auditory sense is the last one to go before death.

 

5) Cyanosis. The person's lips and nail beds turn light blue. This shows severe oxygen deprivation. Respiration would be shallow and fast (panting).

 

6) Loss of consciousness. May respond to painful stimuli for a while, but without transfusion the coma deepens.

 

7) Death. There is insufficient blood volume now so the usual result is cardiac failure. The heart goes into VF and the patient arrests. That's it.

 

And another thing. In movies, we seem to always see someone spitting blood when injured in the abdomen. From what I could read, this is not true for abdominal injuries, but only for chest injuries -- the blood entering the lungs.

Is this true, or am I wrong?

It depends. Coughing up blood is usually the result of damage to the lungs or trachea. What we see in films is a bit crap though. If a person is bleeding into their lungs or trachea, they are essentailly drowning, so they would be choking too much to be capable of speech.

 

However, the result of a ruptured oesophegeal anurism can be quite impressive. Blood gouts from the mouth. The immediate risk here is aspiration. Similarly, if there is damage to the oesophegus through a stabbing, the person is quite likely to bring up blood. If the wound is lower, i.e. anywhere lower than the pyloric sphincter/duodenum then it's unlikley the person would bring up blood. Bear in mind that the stomach itself is quite high; directly under the left lung and largely protected by the ribs on that side. Stab wounds to the abdomen would usually miss the stomach and hit lower in the GI tract. In this case, it is highly unlikely your character would bring up blood.

 

I am trying to do what some movies (and stories) fail to do, and make this situation realistic. My character is currently lying on a floor, stabbed in the stomach 4 times. I want her to end up alive, but I also want her physical state, throughout the story, until she is found at least, to be realistic

 

Thanks!!!!

 

~moo

Ok, if she is to survive, she could go to stage 5, or 6 (above) for a short time. With such a loss of volume, she is at extreme risk of cardiac arrest. Whoever finds her will need to push fluids and plasma expanders, i.e. cannulate her and get a peripheral line in (which will be hard because of her peripheral shut down, so finding a vein would be very difficult). They might have to use the femoral vein as finding a vein in normal cannulation sites would be a nightmare (unless they were large and shallow).

 

They can't use whole blood as presumably she hasn't been crossmatched. Plasma expanders are substances that increase the blood volume. Things like albumin, gelatin and starch are used. Obviously fluid is necessary too. Normal saline (sterile 0.09%NACL solution), or pre-mixed plasma expanders (depends on the resources of whoever finds her). There are also artifical oxygen carriers that can be used in place of a whole-blood transfusion (temporarily), but the priority would be to get her BP up to avoid her arresting. The other priority is to try to stop what you are pushing in from squirting back out.

 

Her physical state would be blanched, clammy and cyanotic with low BP, fast, weak pulse and rapid shallow breathing. She would possibly be on the verge of unconsciousness and not too coherent although possibly responsive to verbal stimuli. Her vision would be impaired. Moving her to an upright position would be a mistake.

 

I hope this helps.

[mooeypoo]

It sure does, wow, THANKS Glider!!

 

This is great I can now fully write a relatively realistic scenario for this without getting knowing-people to gasp in frustration as they read my story That ahppens to me when I see a scientific mistake in a story and it can ruin the entire experience.

 

<bows>

 

Many thanks

 

~moo