Friday, September 7, 2012
The Ambulance and ER Management of Stab Wound to the Chest
What happens to a stabbing victim in an ambulance and the ER? This is a general overview—take what detail you want for your scene. The EMTs or paramedics will stabilize his breathing—if necessary, they’ll put a breathing tube down his throat and into his airway. Then they can “bag” him—use a pliable plastic bag to push air into his lungs—breathe for him. The chest wound will be inspected and covered. An IV line will be started (at least one) of a large size to add volume to the blood supply and keep the blood pressure up. This also allows medications to be given. A heart monitor will be attached. Blankets to maintain warmth and help stave off shock. During all this, heart rate, blood pressure, and breathing will be monitored. The ambulance will be in contact with the ER. In hospitals that have the capability of functioning as a trauma center, a surgeon may be waiting for the patient. Otherwise the ER staff will be ready for a “hot unload,” a seriously ill patient in need of immediate attention. The goal in the ER is to stabilize the patient. Depending on how the hero is doing, he’ll get a chest X-ray, maybe a CAT scan of the chest and abdomen (low stab wounds can involve the belly), and a tube may be inserted into the chest to reinflate the lung if it’s collapsed. This tube drains both blood and air. Blood will be drawn for labwork, including a type and cross for blood. The hero might need surgery. This will depend on the extent of his injuries. The surgeon, the ER doc, and the imaging tests (X-ray and CAT scan [if done]) can make this decision. I’ve seen stab wounds minor enough to require very little, up to life-threatening wounds requiring emergency surgery. You can tailor your scenario to give the result you want. The more severe the injury, the longer the hero will be in the hospital. One last minor detail—he’ll need a tetanus shot unless he’s had one in the last five years! Questions? Comments? Kelly has worked in the medical field for over twenty-five years, mainly at large medical centers. With experience in a variety of settings, chances are Kelly may have seen it. Sometimes truth seems stranger than fiction in medicine, but accurate medicine in fiction is fabulous. Find her fiction at www.kellywhitley.com.