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.

Stab wound to the chest

Hello. My hero is in an altercation, and is stabbed in the chest. I know he’ll be bleeding. I want him to need hospitalization, but don’t want him to die. What can my heroine do besides call 911?

911 is a good start. After you get expert help on the way, the heroine needs to do the ABCs: Airway, breathing, circulation. Airway—make sure the hero doesn’t have anything blocking his throat that would prevent breathing. Breathing: is he? If not, she’ll need to give him breaths. Circulation: does he have a pulse? If not, CPR is next. The current method is to do CPR to “Stayin’ Alive,” the old Bee Gees’ song. (oh, oh, oh, oh, stayin, alive… one compression for each word). Giving breaths is appropriate, but the current focus is on circulation. Since he’s been stabbed in the chest, it’s good to move the clothing away from the wound to get a look. Is air coming from the wound? Pink froth? Seal the wound with something occlusive—a palm, a waterproof jacket, latex glove. Go with what you have available. If the hero seems to be getting worse, and his neck veins are standing out, he may have a tension pneumothorax—a big term meaning air from the damaged lung is leaking into the chest cavity and compressing the lung. Letting the air out helps. This is the maneuver you see on TV/in the movies where someone jams a needle/pen case/straw between the ribs, and air whistles out. If you choose to have this scenario, please have the good Samaritan punch through at the top of a rib—blood vessels and nerves run through a groove at the bottom of each rib, and you don’t want your patient to get worse! Shock may set in—he’ll feel cold, shiver, have a thready (weak) pulse, and become pale and sweaty. This would be a great time to have paramedics show up, as the hero is going downhill fast. The next entry will cover what happens to our stabbing victim in the ambulance and the ER. 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.