herbs-and-poultices

[herbs-and-poultices]

If someone wanted to write accurately about bruised or broken ribs, as well as a possible accompanying pneumothorax, what would they need to know?

Here’s a previous post I did on rib injuries.

1. Simple rib fractures hurt, but there’s not tons we can do about them. We don’t "bind” ribs or put casts around chests. We can have people hold pillows against their injury as a kind of brace for moving/deep breathing/coughing, provide pain medicine and ice to make it easier/more pleasant to move and breathe, and we can give oxygen if that isn’t enough, and finally we can be total sadists and insist that people use their hospital-issue incentive spirometer to prevent pneumonia and atalectasis (a form of collapsed lung where the tiny air sacs in the bases of the lungs don’t open) setting in due to them not breathing as much as they should.

2. More complex rib injuries, like “flail chest” where basically a segment of several ribs is completely broken and moving independently of the rest of the chest, require surgery to correct. After the surgery, it’s the same- cough pillow, pain meds, oxygen, and incentive spriometry (IS).

3. There is a difference between a pneumothorax, tension pneumothorax, atalectasis, sucking chest wound, and hemothorax. It’s something TV screws up a lot. Here’s the quick guide:

Pneumothorax: air escaping from the lung into the closed chest cavity. This decreases the space that the lung can expand, and causes a partial collapse. These can be traumatic (from a blunt chest injury), iatrogenic (side effect from a medical procedure), or spontaneous (such as in Marfan syndrome or COPD). We might just give some oxygen if needed, encourage IS, and keep an eye on it until the body starts to absorb the extra air. If it started to get worse or the patient was in distress, they might place a chest tube to drain the air.

Tension Pneumothorax: This is a pneumo that has become life threatening, and is immediately going to kill this person if the air doesn’t come out. In a field setting this means a “chest dart” or needle thoracotomy, where a large IV catheter is placed in the chest to drain the air, after which the person would get a chest tube. In a hospital, they might go straight to the chest tube.

Atalectasis: This is also, technically, a collapsed lung, but no air has escaped into the chest cavity. Instead, if a patient breathes too shallowly, the tiny air sacs in the lower sections of the lungs never get to expand, and without the positive pressure from breathing, they deflate and eventually collapse. This is bad because bacteria becomes trapped inside them, in a perfect environment to grow and cause pneumonia. This is treated and prevented with IS, breathing treatments, oxygen, and sometimes positive pressure from a CPAP machine or even ventilator if it’s really, really bad pneumonia.

Sucking Chest Wound/Open Pneumothorax: This is a puncture injury through the chest wall. Air pulls in from the wound every time the person breathes, which takes up more and more space until the lung collapses. While the air is still a big problem, it can’t be solved by just making another hole. Instead, the treatment is to cover the hole in the field (sometimes with a 1-way valve to let air out of the wound but not back in) and then later surgery to repair the chest wall and a chest tube.

Hemothorax: Basically the same as a pneumothorax, but something’s bleeding into the chest cavity instead of air being leaked into it. It’s treated with a chest tube, etc...

Hope that’s what you were looking for!

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Hi, have you done a post about treating/caring for rib injuries and broken noses? If not, would you be willing to?

RIB INJURIES:

Simple rib fractures aren’t that serious medically, but they hurt a lot. The muscles around them generally hold the breaks in place, so no splinting or binding is necessary (and can cause more harm). If the person needs to move, holding a folded blanket or pillow to the site can help ease pain.

If the character can go to the hospital, its probably a good idea because like I said, they hurt a lot, and hospitals have painkillers. Pain from rib injuries sometimes causes a person to breath shallowly. While survival instinct will (often) make it so they will breathe enough to live, breathing shallowly for long periods of time can increase the risk for pneumonia, which always complicates a situation. If one of your characters is a medical professional, they would encourage the person to take several deep breaths per hour until they can breathe normally. This will hurt, but its necessary.

If you want to write your character not breathing enough to live, they might display symptoms of confusion (saying weird things, not fully understanding what’s going on or where they are), anxiety, sleepiness, and/or headache. These symptoms may get somewhat better immediately after taking those few deep breaths, and then quickly return.

A much more severe form of rib fracture, called a flail chest, is a lot more serious and definitely requires medical evaluation and care in a hospital setting. Flail chest is where a section of several ribs breaks off and fails to move with the rest of the chest wall. The ceceeding segment will literally move into the chest cavity when the person breaths in and bulge out when the person breathes out, opposite of the rest of the chest.

This can be stabilized in the field by taping a folded blanket or pillow to the area, but not all the way around the chest, which will keep the moving piece in place enough so the person can breathe. The pain will be bad enough that the person probably won’t be able to move.

At a hospital, surgery would be performed to pin the moving parts to the non-moving parts. In really severe cases or if painkillers can’t make a person comfortable enough to breathe adequately, a ventilator may be needed to ensure that the person is breathing enough. But that is rare these days.

BROKEN NOSES:

Again, if this is a simple break, the person can still breathe and the bone has not become dislodged (no weird shape), there might not be much a medical professional will be able to provide except pain control and advice to ice it and keep swelling down.

The next step up is the bone and cartilage portions have become dislodged. that a doctor will be needed to realign the bone portion with the cartilage portion. This can be done manually. It hurts a lot, so if it is done in a doctor’s office, local anesthetic will usually be used.

The next step up after that is that the bone part is broken in several places. This cannot be set manually and needs surgery.

There will be a lot of swelling involved, and usually the nose will bleed initially. Some people get two black eyes that can last for a few weeks.

R E F E R E N C E S

Werner, D., Thuman, C., & Maxwell, J. (1992). Where there is no doctor: A village health care handbook. Palo Alto, CA, U.S.A.: Hesperian Foundation.

[herbs-and-poultices]

the concerned team surrounds a badly hurt whumpee after a battle. their surroundings are still horribly dangerous, so whumpee can't lose it. not now, not here, not without risking lives. but with a burn that pulses like agony, or a wound stinging with corrosive acid, or a spear impaled half through the stomach, it's all they can do to clench their fists, loosely cradle their injury, and shut their eyes tight against the pain. too loud, and the whole team is in danger.

so, with teeth bared, they haul a high pitched, keening whimper up from the back of their throat.

the sound is pleading and uneven and through their normally calm voice, horrifically out of place. it's the final straw to the team that they need to get out, and soon. because whumpee never makes that sound.

(not unless they are desperately holding back a scream.)

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hidden injury is great, but a subversion that gives me so many whumperflies is when Whumpee is injured, it's a bad injury, and the team knows this. but they can't stop. they've got a mission to complete, they have to keep moving, they can't be spotted, et cetera. the brawn supports whumpee's weight, the medic is tracking their vitals with quick glances and questions, the leader is forging onward to get to safety as soon as possible. all while Whumpee doesn't hide the pain, but takes it with grim determination. they have to keep going. they have to. they will.

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whumpee propped up against caretaker’s chest when the fever takes away all of their strength, lucid enough to enjoy some company

whumpee propped up against the pillows, eager to be active but unable to move around all that much; perhaps tomorrow they’ll be able to sit properly, at least

whumpee leaning on caretaker’s shoulder when they try to get up and walk for the first time since the injury

whumpee held up in a saddle, caretaker sitting behind them with their arm wrapped protectively around whumpee’s chest

whumpee sitting at the backseat of a car, their head pressed to the cool glass; they’re still shivering but caretaker’s coat’s warm and cozy, it feels like home, and they can’t help but relax

whumpee leaning on the table, eyes closed and breaths shaky, when a sudden fainting spell washes over them

whumpee sitting on the ground with their back against the wall, too weak to get up while the adrenaline wears off

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Old injuries that flare up... when the character gets sick.

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@comfort-questing Yes to all of the above.

An injured character who's lain out in the elements so long that they are discovered so cold and still and pale it is initially difficult to determine whether they even still breathe, garments damp with dew or rimed with frost and lying as though lifeless where they've fallen.

[herbs-and-poultices]

I'm generally in agreement with what other people are saying.

Any treatment that happens outdoors, in a tent (except one equipped for high-level medical management), or prior to moving the character from the scene of the incident is definitely field medicine. Initial stabilization or stop-gap measures that are performed on the way to a medical facility (except in an equipped medical vehicle) also count as field medicine.

Treatment that happens in a building other than a medical facility can still be field medicine, as long as the level of care available is clearly inadequate for the severity of the character's condition. A lot of care/management must be improvised, at least some can't be done at all, and the character really needs to be in a medical facility and is at risk of or actually experiencing negative outcomes due to lack of more definitive care.

(Personally I would tend to exclude treatment at one of the characters' homes or at the group's "home base", but purely on account of vibes, since I would count a similar situation as field medicine if it happened at a tavern, hotel, hunting cabin, safehouse, or stranger's home.)

In terms of topics, I have little knowledge and much curiosity, so I'm happy to hear about anything really! Off the top of my head though, bone fractures (closed and compound), different types of wounds (scrape slash puncture etc), infected wounds, respiratory viruses, pneumonia, asthma, malnutrition...?

Community Brainstorm for a Field Medicine Project

Hey folks who write (or enjoy) field medicine in fiction/fics:

These last few weeks I've been gathering some sources and putting together a detailed outline for a longer-term project I've wanted to put together for some time.

I'd really appreciate it if you replied to this post and told me:

1- What is the highest level of care you consider "field medicine" (for example, does anything outside a hospital go, or does it need to be in specifically the backcountry or behind enemy lines to count?).

2- Any particular conditions you would like to know how to handle at that level of care <- this is what I'm most interested in, list as many as you want.

Thank you for your time!

[herbs-and-poultices]

The especial slow-and-steady care which must be taken in easing a character's clothes on or off past an injury, both due to the bulkiness of the wounds' dressings and to the pain of manipulating the site to maneuver the clothing into place.

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THIS.

A character rushes to their companion's sickbed-side and catches up their hand, scooping it from the mattress beside them to clutch between both of theirs in a firm but gentle grip, like they're holding some wounded bird, chafing warmth into the pallid skin and pressing strength into the enfeebled fingers, enfolding it entirely within their grasp and cradling it to their chest.

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A character using their own clothing to tend to a companion- using their coat as a blanket to spread over them; tearing strips from a garment to clean or bind their wounds or bathe a fevered brow; turning a scarf or handkerchief into a sling; slipping a pair of gloves warmed by their own heat onto the companion's hands; using their shirt as padding and the sleeves to bind a splint for the companion's broken limb; crafting a makeshift litter from a cloak or coat and branches; pressing any fabric they can get their hands on to an open wound to stem the bleeding- using the material closest to hand for the good of their companion.

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Um... What is whump 😅

Well, like a number of fandom terms, that's a lot of different things to a lot of different people. If you look on a bunch of whump blogs, you will see almost as many answers to this question.

I personally feel it boils down to a genre founded on the way of showing a character's vulnerability in fiction without the necessarily using romance or sex. So generally that means some kind of illness or injury, where one character has to take care of another (or the much more recent version, which is one character hurting another character, with or without the care aspect).

It's been around in a variety of ways since fandom was a thing. The first name for the genre probably originated out of the Star Trek fandom, whose authors wrote "Get!Character" (for example, Get!Kirk or Get!Spock) fanfic in paper zines in the 1960s. The next term, "charactertorture" (for example, muldertorture) came out of The X-Files fandom in the 1990s. Livejournal and Fanfiction.net preferred the term "Hurt/Comfort" to refer to the genre as a whole, without tying it to a specific character or fandom. Finally, around 2005, we started seeing the actual term "whump" gracing entries to Gateworld forums, though originally it referred to "ShepWhump"- injuries and illnesses befalling the character John Sheppard of Stargate Atlantis, which later broadened to include characters from Stargate SG1 and then any other fandom or character. At this point, people who enjoyed whump were called "whumpers".

Around 2016-2018 there was a shift to include explicit torture without following it up with the care and comfort that had long been part of the genre. Now instead of the vulnerability coming only from opening oneself up to care in a dire situation, the vulnerability could be forced onto the character by another character. It is still to an extent accomplishing the goal of causing a character to experience vulnerability, but it depends on the author/reader/watcher as to which definition of whump they ascribe to. At this point, the term "whumper" started to refer to the character who was doing the hurting/torturing within the story, if there was one.

It's honestly been a relatively big split in some parts of the community, which is why you saw the poll I reblogged the other day asking whether people preferred whumperless whump (old definition) or whump with a whumper (new definition).

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survival whump my beloved <3

Soaked to the bone in the rain, her hands trembling with adrenaline as she tries to build a shelter. She just needs to get out of the rain long enough to warm up.

Exhausted but on edge, curled up next to a fire, they try to stay awake through the night. Not that they’re fit to fend off a wolf or a bear in their current state.

Walking for hours under the sun, sweat stinging his eyes and mouth parched, he’s sure it’s not much further. But he’s less sure than he was hours ago.

The hunger is starting to get to zem, zir thoughts slow and vision spinning. Ze doesn’t know what’s poisonous and what’s edible - but that won’t matter if ze becomes too weak to forage.

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Does anyone else out there prefer whumperless whump? I feel like I'm alone out here. Don't get me wrong, whumpers are still lovely fun, but there's something so delicious about the unforgiving cruelty of happenstance. There's something about the cold indifference of accidents, the wilderness, battlefields, illness, etc, that enthrall me in a way that a malicious individual whumper cannot. And don't even get me STARTED on self-inflicted whump (hidden injuries, overexertion, and self-deprivation will always be my bread and butter). I think it's the hopelessness of it, and the way it shifts the focus onto the whumpee's inner thoughts and/or their caretakers'.

Sure, you can punch a whumper. But you can NEVER punch the cruelty of the universe itself <3

Who's with me?

This gets me curious actually. I doubt you're alone in that preference so let's find out!

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Eldrian (wounded in the haunted forest)

The art was made based on his history. After a war and a capture Eldrian finds himself in the haunted forest protected by the witch/wizard after he escaped feverish and wounded.

Made with low quality of color pencils, but I still think it's not that bad 🤔 maybe in a year or two I'll redraw it to see if it looks better.

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Gently kissing an injured whumpee's hand because they're too hurt for any other kind of physical comfort. The tenderness of the texture, but also the inherent distance of it, the 'i'm sorry, this is the best I can do right now'. that's it, that's the post.

YES. GOOD POST.

cradling that hand and not knowing what else to do. heavy grief and worry and heartache bunched up in their chest and needing to do something, anything to comfort the injured person, to convey i'm so sorry this happened to you, this shouldn't have happened to you, you're safe now. holding that hand to their cheek or gently between both of their own, and then the soft press of lips to their palm or knuckles. this is all they can do, and it's devastatingly tender, but it's so... exactly. distant. it seems so small against all that pain, all that trauma.