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Writing Notes: Realistic Injuries

References (Minor Injuries; Head Injuries; Broken Bones; Dislocated Joints; Cutting & Piercing; Blood Loss; Blunt Trauma; Burns)

WHAT'S "NORMAL"

For a normal, reasonably healthy adult the following reading are ‘normal’. Some variation is usual and what’s normal for one person may be abnormal for another.

Pulse Rate

Between 60-100 beats per minute

A fitter person will have a rate towards the slower end of the margin and a child or young person will have a naturally high rate.

Any drastic increase or decrease in pulse rate is cause for concern.

Blood Pressure

120-140 over 70-90

Can vary with the time of day, amount of stress and a number of other factors.

High blood pressure is not usually immediately dangerous but can cause long term damage.

Low blood pressure can cause faintness, dizziness and blackouts and is usually a sign that there is an underlying problem to be treated.

Body Temperature

36°C (98.6°F) to 37.5°C (99.5°F)

Relatively minor variations in temperature are cause for concern.

MINOR INJURIES

Bumps, bruises, cuts and grazes

All inconvenient.

But not incapacitating.

A blow to a bony part of a limb or to a joint

Hurts a lot at the time of impact (as anyone who’s banged their shin will agree) and may swell and stiffen.

The impact may also have the effect of temporarily disrupting the ‘power supply’ to the limb meaning the person getting hit is likely to lose their grip on anything they’re carrying and be unable to move the joint for a few minutes.

Bruises

Can take anything from a few seconds to over a day to appear and anything from a day to several weeks to fade away again.

Soft fleshy areas bruise much more colourfully.

Sprains and torn muscles/tendons etc.

Will stiffen, swell and become more painful after a few hours.

A bad sprain can be every bit as incapacitating as a broken bone.

HEAD INJURIES

Probably the most common injury in fiction.

From “let’s bash the bad guy over the head to stop him running after us” to those scenes where everyone gets thrown all over the flight deck by the first bit of turbulence and bounce their heads off consoles.

Minor Head injuries

The human skull is pretty robust and designed to take a fair amount of punishment. Consequently the occasional bump won’t do all that much damage.

A minor bump on the head may leave a character feeling dazed and suffering from a headache, blurred vision and ringing ears but will clear within a few minutes.

Facial bruising - quite uncommon, it takes quite a hard blow or a blow that impacts with the soft tissue around the eyes to leave a mark.

Minor cuts and lacerations on the scalp and face will hurt and bleed out of all proportion to their seriousness. [NOTE: A ‘laceration’ does not mean ‘a very bad cut’ – it is a term for a specific type of wound caused by the tearing rather than the slicing of the skin. It’s the sort of cut you get from being hit with a blunt object (or a fist).]

Medium Head Injuries

A more forceful blow (equivalent to a fall of several feet) can lead to complications of the injury.

Concussion (damage to the brain tissue) is quite common after a hard blow to the head and is often accompanied by temporary unconsciousness. (And it should be very temporary if you don’t want your character to be permanently damaged). This can also result in dizziness, nausea and, not surprisingly, a nasty headache.

Medium cuts and lacerations will be painful and messy but not dangerous. There may be scarring.

Severe Head Injuries

A blow to the head resulting in prolonged unconsciousness will almost certainly result in brain damage, possibly a fractured skull and bruising or bleeding within the brain itself. It can be fatal either straight away if the damage is extensive enough or later as the blood from the injury causes pressure to be put on the brain.

Severe cuts - can damage muscle and sinew and do permanent damage. The pain from such injuries would have most characters unable to concentrate on much else.

Concussion Symptoms

Confusion, disorientation, memory loss,

Dizziness, headache (lingering after the first few hours)

Nausea, vomiting,

Pupils uneven in size and/or reaction,

Sluggish reactions, sleepiness.

Any painkillers given to treat the headache must be non-narcotic and relatively mild. Otherwise it is difficult to tell if sleepiness is caused by a worsening of the injury or by the painkillers.

Someone suffering from a suspected head injury should be watched for at least 24 hours, and woken every few hours if they’re asleep, to check for the above symptoms.

BROKEN BONES

In general they hurt. A lot. Any character with a broken bone (with the possible exception of the ribs) is going to know about it and not be very happy. It is possible that if there is no displacement they might not hurt much at all, and it may not be immediately obvious that the bone is actually broken.

The initial shock and pain is often enough to cause unconsciousness. Keeping the limb immobile will minimise the pain but any pressure or movement is going to be extremely unpleasant.

Severe breaks (compound fractures) can cause part of the bone to protrude through the skin, this will also cause blood loss, which can be severe enough to be dangerous. Nerves and blood vessels can also be permanently damaged.

Smaller bones are obviously more likely to break than larger ones but they hurt every bit as much.

Distinguishing between breaks/sprains is not always easy with just 'it hurts to go on but as a guide… Lots of pain but some movement is a relatively good thing -- it indicates 'just' a tear. Less pain but very limited movement is a worry, because it can mean you've snapped something, and the joint becomes useless without surgery.

Broken Ribs

All sorts of nasty complications can arise here. For a start, though a character who has just broken a rib will feel winded and uncomfortable, the initial discomfort will pass quickly and they may feel fine for some hours afterwards. Possibly they may not even realise that they had broken anything.

After a few hours it will start to hurt badly and breathing may be impaired and painful. Problems can occur when the injured person is breathing only shallowly because of the pain and not expanding their lungs fully, lungs can collapse as a result, causing pneumonia. Interesting in a morbid kind of way is that the breathing difficulties of a collapsed lung aren't what gets you - it's the air pressure that builds up in the chest cutting of the blood flow to the heart.

Broken ribs can also puncture a lung or even the heart with fatal results. A punctured lung would result in death within 3-15 minutes if untreated.

DISLOCATED JOINTS

Hurt just as much as broken bones.

Can be forced back into place without medical facilities but it’s not recommended and will hurt a lot, probably enough to cause unconsciousness. On-the-hoof treatment is the same as for broken bones – imobilise and support the limb.

There are a few dislocations which can be life-threatening -- the sterno-clavicular joint (where the collarbone joins the breastbone) is one. It requires a lot of force to pop it (most people's collarbones will break before the joint goes), and the collarbone usually goes outwards, but if it displaces inwards, it can compress the airways. This joint can dislocate if you get slammed very hard into something like a wall and take the impact on the point of the shoulder. I can also say it hurts very badly and for a very long time.

CUTTING & PIERCING

most human beings come equipped with a healthy set of defensive reflexes to avoid it. If at all possible they will try to put something else (like hands) in the way of the blow. Most people injured in a stabbing have injuries on their hands and arms as well from trying to ward off their assailant.

The severity of the injury depends a great deal on its location:

Limbs

The arms and legs are not protected by much flesh so even a shallow cut or piercing injury here may damage bone and muscle and render the limb effectively useless.

Severe blood loss can occur if the major blood vessels in the inside of the upper arm and inner thigh are damaged.

Abdomen

Piercing injuries will bleed a lot and can easily do fatal damage, although unless a main artery is hit then it’s not going to be a quick death. A piercing more than 2 inches deep starts to get dangerous.

If the main descending aorta is hit, the character has seconds to live.

The femoral or renal arteries will lose a fatal amount of blood in 2 – 3 minutes.

Injury to internal organs would cause bleeding, infections and a nasty slow death if left untreated. Bleeding from the spleen or liver would cause death within 20 minutes. Less major damage to internal organs would cause death either from blood loss over several hours or up to several days later from infection and other complications.

Relatively slight cuts to the stomach area would affect breathing and damage muscles, More major cuts to this area can damage nerves and muscles, meaning the injured character would have no control over their legs. Not nice, when you’re trying to get away from the nutter who’s just sliced you up and suddenly your legs don’t work…

Extensive cuts here can also mean the insides are suddenly outside. Not pretty, not comfortable and, untreated, leaves the character with about 15 minutes to live and they’re going to wish it was much less. Quite apart from the pain (which is pretty horrific) the sight of their own insides tends to make most people quite hysterical.

BLOOD LOSS

Major blood loss will result in a fast weak pulse and accelerated respiratory rate.

For an average healthy person about a litre of blood lost is enough for shock to set in.

Loss of approximately a litre and a half to two litres or more will require transfusion.

Loss of more than 2 and a half litres will probably result in unconsciousness and, if transfusion is not given, death.

Symptoms of Blood Loss

Blood loss in litres < 0.75 || 0.750-1.5 || 1.5-2.0 || > 2.0

Percentage of blood lost < 15% || 15-30% || 30-40% || > 40%

Blood pressure Normal || Normal || Reduced || Low

Pulse rate (beats per minute) < 100 || > 100 || > 120 || > 140

Pulse pressure Normal || Decreased || Decreased || Decreased

Respiratory rate (breaths/min) 14-20 || 20-30 || 30-40 || > 35

Mental state Alert || Anxious || Confused || Lethargic

State of extremities Normal || Pale || Pale/Cool || Pale/Clammy

Amount of blood loss by injury

Severe blood loss, as a wound larger than a fist or that caused by a compound fracture. All figures are approximate and somewhat variable. They are meant as a rough guide only.

SITE OF INJURY || NORMAL BLOOD LOSS (Litres / %) || SEVERE || MAXIMUM

Shoulder: 0.85 / 17% || 1.25 / 25% || 2.1 / 42%

Arm: 0.4 / 8% || 0.85 / 17% || 1.25 / 25%

Elbow: 0.4 / 8% || 0.85 / 17% || 1.65 / 33%

Forearm: 0.4 / 8% || 0.85 / 17% || 1.25 / 25%

Wrist: 0.2 / 4% || 0.6 / 12% || 0.85 / 17%

Chest: 1.25 / 25% || 1.65 / 33% || 5.0 / 100%

Spleen/Liver: 1.25 / 25% || 1.65 / 33% || 5.0 / 100%

Pelvis: 1.25 / 25% || 1.65 / 33% || 5.0 / 100%

Thigh: 1.25 / 25% || 1.65 / 33% || 2.9 / 58%

Leg: 0.85 / 17% || 1.25 / 25% || 2.1 / 42%

Ankle: 0.85 / 17% || 1.25 / 25% || 2.1 / 42%

BLUNT TRAUMA

Getting hit…

Aside from the obvious risk of getting smacked upside the head or breaking bones (see above) there are assorted other injuries and complications which can arise.

Due to the elasticity of the ribcage getting smacked in the chest can cause a person to fly backwards some distance. Of course this means they can bounce off of something else and hurt themselves that way. At best they’re going to be winded and have difficulty breathing, which causes a certain amount of panic in most people. And it looks rather alarming.

Heavy blows to the back can damage the spine resulting in possible paralysis and death. Kidney injuries are also common when someone is hit in the small of the back. They can bleed and may shut down altogether. Kidney failure means the body can’t clear certain waste products from its system, if the waste products build up too far then coma and death can result.

Internal organs such as the liver and spleen can also be damaged by blunt trauma and bleed as detailed above. Other organs which may be injured are the pancreas and the intestines.

If the pancreas is damaged it may spill digestive enzymes which start to digest the person’s own insides. Obviously this is rather painful and unpleasant.

Damage to the intestines can result in blockages (causing pain, nausea and vomiting), bleeding, and the release of bacteria into the bloodstream resulting in septic shock (high fever followed by sudden drop in temperature and blood pressure – fatal if not treated) This can take 24 hours or more.

Usual treatment for internal injuries is IV feeding, antibiotics, painkillers and sometimes surgery.

BURNS

Burns are classified into degree by their seriousness.

1st degree burns – Red, sensitive skin, like a sunburn.

2nd degree burns – Blistering on the first layer of skin (the epidermis) only.

3rd degree burns – Damage to both the epidermis and dermis (the first two layers of skin), visible scars.

Burns over more than 70% of the body are life threatening due to dehydration and the risk of shock, kidney failure and infection.

Electrical shock

Physical marks can vary from none at all to severe tissue damage depending on the severity of the shock.

Internal damage can be done by electrical current traveling along the nerves and blood vessels.

Source: Leia Fee (with additions by Susannah Shepherd) Part 2 ⚜ Writing Resources PDFs

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