#accurate whump

[scifimedic]

Hi! I just found your blog and noticed you have some posts where you explain how to write certain medical conditions, and I was wondering - could you perhaps do a post on blood poisoning, please? I am struggling with it a little lol.

I have a character that got stabbed, and I don't know what are the odds they could get blood poisoning and if yes, how fast and generally how it progresses.

If you don’t have time or something, don't sweat it, it's just a silly idea I got lol :D

Episode 4 of SciFiMedic Explains: How do I write sepsis?

Hi Anon!

So, your character got themselves stabbed, huh? Before we get to the nuts and bolts of how this is going to progress, we have to clear up a little choice of words here. 

The term blood poisoning is not the medically correct term for an infection inside the blood- we call it sepsis. Unless you meant literal poison from the weapon (which I can do a follow-up post on, if that’s the case) I’m going to guess that we’re talking about a severe, system-wide infection of the blood. 

Let’s walk through a few options: 

Scenario 1: 

Your character is stabbed in an area with lots of big blood vessels (highlighted red in diagram), and while everyone does all they can, the poor guy quickly dies of blood loss. There’s no time for infection to set in. 

Scenario 2: 

Your character is stabbed in a non-lethal area, like the arms, legs, or shallowly on the gut (highlighted green in diagram) They’re able to bandage themselves up, or maybe someone helps them out and they manage to get the bleeding stopped. 

Unfortunately, 12 hours later, they notice red streaking coming from around the wound. They also: 

Feel freezing cold, but have a high temperature

Are dizzy

Are shivering

Can’t quite catch their breath and feel the need to pant

Throw up

Look pale

These are all signs of the injury going septic, which is when the infection spreads away from the site of the wound and into the bloodstream. It happens fast. From the onset of these symptoms, they can be dead within only 12 hours. 

Here’s what needs to happen for them to survive: 

1: Hospital. No buts, no delay. If you want them to survive, they need advanced medical treatment, detailed below. (I will allow for a field hospital, or a makeshift hospital with a trained professional and plenty of supplies.) 

2: Blood and wound cultures. This means taking a small tube of blood from the arm, rubbing a cotton swab in the wound, and then sending both samples to the lab for study. They will smear the sample on a slide, put it in a warm, wet environment, and wait for it to grow out. Then, they’ll pop it under a microscope and run chemical tests on it to find out what the infection is. This process can take up to 4 days. The good news? The more pathogens that’s in the sample, the faster it will grow out. If you have blood that is severely infected, it could take as little as 12 hours to see results. (I know this from personal experience.) 

If you’re in a field hospital, unfortunately this is a luxury you don’t have. See next step. 

3: IV antibiotics immediately. Since you don’t know the bacteria causing the sepsis, you don’t know which antibiotic to give. Good news, people a lot smarter than I have created a plan for this. 

3a: According to this study done by the National Library of Medicine, 67.9% of people presenting outside a hospital setting had their wounds infected with either Staphylococcus aureus or Pseudomonas aeruginosa.  3b. Thankfully, we have two very strong antibiotics- Vancomycin and Ciprofloxacin- that can each treat these pathogens. Unfortunately, each antibiotic is effective against only one of these pathogens, and nearly useless (or has developed resistance) against the other one!  3c. Good news, these antibiotics can be safely run together. Boom, you’ve just slammed (and it’s a slam- these drugs are horrible for you long term) 67.9% of patients with the right antibiotics to start treating their sepsis.  3d. What about the other 32.1% you may be asking? Good news, they’re not doomed. Just because a given antibiotic isn’t the best choice against a certain pathogen, it doesn't mean it will be completely ineffective. You may be buying them more time for the cultures to come back. You can also take your next best guess, and switch the antibiotics after a few hours if they aren’t having any effect. 

4. Fluids. IV time! The biggest tell that someone has sepsis is that their blood pressure plummets to dangerous levels (which is what will eventually kill them, but we’ll get to that.) In order to prevent that drop, we need to raise the blood pressure by adding more volume to the blood through fluids. They might also need a blood transfusion, depending on how much blood they lost from the initial stab wound. 

It’s important to note that it may not be possible to gain IV access, because when the blood pressure is that low, the veins tend to shrivel up and disappear (not literally.) In that case, your next best option is an IO, which is a needle drilled into the center of the upper arm bone, or lower leg bone. Yes, it hurts. 

5. Vasopressors. Fancy name for medications that force the blood pressure to come up. There are four main pressors: 

Norepinephrine

Epinephrine

Phenylephrine

Vasopressin

They should be added in that order, although this article admits there isn’t too much hard evidence to back this up.

It’s important to note that this is ICU level care, and unless we’re in the middle of the woods, we will have transferred there.

How do you know if it’s time to add another pressor? You’re not getting the results you need- AKA the blood pressure is continuing to stay or fall too low. In the ICU, we use a different measure of blood pressure that most people aren’t as familiar with, called a MAP score. It’s easy, I promise. 

We use this method because it’s more representative of the amount of blood actually getting to the organs- though that is debated quite a bit in various circles. In America however, that’s the way most ICUs do it. 

The ultimate goal for a sepsis case is to have a MAP above 65 mmHg. You can use this calculator to play around with the numbers and see if the blood pressure you’re thinking is within those parameters. If it’s not, time for another pressor. 

At this point, your character is passed out most of the time. They’ve got a high fever, rapid heart beat, and are covered in sweat. They might also have a seizure from the fever and general stress on their body- at the very least they’ll be shaking from the chills. Their skin will be very, very pale, and might look kinda blue or gray in places- kinda like spots. 

6. Hold your breath. No, not literally. But at this point, you’ve done all you can and you have to wait for them to either get better, or get worse. 

If they get better, they’ll slowly start to maintain their own blood pressure, the fever will come down, and they’ll be able to string a coherent sentence together again. Recovery from sepsis can take a long, long time- as many as two to four months in the hospital. It totally depends on the person and how strong they are. The fittest, luckiest patient I’ve seen recover from sepsis was with us in the ICU for three weeks, then spent another month in a step down unit doing various therapies to regain strength. 

However… if we’re looking at failure… well, then it’s time to move onto scenario 3. 

Scenario 3: 

After completing all of the above steps, they end up getting worse. Don’t worry, it’s not your fault- sepsis is fickle and kills fast. At this point, their kidneys are starting to fail from the inadequate blood pressure- you’ll need dialysis for that. They might stop breathing, or be unable to oxygenate their blood properly, then they’ll need a ventilator. At this point, they’re not stable enough to go into surgery anymore, so there’s no hope there. Eventually, the high fever will cause seizures, which will lead very quickly to brain death. As little as 12 hours after the initial dizziness and red streaks, their heart stops and they’re pronounced dead. 

Summary: 

The odds of your character developing sepsis from a non-fatal stab wound without immediate medical care are high- 90% 

If they’re rushed to a hospital, their odds are better- 50%

If they do develop sepsis inside a hospital, they’re likley to survive- only 10.55% of people die of this kind of wound infection.

If they develop sepsis outside a hospital, then it’s almost certain they will die- 99% 

Disclaimer: Although I’m in school to become a medical professional, I’m not one yet. All mistakes are mine, and I’m always open to discussion.

Anon, this was a fun prompt! If this isn’t quite what you were looking for, feel free to submit another ask with more follow up questions!

Everyone else, also feel free to send me an ask, or reblog this (or any SciFiMedicExplains Episode) with a scene you’d like me to help you write!

[thereweredragonshere]

Idiot moron dumbass forgets to eat and sleep for like three days. Passes out like a stupid fuck

[vivisectedboy]

"Just focus on your breathing. Yeah, good, like that."

Whumpee tries their best to stay in control. To collect themselves. To stop their mind from screaming at how wrong all this is. To ignore Whumper's hand still resting on the knife.

"In," while Whumper counts to three on his fingers, "and out." an other three seconds.

It's uncomfortable at first.

"In,"

Their body isn't used to the rhythm, their lungs fill up too fast and too shallow, and their exhales are accompanied by miserable noises forced out of their throat.

"Out."

But their breathing steadies slowly. Their body isn't shaking violently anymore, their hands aren't desperately grasping Whumper's shirt, their thoughts getting less and less jumbled.

"In."

They recoil at the sheer absurdity of the situation. Sitting in their captors lap, his hands running up and down their exposed back. The same hands that held him down and scarred him forever.

"Out."

They hate how despite this, they managed to calm down. For a moment of impossible peace, only their breaths exist, and the warmth they've been craving for so long.

"In." He says, tightening his grip on the knife.

Their mind switches back instantly as they notice the blade shift in Whumper's hand. With the swiftest movement, it's now held against their throat, threatening to cut if they dare exhale too early. Panic sets in once again, their heart rate rising with every painful second.

They close their eyes as their vision starts to go black. Their chest feels like it's about to burst from the pressure.

"Out." After what feels like several minutes, he finally commands.

Whumpee is only relieved for a moment, as they exhale, but it doesn't last long.

It's even worse this time. Their lungs burn. Their ears start to ring, and they feel their heart pounding in their throat. Black spots start appearing in the corner of their vision again, and they just can't help it. They reflexively suck in a small, hitched breath. They, of course, quickly realise just how big of a mistake that was.

Whumper pushes the knife harder against their throat, and as they try to squirm away, they're stopped by his hands firmly holding his back.

"You only breathe, when I say so. Do that again, and I might just go a lot deeper. Understood?"

Whumpee nods, only driving the knife further into his skin. Whumper grins at their desperate struggle not to breathe, panic growing with each second. Even when he moves the blade, they don't make a sound, only the slightest movement and a small twitch of his facial muscles.

"In."

A horrible gasp, on the verge of tears. They can't cry, that would surely be the end. They keep staring at the ceiling. It hurts so bad. Drops of sweat roll down his neck, mixing with the blood from the wound. Their hands start to go numb, either from clenching them too hard, or from the lack of oxygen. Just keep looking up. They let their mouth fall agape, closing their throat instead. Keep looking.

"Don't pass out."

The ceiling is spinning. Is there a fan? Or is that just a lamp?

It won't stop spinning. It's so bright.

Keep looking. Keep looking. Up.

"You can do it. A few more seconds."

Where is that sound coming from? A repetitive thump-thump-thump from afar. The kind of bass that reverberates in your whole body. Must be a concert somewhere.

Did they turn the lamp off-

"Out."

[c3realkilluhz]

I’m not elaborating anything either …

[whumping-valentine]

We use being cold, hungry, and tired a lot in our writings, and that makes sense! Those aren't pleasant feelings, but what's not used enough is all of the other symptoms that can occur under those conditions.

Being malnourished not only causes the feeling of hunger, but can give you headaches, and make you feel weak, faint, sick, cold, and tired. It makes you irritable, unable to concentrate, and can even cause wounds to take longer to heal, while brusing much more easily. After a while you even develop an aversion to food, and don't want to eat. You feel nauseous just thinking about it, and breaking a fast isn't something you can do with a flick of your fingers. Your body isn't used to eating, and it may not sit well with you.

Not eating can also cause your blood sugar to drop, which is a whole entire thing in and of itself, and you don't have to be a diabetic to experience it. Low blood sugar is horrible 0/10 do NOT reccomend (but definitely do in whump!)

As for being cold, it can not only be uncomfortable, but it can make you feel physically ill. Especially when paired with a lack of vitamin D from low sun exposure. You just constantly feel sick, and may even begin to feel hot. It is absolutely FREEZING in my room all the time and I always feel sick. Horrible. Do it to your whumpees and tell them if they're good they can go outside and lay in the sun. That's shit's awesome when you're cold.

And of course, with sleep deprivation, it not only makes you drowsy, but it basically screws everything up. Your ability to think, your coordination, your strength. All you wanna do is curl up into a ball and go to sleep, no matter where you are. There's so much you can do with a tired whumpee.

The most fun thing about all of these is that they can generally go together all at once, inflicting symptoms of the others in an endless loop of torment. So yeah, go nuts! It's miserable!

[amirmeavid]

Merlin and Mordred but Mordred hasn't reached Stage 3 Disillusionment yet:

Merlin: *making the fire while on a hunting trip* What?

Mordred: *wheezing. coughing. sobbing. because why is his GOD doing menial tasks!?* This outrage! This is heresy!

Arthur: ..the soup? *hesitantly licks the spoon* Its not that bad.

Gwaine: Yeah, trust us Mordred. Merlin makes great soup!

Mordred:

Mordred:

Mordred: What did you just say?

Merlin: Oh no.

Mordred: *starts throwing a hissy fit because no, thats illegal, but also he can't tell the knights how important merlin is because what if his god SMITES him?!- (merlin does not yet know how to this, or he would have alreadu done it)*

*2 hours later*

Mordred: WHAT DO YOU MEAN HE ALWAYS DOES IT?! DO NONE OF YOU KNOW HOW TO COOK!?

Long story short, Merlin's chores dramatically decrease when Mordred is around, because nobody wants to kill their youngest knight by stress, even though they don't know why he acts that way.

Merlin is grudgingly pleased.

[theres-whump-in-that-nebula]

Notes on Bite Injuries

If something or someone bites you, pulling away while their teeth are in you will cause them to rip out a chunk of flesh. The proper way to get something or someone off of you is to push into their mouth and force them to release.

If one leans into a bite in time, the resulting wound may look more like an abrasion or very nasty bruise rather than a puncture wound.

Human bites are more dangerous than most animal bites due to the type of bacteria and viruses humans can carry.

Punching someone’s mouth is inadvisable since a hand can become seriously mangled on teeth, and potentially become infected.

The longer someone waits to clean a bite wound, the more likely the chance of infection.

Depending on what part of the body has been bitten, the bite can also cause painful bruising and swelling in the area.

Riskier places to be bitten include the hands, wrists, feet, ankles, and face due to the potential for nerve damage and fractures.

In minor bites, the bruising will probably hurt more than the skin being broken, especially if a vein is burst in the process; but due to the broken skin, will be extremely tender to the touch and to any ice or cold water applied to the area.

Bites can still break the skin even through multiple layers of clothing, but contact with saliva will lessen with more, thicker layers.

If the bite occurs over clothes, the clothes in the affected area will be stretched (with puncture impressions) or torn.

A crocodile will roll after biting its prey to rip off the limb. The only way to survive a crocodile death roll is to hug the crocodile.

If someone is bitten by an animal of unknown medical history, the person will need to get a series of vaccines to prevent rabies. If someone has rabies and starts showing symptoms, they are already dead.

Symptoms of rabies include throat spasms which cause a severe and entirely debilitating fear of swallowing fluids, including their own saliva, which is why rabid animals (and people) foam at the mouth.

[cravesunconditionallove]

On your recent post for Vivisections

Do you have any more advice or maybe a quick scene lay out on how you'd accurately describe and show it? I've not seen many people explain this before I'd love to know more!

Permission to infodump?? awesome :D

Because it's on topic here, there are a few blogs I think need a mention because they have AMAZING medical/torture writing advice (@scripttorture and @justkidneying )

You didn't ask whether the character lives or dies, I don't know which you want so here's info on both scenarios:

Dying:

First off, without anesthesia, the pain alone would likely lead to a thing called Neurogenic Shock, which will in turn cause a BP drop and organ failure among other things. Your character will likely be breathing quickly, appear pale, have a rapid pulse, and be confused if they are still conscious. And yelling in pain of course.

For death due to blood loss: it's hard *not* to hit a major blood vessel if you're flaying someone open neck to groin, and that will also lead to quick death without immediate treatment. Cautery (using electricity to burn an area, stopping bleeding) will work on smaller bleeding but major blood vessels not so much. Symptoms are similar to shock: clammy/pale skin, thready/weak/rapid pulse, loss of consciousness.

Other: you can also risk damaging organs (someone being vivisected probably isn't going to be staying very still, even restrained, and one slip of a scalpel and oops, that's the aorta...) A punctured lung could lead to pneumo/hemothorax (air/blood in the chest cavity (pleural space), where it shouldn't be) causing respiratory distress—and then shock, and without treatment—death. If the heart is damaged, death would be near instant. Other organs like the liver, kidneys, bowels, spleen etc are pretty big bleeders, so see my Blood Loss section.

Sepsis: If they don't die immediately, sepsis is a big risk, as even in sterile environments you can't completely prevent it. Sepsis is when an infection reaches the bloodstream and is very serious. I imagine whoever is vivisecting the character probably wouldn't care too much about using sterile technique, so you can bet on an infection happening. This can set in within hours or days. Symptoms include high fever, pain, confusion/delirium, sweaty/clammy skin, low blood pressure.

Now, if you want them to live?

Surviving:

If the vivisectionist wants their patient/victim to survive, they'd need a lot of materials. Like any major surgery you'd need blood products, fluids, antibiotics, ligatures, and a way to keep the pain (somewhat) under control. Alcohol has been used in the past for similar procedures, but you could also just opt for a dose of opioids.

Antibiotics are necessary, opening someone up like that is a MAJOR risk (see "Sepsis").

I imagine they'd also somewhat monitor the character's vitals. They'd also probably have a few assistants to help with similar smaller tasks like that—stopping bleeding or handing tools, etc.

Closing the wound: Stitching someone up from such an event would be a lot of work, as you have to close many skin layers (muscle, fat, and the surface skin) and bandage it.

If you don't want to stitch them up immediately, a wound vac (negative pressure wound therapy) would be a good option. Doctors use these in cases of things like compartment syndrome. It is used when you cannot close someone back up right away.

Bandages and proper wound care are also important, you'd need to change the bandages every few hours for the first few days as deep wounds tend to produce a lot of fluids (called "exudate.") Sometimes doctors place drains to help drain away this fluid faster.

All in all, Healing from this would take months, not to mention the psychological trauma from all of this.

The scene:

Writing these scenes is honestly so variable so here's a few thoughts of mine:

You could describe the environment: (cliche, but cold metal table? Harsh lighting? Straps? A table with sharp scary-looking objects on it? How about the scent of disinfectant (or its absence).

The initial sensation would be the biggest to focus on: does the vivisectionist take their time? (pressure before pain?) shock as nerves fire as they are severed (lightning sensation shooting upwards), and the body’s instinctive flinch or freeze. Initially screaming, swearing? Sweating, rapid breathing, muscle spasms, or even vomiting as the body tries to cope?

Smells: Metallic tang of a large amount of blood (I personally HATE this smell, it's like having a penny in your mouth, or if you've ever used a metal scrubber to clean a pan, it smells kind of like that.), burning flesh (if they use cauterization) etc

If the character is partially sedated for it, keep in mind they will still react to pain, albeit sluggishly.

I hope this helps!

[whumpster-dumpster]

Had a dream from the POV of a non human whumpee who had a pretty bad fever and the caretaker for some reason had to use one of those candy thermometer probes instead of a regular thermometer to track their temp and keep holding it in their mouth because the probe was so much more uncomfortable under their tongue but it was all they had. It was great

[thereweredragonshere]

Buff Astrid looks like she gives the best hugs

She defo does

[innerward]

[allthingswhumpyandangsty]

the struggle a whump writer — who wants to write their blorbo as canonically accurate as possible — goes through when their blorbo is bulletproof, knifeproof, physically invincible with healing ability that makes any injuries they sustain go away almost immediately in canon, and so trying to Whump them means having to try to come up with convincing reasons why they're hurting now or why bullets can pierce their skin this time or why their healing ability is out of reach in this specific scenario. thus they can feel the pain and are severely injured; it will be a long and difficult road toward recovery, etc.

*I know we could always ignore canon and that's what most of my fics are about, but my mind still needs me to portray them as canonically accurate as I can when it comes to things that aren't about the state of the character's love affair (who they date in canon) or if they're alive in canon. like my brain needs me to write them as 'in character' as possible, and it's a pain in the ass when my brain also sees their 'healing ability' as part of what's 'in character' for my blorbo. sighs.

[aspens-whump]

Mending spells are for objects, healing spells are for people. That was one of the very first things Whumpee learned from Mentor as a spellcaster. Though they weren't quite sure what caused this difference, they also weren't one to test it. Every spell Mentor taught had been passed down and refined for generations, so Whumpee trusted that they had good reason for emphasizing that such a distinction existed.

Well, at least, they never intended to test Mentor's instructions. Now that they'd tripped and fallen into a ditch full of jagged rocks while looking for spell components in the woods, they were considering it as an option.

A boulder scraped against them on the way down, leaving a thick red streak of blood along the edge of the ditch. They groaned as they lay on their side. Each frantic, shallow breath sent a wave of stabbing pain through their body, undoubtedly because of a broken rib or two. As their mind stopped spinning, they realized they were clutching at a large gash that ran across their stomach.

They pushed themself into a sitting position, still cradling their stomach. "Mmnh... Somebody. H-help! Please!" Tears ran down their cheeks, stinging the cuts that dashed across.

Moments passed, yet there was no response. Whumpee began to try to call out again, but they were taken by a coughing fit and fell onto their back. They winced, feeling blood spatter from their lips.

Whumpee cursed themself for using up their one health potion earlier in the day on a stupid scraped knee. And then foolishly separating from the rest of their party, which was surely hours down the path by now. They hadn't even properly learned how to cast a healing spell, one of the more difficult spells to learn, thinking that carrying around a potion meant they wouldn't have to.

At this point, even if a mending spell wasn't specifically meant to heal, they figured it had to be better than nothing. And they knew it well, having used it to repair things countless times. They closed their eyes in an effort to calm themself enough to focus. They took a shaky breath, rested one hand above their stomach and clutched their spell focus with the other, and whispered the spell.

A soft light shone from Whumpee's palm. It flickered for a moment before fading away. Whumpee propped themself up on their elbow to look, only to find that the wound continued to flow steadily, coating their fingers with sticky blood. Nothing had changed. They sank to the ground again, defeated, when they felt a warm tingling sensation across their skin.

A scream tore through their throat as their flesh started to warp, twisting into strips and sprawling across the wound like vines. The pain left them writhing on the ground and choking on splintered cries.

"... Ple-please... It hurts! Make it stop!" They weren't sure to who or what they were calling, but it didn't matter. Every desperate plea went unanswered in the empty forest, as the magic continued its work undisturbed. Whumpee sobbed with each surge of pain. Every movement sent a sharp, burning pain from their wound, but they couldn't hold still, not like this.

Finally, the pain slowed down to a dull, throbbing sensation. Whumpee shuddered and carefully pulled themself back onto their elbows to look. The wound didn't look much better than before, other than having some rough strands of flesh stretched across as if it had been clumsily sewn over with rope. At the very least, it seemed like the spell had pulled the wound shut by a little bit and slowed the bleeding.

Whumpee stared up at the sky. Though they'd left in the bright afternoon, the sky was now fading to a warm purple, speckled with a few faint stars. If this was the best they could heal themself, they had no better choice than to wait and hope someone found them, and soon.

[cravesunconditionallove]

Do you like tying up your Whumpees? Read this!!

so y’all I just found this out doing some research on torture:

Stress positions can kill you.

Stress positions are used as a torture method and are things like, say, wall sits or squatting (mild examples) and you are forced to do this until you collapse. A specific one called Strappado is particularly dangerous. Imagine your hands have been tied behind your back and then you’re hung up by your wrists. Yes, it will dislocate your shoulders.

If you search it up prepare to see some BDSM stuff

According to Wikipedia:

“Prolonged suspension [in Strappado] may eventually cause infarction of the muscles of the shoulder and chest wall and subsequent rhabdomyolysis (muscle cells break down in large amounts), acute kidney injury, and eventual death.”

I imagine this would take hours to days, but just remember, if you’re hanging your Whumpee by their wrists, if you want to be medical accurate and have them survive too, only do it for a little while.

[voidwolf]

shoutout to that person on tiktok who said that whump is like porn for asexuals. bro wasnt lying

[misstressviole]

Lucifer before and after the fall