#and applying steriod not helping either

[pikachupapi]

My skins annoying the shiiiiit out of me :(((

[antimundi-blog]

disability

Injury/cause

Twelve years ago, even through the Empire’s harrowing subjugation of much of Tenebrae, the ruling families of Lucis and Tenebrae shared close relations through a historical compact from the historical unions between Lucian kings and their Oracles. The concordant often led to close relations, and as such, Noctis spent much of his childhood in Tenebrae playing with Ravus and Stella while Luna had her duties as Oracle to contend with. Though this yielded to an extremely close friendship between them, it would later fuel the flames of war. 

 It was around this time that, as Etro’s chosen vessel and her son, that she took possession of the young boy and, sensing the bloodline that Bahamut had blessed, unleashed a bloodied frenzy and had possessed Noctis to kill her. This was an unconscious reaction, but it still sealed his fate. Her elder brother, Ravus, had been a gifted swordsman even then. In a blind attempt to protect her, he cleaved at Noctis, unknowing of where he struck. Though, he struck true and did manage to incapacitate Noctis, it was too late: Stella was dead and Noctis was gravely wounded. 

  This, of course, had been dealt to the spine. The lumbar and sacral vertebrae, which are, in part, in control of the motor functions of the legs. This injury left Noctis’ leg paralyzed in which he attempted to crawl to safety and hide from Ravus while the older boy found his mother. Or, tried to. It was at this time that, aware of the goings-on, they learned of Regis’ presence in Tenebrae and Stella’s death and dispatched a squadron to find Regis and his son and attempt arresting them for murder.

Initial reaction:

Within moments of being injured, Regis was made aware of the tumult and was able to fend off a distraught Ravus while he procured Noctis and fled with him to safety. This, of course, may have aggravated the injury while Regis managed to have a pilot with a medical gurney arrive within moments of Niflheim invading and killing Sylva, divvying the Fleuret children as to who would keep them under supervision.

 For Noctis, meanwhile, a process need be had in order for the prince to be safely transported and healed, initially.

Transportation:

In order for transport to not be extremely stressful, they had to ensure his breathing and blood pressure were kept stabilized (i.e. hypotension and hypoventiliation) and that he was laying in a supine position to prevent further injury while being transported to a hospital (likely still within Tenebrae proper)

Having ventilation support, tracheal intubation, usually manual, would be used to prevent hypoventilation  

A chest x-ray would be performed early on to ensure there aren’t any severe chest injuries

Once it’s ensured he’s stable, a Stifneck collar would be worn to prevent injurious movement

Radiographic & neurological examinations would be performed to assess the amount or lack of motor control

Hospitalization & surgery:

Due to spinal shock, swelling would occur. A primary goal, usually a day or several before surgery, is to reduce swelling as much as possible

This would be performed by applying cold compresses to the injured area as well as steriods—aside from other, compatible pain medications for pain—in order to help ease the swelling

It is during this time that steps must to taken to treat the spinal shock that usually determines the degree of paralysis

Using a rigid brace to realign the spine and prevent dislocation of other vertebrae would be necessary

Noctis’ injury, according to the ASIA scale, would’ve been B-class: sensory, but unable to move

The side-effects of the injury would include breathing problems, pneumonia, irregular heartbeat/low blood pressure, spasms, and others

Once the swelling would be treated, it is only then that he would be operable

Once he goes under the knife, the surgery itself would use invasive methods to realign the injured vertebrae and promote regeneration of the spinal cord

A bone graft would be set in place to promote healing and re-fusion, which would likely take a few months or more

Recovery/living:

Healing time would likely take a month or two while the body repairs itself and he could be transported back to Lucis once stabilized

During this time, Noctis would spend some time in a brief coma afterwords—that was believed to have felt much longer than it actually was, spending time in the dream world created by Carbuncle

Upon waking, while his body would be repairing, the paralysis would be slow to recede and it would take months of physical therapy to regain what was lost

This would mean adjusting his living situations as well, such as using a catheter strapped to his leg that would need to be emptied, being transported via a wheelchair, assistance changing/grooming/personal hygiene, and other necessities

Umbra, technically Luna’s dog/messenger, would often help Noctis—whether in human or canine form, the messenger was trained to handle helping someone disabled like Noctis and serve him—though he would then pass on to Ravus, who would be blinded, once he recovered

Physical therapy would take several months and include occupational and physical therapy on a rigorous level to help Noctis learn to walk again

It was during this time that Noctis was pulled from a private academy meant for the children of noblemen and noveau riche (mafioso families loyal to Regis, especially)

He’d transition to private tutoring

Instead of living in the higher echelons of the Citadel, Noctis had a special bedroom outfitted for his disability on the lower levels easily accessible by ramps and elevators, especially when in a wheelchair

This room would be outfitted with lower shelves and bars for accessibility, as well as being spacious and free of clutter, and large enough to accommodate a wheelchair

During his time in therapy, he’d transition from a wheelchair, to one to two crutches, to a cane, then being without

He’d be able to walk again, fully, by the time he’s 9½  

Afterwards:

Due to the way in which Noctis’ injury healed, he still has some stiffness in his left leg that is especially apparent when he walks, jogs, trots, canters, and even runs

When in either of those gaits, he seems to place little weight on his left leg and instead appears to bounce, leading with his right leg when moving

He’ll favor his left leg and often shifts between his legs due to how his left leg is prone to falling asleep, especially in his knee and below

When sitting, Noctis dislikes anything that might involve his left leg falling asleep and tries to avoid this at all costs

This also manifests when riding Chocobos as he has a bit of difficulty utilizing commands that involve his left leg, especially finer motor control like two-point position when trotting, the Chocobo jumping, and commands that involve the left leg/foot as he has difficulty keeping his toes angled upwards as is required when riding; he dislikes riding Chocobos for this reason

[scriptmedic]

Anonymous asked: 

i have a character (in his early sixties, if that helps at all) whose leg is crushed almost entirely through at the knee by something akin to a bear trap on steriods. his companions rush him to shelter from the blizzard they were all traveling through. assuming basic supplies are available to prevent him from bleeding out quickly for starters, would the cold put him at further risk for any adverse effects like shock, decreased resistance to infection/gangrene/etc? how long might he take to recover from those after finding proper medical care 2-3 days later, if he'd live that long? 

Hey there nonny! 

So the biggest threat to your character is bleeding. The knee has some pretty vulnerable blood vessels, which include the popliteal artery at the back of the knee, and it wouldn’t be beyond the realm of possibility, without care of any kind, for him to bleed to death after he escapes the bear trap. 

However, tourniquets are a thing, and are an A+ intervention for significant bleeding, and one can be fashioned from a belt or anything handy and a stick. (The wider the tourniquet, the safer it is; a shirt sleeve might be perfect). 

Because of the way implanted things in the wound work, I also wouldn’t throw my Kindle across the room if, reading your story, the character didn’t start massively bleeding until the bear trap gets opened and your character is freed. (It takes about 400lbs of force to open a bear trap, so if this one is on steroids, your character will definitely need friends to free them!) 

The other option is that the bear trap is so strong that it amputates his pitiful human leg, and the bleeding starts immediately. 

So let’s move forward a pinch. He’s out of the trap, he’s bleeding badly, but someone -- a friend, or even your character himself -- applies a tourniquet. Hooray! Mischief Hemorrhage managed! 

Your character is going to be in a lot of pain. The tourniquet itself has to be tight enough to pinch off an arterial bleed (which is a lot of pressure), and the tissue below that is going to be unhappy. 

That pain will only get worse as tissue starts to die. Because of the way things work and the timeframes you’ve mentioned, your character’s leg is going to turn necrotic and die. 

Tourniquets are safe over a course of a few hours -- 4 hours is proven safe, especially with a wide tourniquet, but 6 isn’t good, and at that point the tissue starts to die. This is absolutely agonizing. Gangrene, as you said, will likely set in as well. 

Meanwhile... you mentioned shock. One of the key components of shock care is keeping the patient  warm. That’s because, in a shock state, your character is going to lose a lot of body heat, and hypothermia is part of a very lethal triad that takes over in shock cases. (Hypothermia, acidosis, and coagulopathy is an UGLY combination.) 

So your character’s friends are going to be covering him in blankets and keeping him close to the fire. (He’s also not walking, and you mentioned a blizzard, so I’m assuming some kind of sled or makeshift litter for him.) 

Now, I can’t quite guarantee that your character will go into shock if they got the bleeding under control early enough. But it’s certainly not outside of the realm of possibility -- again, I wouldn’t throw my Kindle across the room if I read it in a book. 

However, surviving like this for 2-3 days isn’t unrealistic either... for most of your character. 

But after 3 days with a tourniquet, that rotting leg is going to have to go. Amputation will be his salvation, because if that tourniquet comes off after the leg starts to die, he’s going to get a whole flood of toxicological mess coming back up into circulation. As cells die they lyse (break apart), and they let out a flood of potassium and myoglobin (part of the muscle) as they die. If that tourniquet comes off before the leg does, that will come flooding back and destroy his kidneys, and potentially cause a lethal arrythmia due to hypekalemia (too much potassium). This is more commonly known as crush syndrome. 

So when they reach civilization, he’s going to a hospital, and he’s going to say goodbye to his lower leg. He may need several rounds of antibiotics, and he’ll probably stay in hospital for a week or so, with a stint in a rehab center as well. But he’ll likely be up and walking on crutches the same day as the amputation. 

But this is ultimately a survivable injury, and he will walk again (on a prosthetic lower leg, which is very common -- there are photos of paratroopers with two prosthetic legs below the knee, having just landed out of an airplane jump). 

One note on rehab: because the sutures have to heal and inflammation at the stump has to go down, your character won’t likely get a permanent prosthetic leg for about two months (longer if the recovery is complicated). So crutches will be the order of the day for quite some time after rehab.  

I hope this is what you needed and good luck with your story! 

xoxo, Aunt Scripty

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