#hemothorax

[macgyvermedical]

what are some examples of injuries that work well for a hidden/delayed injury trope? is there like a slow internal bleeding situation or something that can show up later just when everyone thinks things are okay?

Head Injury: The skull has a finite amount of space inside it. If it gets knocked around and the brain starts to bleed or swell, that blood or swelling takes up some of the space. The more bleeding or swelling there is, the less space for brain there is, the harder it is for blood to deliver oxygen and nutrients to the brain tissue. As less and less blood gets to the brain, the more it starts to malfunction, and the person begins to get drowsy and disoriented, leading to unconsciousness (along with a severe headache). The interval between the initial impact and the symptoms of disorientation is called the "lucid interval" and can be hours to a day or so.

Injury to the digestive system: If a character gets hit in the abdomen hard enough a couple different things can happen. One is that the intestines can perforate. A small perforation might not be immediately noticeable (beyond the pain from the impact) but within a day or so a severe infection called peritonitis can set in. This requires surgery and IV antibiotics to correct. Another, especially if the blow was close to the appendix, is that swelling can block the entrance to the appendix, causing appendicitis. This can take a few days to become apparent.

Internal bleeding from the spleen or liver: Another thing that can happen if someone takes a blow to the abdomen is internal bleeding. In this case, there are two big bleedy things in the abdomen to watch out for- the spleen and the liver. Either can get a relatively small tear in them from a blow, and it might not even cause severe pain initially. Instead, they start to bleed, and the blood starts to pool in the abdomen. Blood irritates the lining of the abdomen, which causes pain to slowly worsen as the person bleeds. This usually takes a few hours.

Compartment syndrome: This is something that can happen after a musculoskeletal injury like a fracture or a sprain. Muscles sit in tough sheaths. The swelling around the injury site can increase pressure inside one or more of those sheaths. This causes gradually worsening pressure and pain until, like the head injury, blood stops being able to get to the muscle. This causes the muscle to begin to die. To fix this, a surgeon has to cut the sheath and allow the muscle space to swell. This can taken anywhere from a few hours to a few days.

Slow hemothorax. A hemothorax occurs when part of the chest cavity starts to fill with blood after an injury. If this happens slowly enough, it might be hours before enough blood has accumulated to cause breathing difficulty (breathing would become steadily more difficult as time passed). This is fixed by inserting a tube into the chest where the pocket of blood is and draining the blood.

[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!

[rookinthecrownest]

Bedtime Stories For a Demon, Night 3: The Girl Who Knew Despair (Lucanis x Rook Fanfic)

*Endgame spoilers for Veilguard ahead

** No seriously if you havent played to the end of the game dont read this

Soft candlelight flickering. An exuberant chorus of voices outside the door, celebrating victory. The smell of alcohol and Embrium and Elfroot in the Diamond’s infirmary. The Cantori Diamond, still standing like the rest of Treviso. Free of the Blight and the wrath of a God’s anger.

Thanks to Rook.

Madeleina.

Lucanis sits on a wooden chair by her bed. He asked Teia for a private room in the infirmary – a request she was happy to accommodate for Treviso’s saviour.

As grateful as he is for her help in Treviso – and he is incredibly grateful, he’s equally infuriated by her recklessness in battle. Not many can claim to have injured a Blighted dragon and lived to tell the tale, but even fewer would have been stupid enough to try and conceal a mortal wound until they were bleeding out on the ground.

He remembers the blood spilling like a crimson waterfall from her mouth. Choked gasps for air as she drowned in it. The thud of her body as it hit the ground while Viago was mid-sentence thanking her for her help.

A shard of ice from the dragon’s last attack before it fled had lodged itself into her chest, piercing her right lung. She must have quickly removed it before anyone else noticed, and her thick mage’s overcoat hid the worst of the damage. The dragon’s attacks only left them with enough time to worry about their own survival – hurling cold, sharp death their way with brutal force and terrifying speed. Even with Spite’s wings, he was barely able to dodge them.

He and Davrin quickly dragged her back to the Diamond, with the help of Teia and Viago to clear the way for them.

Madeleina was still choking on her own blood.

Hemothorax, he thought bitterly. Mierda.

The idiot actually apologized to him for getting her blood on his nice coat while her death rattles filled the air. He is fairly certain he told her to shut up. He desperately hoped those were not the last words he would ever say to her.

Lucanis started barking out orders for supplies – alcohol, a thick needle, and a mage who could heal. He needed to decompress the pressure on her lung and get the blood out before it completely collapsed. One of their mages, Lucrezia, stood at the ready to assist. She had given Madeleina a cloth to bite down on. Davrin, Teia, and Viago stood around the bed and held her limbs down.

Mercifully, Spite was quiet enough to let him get through the procedure. One he hadn’t done in a long time, but still remembered well enough.

He poured alcohol over exposed chest to sanitize the skin.

He inserted the needle through the fourth and fifth ribs in the mid-axillary line. The mage sucked the blood out of her chest, using wind magic to create a vacuum. The blood came flowing out and spattered onto the floor. Agonized cries through the fabric of the towel. Terror on her face, limbs shaking, while he stitched her back up. The mage casts a healing spell to help mend the rest of the damage and hopefully restore some of what was lost.

Then, silence as she finally fell asleep.

Davrin, the new member of the group, stood beside her after Teia and Viago had left.

“Is she going to be alright?” He asked quietly.

Lucanis didn’t have an answer for him. He was fairly certain she was out of immediate life-threatening danger. But she lost a lot of blood, and nearly lost a lung. Only time would tell how well she would recover. If she would fully recover.

“I’ll watch over her – you should go back to the Eluvian. See if you can help Neve and the others in Minrathous. It might not be too late” He answered, nodding towards the door. “We’ll meet you back at the Lighthouse when she wakes up”

When, not if, because he refused to let her die for the crime of choosing to help him. He didn’t need that on his conscience.

Mercifully, Davrin didn’t fight him on it and left soon after.

He’s not sure exactly how much time has passed. There’s no windows in the infirmary, so he measures it in forehead towel changes. Four by now, at least. Maybe a few hours he estimates.

A soft and pained groan, and the rustling of bed sheets fill the quiet room. He looks up to see Madeleina’s green eyes fluttering. She hisses and holds her right side, her face twisting with pain. She coughs, but this time, no blood comes sputtering out of her mouth. The warm towel on her forehead slips off.

“L-Lucanis?” she asks quietly, blinking at him with glassy eyes. She groans again “Ahh… Venhedis…”

“Hey, take it easy” Lucanis holds a hand in front of her, “Try not to move too much right now”

Madeleina frowns, and speaks with no small amount of strained effort “We … won … right?”

“We did. But you almost died” He points to her chest, “Would have died, if that wound kept bleeding out. Why did you try to hide it?”

“Didn’t want … to ruin the …  ‘we survived… a Blighted dragon attack’… party” She smiled weakly. Her voice was raspy and uneven. She was gasping between words. “You … know me … I hate to bring… down the mood…”

Lucanis clapped a hand to his forehead, “Mierda… unbelievable”

His frustration only grows when he sees her trying to sit up, grunting with effort. “What did I just say? You’ll rip your stitches.”

I worked hard on those, he wants to add.

“Min…rathous …. Need to get … back” She winces as another wave of pain sweeps through her body. Madeleina manages to get herself upright and leans against the headboard of the bed. “Neve … Shadow Dragons…”

Lucanis frowned deeply, “You’re not going anywhere. And if you are, it’s back to the Lighthouse.”

Madeleina sighs and leans her head back, hitting it against the headboard softly. She looks utterly defeated.

“They need my help Lucanis…” she whispers, staring at the opposite wall. She’s starting to blink away tears. “I … I left my city to burn”

He’s not sure how to comfort her. He settles by saying what is in his heart, uncertain if it will be enough to assuage her guilt.

“But Treviso lives to fight another day because of you. Free of the blight, free of Ghilan’nain” He pulls his chair closer to the edge of her bed. “And none of us will ever forget it. I won’t forget it”

Lucanis realizes she was forced into an impossible decision. Madeleina was a Shadow Dragon, she was from Minrathous. He didn’t expect her to aid Treviso. But the relief that flooded his chest when he saw her come to his home’s defense was indescribable.

A tense quiet passes between them. He watches, helplessly, as she bites her tongue to keep a deluge of tears from streaming down her face.

“You saved a lot of people today” Lucanis says quietly.

Madeleina shuts her eyes tight and bit down on her bottom lip. Her voice is quivering as she replies, “And doomed so many more.”

“You don’t know that” He leans forward. “Davrin left some time ago to help, he might have- “

“Don’t” She hisses, her chest heaving. “Don’t … do that”  

His brows lift in surprise, taken aback. “Do what?”

The defeated look on her face as she turns to him makes his heart sink into his stomach.

“Give me hope …” Madeleina says weakly, as her shoulders start quaking. “I … I don’t … deserve…”  

He isn’t sure if letting her cry it out is the right thing to do, but lets the sound of her quiet sobbing fill the little room. The weight, the magnitude of the choice she had to make is not lost on him. How unfair it all was. Few things in life are fair, he knows that better than anyone. But forcing someone as young as her make that kind of choice had to be up there.

He sees Spite manifesting beside her bed, a purple doppelganger of him. Spite leans in closer, it’s face – his face, twisting with anger.

Smells like salt and ice and smoke. Not right. Not RIGHT. The demon howls. Lucanis pinches his nose bridge and sighs. Spite’s gaze drifts between Madeleina and Lucanis. He frowns at Lucanis, Make. Her. Right.

“Mierda, not now Spite…” Lucanis whispers, exasperated.

Madeleina sniffles and stops crying for a moment. Her eyes are red and puffy. She wipes her nose with the sleeve of her tunic. “Spite’s bothering you?”

Lucanis crosses his arms over his chest and frowns, “Don’t worry about Spite. You have enough to deal with right now”

She looks around the room, as if she could see him.

“Would Spite … like a story?” Madeleina asks, after a few moments of silence.

Spite tilts his head and leans in closer to Madeleina. He grins maniacally and nods. Yes. Story. That will make her Right.

Lucanis is quick to answer, “Absolutely not. You need to rest, Madeleina. Leave Spite to me”

He’s still not used to the feeling of her name on his tongue.

She sucks in a deep breath, one hand holding her right side. Then, she’s looking at him with an uncharacteristically stern look on her face. “You … always say that”

“Say what?”

“That Spite… is only your problem” She grips her blanket tighter.

“He’s my demon. Of course he’s my problem”

Madeleina sniffles again, her brows drawing together. “That’s not … how being on a team works, Lucanis. We help each other”

“You’ve helped me more than enough” He replies, gesturing around the room, “You saved my home. I can’t ask any more of you than you’ve already given”

Madeleina blinks slowly and draws her knees to her chest, considering his words.

“I … want to help …” She frowns, and she’s staring at the opposite wall again.

Spite’s apparition has disappeared, but he can still feel the demon rattling in the back of his mind.

“You can help by resting” Lucanis rises from his chair, “Are you hungry? I can bring you something to eat”

Madeleina shakes her head. “No… but … will you stay? Just for a little bit”

He stands above her for a moment, letting the request hang between them. He knows he should let her get some rest before they make their way back to the Lighthouse. Before she has to face the other side of her decision. Yet, he finds himself increasingly unable to say no to her bright green eyes and tired smile, and that worries him deeply. What it means, what it could mean.

He sits back down in the small wooden chair, and she gives him a weak smile.

“Thank you”

“It’s the least I can do” he returns the smile in kind.

Madeleina is quiet for a moment. Thoughtful.

She raises one hand, and it starts glowing a familiar blue.

“Madeleina – “

“Please – just let me tell the story” He knew her well enough to know that tone would brook no argument. He can do nothing but gesture for her to continue.

“At least one person ought to know”

Her face awash in eerie blue light, Madeleina flicks her wrist.

She looks like she is struggling to keep the illusion alive. He sees a bird’s eye view of a small village, nestled between a dense forest and a mountain range. It flickers in and out and lacks the usual care and detail of her illusions.

“Once… upon a time … in a land far, far away…” her voice is shaking, and she’s using her free hand to keep pressure on her right side. “There was a small farming village. And… in that village… lived a family.”

Another flick of her wrist and the mountainside village vanishes, now replaced by three figures. The man is tall and lanky. He has a lyre strapped to his back. His hair is wild and curly, much like Madeleina’s. His eyes look like hers too. The figure of the woman is maybe a head shorter, with long, pin-straight hair. She has Madeleina’s high cheekbones. The same nose and lips and heart-shaped face. Finally, he sees the figure of a young girl. A young Madeleina. All wiry limbs and wild curls.

“Eurydice, Orpheus and their daughter”

The figures rotate in the air between them.

“Eurydice ran the town’s bakery, and Orpheus played at the local tavern”

The figures ripple and a young Madeleina is now helping the figure of her mother bake bread.

Madeleina’s glassy eyes looked sorrowful.

“They didn’t have much. The village was small… there were no mages … only regular people.”

She smiled ruefully. “But they were happy. Orpheus,” She paused and waved him back into existence, “Kept their home alive with music and stories” He’s playing the lyre for his wife and daughter, while he chases her around an invisible room.

“And Eurydice made sure a warm meal was always on the table”

Her mother brings a plate of something to the young Madeleina, who wastes no time devouring it.

Madeleina sucked in a deep, shaky breath, before continuing.

“One day, their daughter discovers she can use magic”

The figure of young Madeleina is laughing as blue spheres of light dance around her. The figure of her mother brushes a hand through her unruly hair and pulls her into a tight hug. The figures ripple, and she furrows her brow to concentrate harder. They become solid again.

“Her parents are so happy for her. It means she will become Laetan, instead of Soporati. A chance for a better life. Her mother wants to do something for her”

Madeleina winks out of the scene, and Eurydice is pulling a garment out of a small chest.

“A new dress, she thinks… One from her youth. Her daughter is finally big enough to wear it” Madeleina blinks another tear from her eyes. “But wants to dye it her daughter’s favourite colour. She can’t afford a fancy dye but can make her own. Her daughter wants to help. She’s old enough to go pick the elderberries deep in the woods.”

The figure of the mother disappears, and a young Madeleina is in the forest bordering the village, placing berries in a large wicker basket.

“But the girl didn’t know what was coming for them, or she never would have gone to the forest that day”

He frowns, and a feeling of dread takes hold deep in his chest. He knows that whatever comes next is not likely to lead to a happy ending.

“A Venatori blood mage had escaped capture in Ventus.” The young Madeleina flickers out of existence and is replaced with a tall, cloaked figure, holding a stave in one hand and an amulet, glowing bright crimson, in the other.

“He held a dangerous amulet in his possession. The Amulet of Liberum” Madeleina whispers, “Forged by a Dreamer centuries ago, it held a pocket of the Fade inside it. Allowed the wearer to store an infinite number of demons and summon them at will with blood magic”

The cloaked figure arrives at the border of the village, her village. It takes a knife and runs it across his hand. The blood seeps onto the amulet in the other. The bright red glow becomes even more intense, and a horde of demons springs forth. They rampage through the streets, tearing the nameless and faceless villagers apart.

The scene shifts to her parents, backing away from the demons. The father, Orpheus, stands in front of the mother with a small dagger. It does him little good. They are both swiftly torn apart by demons.

The figure of the mage comes back into view, and sucks them back into the amulet, before disappearing.

Madeleina’s expression shifts between anger, grief and sadness. Something he is intimately familiar with.

“The girl comes back from the forest to see her entire village slaughtered”

The form of young Madeleina drops the wicker basket. She is walking through the main path of the village, by ruined houses and bodies torn apart. Bodies of people she once knew.

She comes to a lone house on a hill. Her home.

Madeleina breathes in sharply.

“Madeleina – you don’t have to …” He begins, but she holds a hand up to stop him.

“Yes, I do” she says, resolute. She shifts on the cot and brings the illusion back to life.

The young Madeleina is standing over the bodies of her parents, mutilated beyond recognition. She falls to her knees, and the figure starts screaming. He can almost hear it. The raw anguish rippling in the air like a shockwave.

“She screams and screams until her throat is dry” Madeleina says quietly, “Keeps going until she’s cried herself to sleep.”

The young Madeleina is still on her knees, her eyes closed, and the bodies of her parents disappear.

“In her dreams … a voice finds her in the Fade”

A faceless figure, layered in several layers of tattered cloaks, hovers above her.

“‘Have you lost all hope, child? Has it become too much to bear?’ The voice asks her. And it was … it was all too much …” Madeleina says, her voice barely above a whisper. “The voice offered to take her pain, her regret – everything, away. ‘So much for one so young’ it said”

Lucanis frowns. Spite’s rage prickled under his skin like a starved beast gnawing at the bars of its cage. Spite hates Despair.

He watches as the familiar blue glow of Madeleina’s figure starts to change colour. Veins of black light crawl up her legs.

“The Demon’s name was Despair. And it would eat everything she was, everything she would be”

As the tendrils of black light crawled further and further up her body, Madeleina continued.

“It ate her love, her hope, her joy” her lip quivered, and the figures flickered again. “It ate up her life until nothing was left”

Lucanis made a fist as waves of rage surged through the back of his head, the pressure behind his eyes mounting.

The tendrils were now creeping along the left side of her face. The figure only looked up at the Despair demon above it and continued to be consumed.

“But the girl didn’t know that the Templars who had tracked the maleficar had arrived at the village. One of them, a young man by the name of Tiberian Mercar, found her” She waved the figure of a tall man, adorned in Templar heavy plate armour, into existence.

“He would have been right to strike her down where she stood. She was becoming possessed. She was becoming an abomination” Madeleina wiped a stray tear from her eye with her free hand.

“To this day, she’ll never understand why he didn’t.”

The Templar, instead of drawing his sword, steps closer to the young girl. Lucanis watches with bated breath as he pulls the girl into a hug.

“’It will be alright child, you are going to be alright’” She says, her voice hitching. “Whether he really meant it, or he was just trying to comfort a girl moments away from dying, she’ll never know”

A bright, golden light shines from the figure of the Templar, and then slowly envelops the young Madeleina. The black light is dying out, overcome by the warm glow shared by the two figures.

“But that simple act of kindness brought her back from the brink of despair, from the brink of the abyss” Madeleina’s lips quirk into a sad smile. “He saved her that day, in more ways than one”

The Templar and the girl stand and begin walking away from the cloaked figure.

“The Templar couldn’t take care of her, so he asks his brother to adopt her into his family” She waves to life four new figures – a man, a woman, and two small boys. “His brother agrees, and she goes to live with them” The young Madeleina walks away from the Templar and towards her new family.

“The Mercars are a military family. One of a precious few non-mage families in Tevinter who enjoy more than a modest life” Madeleina explains, “She’s given an education, nice clothes, and a seat in the Circle of Minrathous. But everything comes at a cost”

The figures all wink out of existence, and are replaced by Madeleina, in apprentice robes, standing alone amongst a sea of other robed figures.

“She can never whisper her old name – the one her parents gave her. She can never tell anyone she’s not a true Mercar.” She fists her blanket, gathering the fabric in her right hand. “When the family agreed to take her in, they erased all of what she was. She was not a foundling, but a long-lost member of the family. She’s named after a great-great-great-great-grandmother, the last in their lineage to be born a mage. It gave them more legitimacy that way”

Madeleina’s eyes fall and all the figures disappear. “And in time… she forgets who she was before she joined them. Forgets her own name”

She brings her knees closer to her chest and wraps her arms around them. Lucanis releases a breath. He wants so badly to reach out. A hand on her shoulder. A hand on her arm. Anything to provide some kind of comfort. But all he can do is listen, as if some invisible rope binds his arms to his sides.

Madeleina gestures with her left hand, and a young Madeleina is standing next to an older, tall, rather handsome man.

“But she wants to help, so she finds those in the Magisterium working for the greater good” She continues. “She finds Magister Dorian Pavus, and he brings her into the Shadow Dragons. He gives her a cover to use so her family doesn’t grow suspicious. She tries to do good, tries to make use of the second chance she was given”

The figures blink out of existence a moment later. Her face falls. “But she never feels like she’s ever going to get there. Always feels like she's falling short of some unattainable goal”

“Madeleina…” Lucanis starts, but he doesn’t know where to go from there. What to say.

“That’s why I chose to come to Treviso” Madeleina is looking at him now. “I… I didn’t want another defenseless city to suffer the same fate as my home town – as Arvanitum did”

Lucanis clasps his hands together in front of him and leans forward.

“Whatever the reason you chose to help us … just know we’re grateful” He gives her a small smile. “Thank you for sharing that with me”

Madeleina gives him a weary smile in return. “It feels nice to have someone know … the Shadow Dragons, Dorian, Neve – I was never able to tell any of them. On paper, there are no survivors from Arvanitum. On paper, I am dead”

Lucanis rises to his feet and takes the towel from her pillow.

“For whatever it’s worth …. I’m glad you’re only dead on paper” He chuckles and twists the towel in his hands. “But you need to stop tempting fate, hm? Contract is no good if the employer dies”

Madeleina snorts, “I promise if I get another mortal wound, I’ll come right to you”

Lucanis grins, “Deal”

He motions to the bed, “Get some rest, we’ll go back to the Lighthouse when you’re ready”

Madeleina groans as she slithers back down into the bed. She yawns and turns to her side. “Alright … I should… need…. to check in with Varric soon ….”

Lucanis hesitates a moment before leaving the room. As he closes the door, he wonders to himself.

Who is Varric?

[skyloftian-nutcase]

So this is for writing, how fast do you bleed out from a ruptured organ? Is it seconds or minutes or hours or even days? What do you feel and what should someone do in said situation

Oh honey, that depends entirely on the organ.

Ruptured lung? Depends on the amount of damage, but a pneumothorax is more likely than a hemothorax. And that’ll crush your organs and asphyxiate you depending on severity.

Ruptured heart? Yeah, uh, bye bye. Ask me about cardiac tamponade.

Ruptured spleen? You’ll bleed out fairly quickly, but not immediately. Also spleens tear like tissue paper. 😒 I have a beef with them.

Ruptured liver? Please no. They’re such vascular organs. Please no.

Ruptured bowel? You won’t die immediately but boy will you get an infection. And probably lead to sepsis and massive organ dysfunction and eventually dying.

Ruptured kidneys? Not the beans! They do so much for you, a retroperitoneal bleed might take a few days to catch or kill.

So yeah. It depends. :) But any injury can be minor and just kind of… leak. Until it becomes a bigger problem.

[rainysflowers]

Hemothorax… save me..

Pneumothorax

Save me punctured lungs

[mylonelybraincell]

Hi there! I'm Cate and for the last 6 years I've worked in emergency medical services on an ambulance in the Northeastern United States. I have also been an avid fanfic reader for a long time with a love for hurt/comfort and enemy-to-caretaker. With that in mind, I want to provide a resource to writers.

With the upcoming @whumptober having a plethora of options with trauma, I want to help make the research for injuries a little easier to find and understand.

Below the cut is a long list. If there is a specific catagory you want to see sooner rather than later, send me a message or an ask. Same for if there's something you want to see that's not there.

For ease of injury descriptions "Sam" is our injuried/ill character.

If you have any questions regarding country/regional/state treatment guidelines for your fictional first responders, please reach out and I will try to point you in the right direction. This information is intended solely for use as a fictional writing resource.

DISCLAIMER: This is not medical advice nor is this a suitable substitute for training. Please do not use this information to diagnose or treat yourself for any injury or illness. Seek professional medical advice (emergency medical services, hospitals, urgent cares, tele-health, ect.) if you are injured or ill.

Glossary

Mechanism of Injury

Motor Vehicle Collsion

Motor Vehicle Vs Motor Vehicle

Character on Motorcycle/ATV

Character struck by Motor Vehicle

Character on bicycle/scooter struck by Motor Vehicle

Fall

Assault

Without Weapons

Penetrating Injuries (Stabbings)

Gunshot Wounds

Blunt Objects

Fires/Explosions

Burns

Smoke Inhalation/CO2

Explosive injuries

Head/Face/Neck/Neurological

Concussion

Stroke

Seizure

Spinal Injury

Facial Injury

Nose Bleed

Mouth/Airway/Choking

Chest/Cardiac/Respiratory

Cracked/Broken Ribs

Pneumothorax/Hemothorax

Cardiac Arrest

Pulmonary Embolism

Chest Pain

Asthma

Gastrointestinal/Urinary/Genitals

Internal Bleeding (Organ Damage)

Evisceration/Disembowlment

For genital/urinary injuries

Reproductive Systems

Kidney and Urinary Systems

Sexual Assault

Bones/Muscles

Muscle Sprain/Strain

Dislocations

Broken Bones

Radius/Ulna (forearm) and Tibula/Fibula (calf)

Humerus (upper arm) and Femur (thigh)

Pelvis/Hips

Back/Spine/Neck

Ribs/Clavicle

Fingers/Toes

Amputation

Organ Functions

Heart

Brain

Lungs

Liver

Spleen

Gastrointestinal System (stomach, small intestine, large intestine, and appendix)

Kidneys and Urinary System

Reproductive Sysems (male and female)

Special Topics

Anxiety/Panic Attacks

Blood Thinners

Suicide

Overdoses

Sexual Assault

Anemia/Hypovolemia

General Knowledge Topics

Hazardous Materials

General Mental Health

Child/Elder Abuse

Refusal of Medical Care

Basic Anatomy

Basic Patient Assessment

Blood Pressure (From my main blog)

[bunnywip]

𝘼-𝙕 𝙇𝙄𝙎𝙏 𝙊𝙁 𝙄𝙉𝙅𝙐𝙍𝙄𝙀𝙎/𝘼𝘾𝘾𝙄𝘿𝙀𝙉𝙏𝙎 𝙁𝙊𝙍 𝙔𝙊𝙐𝙍 𝙎𝙄𝘾𝙆𝙁𝙄𝘾𝙎/𝙒𝙃𝙐𝙈𝙋𝙎

A

Achilles tendon rupture.

Airsickness.

Aerosol burn.

Aftercare.

Appendicitis.

Asthma attack.

Abuse.

Amputation.

Abdominal pain.

Ankle sprain.

Adrenaline crash.

Aortic disruption.

Anaphylactic shock.

B

Bear trap.

Blunt kidney trauma.

Broken bone.

Buried alive.

Blood poisoning.

Backache.

Blunt cardiac injury.

Bullying.

Burn out.

Burns.

Blood sugar crash.

Black eye.

C

Concussion.

Cat bite.

Cut.

Crossfire.

Collapsing.

Coping mechanisms.

Car crash.

Carbon monoxide poisoning.

Confusion.

Carsickness.

Cavity.

Coma.

Cramps.

Carpal tunnel syndrome.

Chemical burn.

Chilli burn.

Cardiac arrest.

Corneal abrasion.

Choking.

D

Drowning.

Dehydration.

Delirium.

Dangerous diet.

Diffuse axonal injury.

Dizziness.

Diarrhoea.

Dog bite.

Deafness.

Dislocations.

Diaphragmatic rupture.

E

Electric shock.

Exhaustion.

Electric burn.

Edema.

Emergency surgery.

Ear infection.

F

First-degree burn.

Flail chest.

Flash burn.

Fighting.

Fire.

Food poisoning.

Frostbite.

Fainting.

Falling from height.

Falling over.

Fear.

Friction burn.

G

Groin pull/strain.

Gunshot wound.

H

Heart attack.

Herniated disc.

Human bite.

High fever.

Home invasion.

Hypoxia.

Hyper/hypothermia.

Hernia.

Hemothorax.

Hematoma.

Heat exhaustion.

Hay fever.

Hemorrhage.

Hidden injury.

Homesickness.

Heart palpitations.

I

Infections.

Ice (slipping, falling through, etc).

Impalement.

Internal bleeding.

Indigestion.

J

Jet lag.

K

Knee dislocation.

Kidnapping.

Ketosis.

Kidney stones.

L

Laryngitis.

M

Memory loss.

Migraine.

Mutism.

Muscular atrophy.

Muscle bruise.

Muscle overuse.

Missing.

Manhandling.

Mono.

Menstrual cramps.

N

Nightmares.

Neck sprain.

Nosebleeds.

O

Open fractures.

Overdose.

Over-stimulation.

Overeating.

P

Penile fracture.

Perforated eardrum.

Poisoning.

Pulled muscle.

Psoriasis.

Pinched nerve.

Pinned.

Paralysis.

Puncture wound.

Pregnancy.

Pneumothorax.

R

Rotator cuff tear.

Rashes.

Ransom.

Rib fracture.

S

Shoulder dislocation.

Shock.

Subdrop.

Shark attack.

Stubbed toe.

Skull fracture.

Sunburn.

Sting (wasp, jellyfish, etc).

Smoke inhalation.

Self-harm.

Slipped rib.

Smoke inhalation.

Stalking.

Second-degree burn.

Stomach ulcers.

Seizures.

Starvation.

Spiked drink.

Sleepwalking.

Stab wound.

Snake bite.

Skinned flesh.

Scraped flesh.

Sleep deprivation.

Sleep paralysis.

Stitches.

Subconjunctival hemorrhages.

Stroke.

T

Traumatic aortic rupture.

Torn muscle.

Trapped.

Third-degree burn.

Touch-starved.

Torture.

Toothache.

Tuberculosis.

Traumatic asphyxia.

U

Uterine perforation.

V

Vomiting blood.

Vertigo.

W

Wisdom teeth.

Whipping.

Worked to exhaustion.

Whiplash.

Waterboarding.

Water infection.

Y

Yeast infection.

Z

Zombie apocalypse.

[sandimexicola]

A kiss

Midjourney prompt: A surreal and dark fantasy painting of an elegant alien woman with long, flowing hair sitting on the back of her large wings as she is being gently kissed by another creature that resembles half-robot-hemothoraxes with legs. The background features an ominous looking architecture that has no windows or doors but instead had exaggeratedly wide doorways. In the style of artist Giger. Use soft lighting and deep shadows to create depth in composition. --personalize nwnj8ta --style raw --quality 2 --chaos 37

[justkidneying]

Lung injuries.

I mean, there's so many to choose from but what about a bullet through the lungs? And what about an arrow too for the old fashioned types? Stuff to consider, what often gets portrayed wrong, etc.

That's something angsty people write about right

I really like this question, because I think lung injuries are just so dramatic. Coughing up blood (hemoptysis) is so cinematic. We'll go over basic lung injury, the treatment, and then the specifics for projectile/GSW injuries.

Alright so GSW to the chest, we're looking at some massive hemothorax (a fun word, imo). This is blood in the pleural space (lung cavity), which has a compressing effect on the lung. The lungs do have a high concentration of thromboplastin and low pulmonary artery pressure, which means that bleeding of the lung itself is limited. Mostly the issue is bleeding of intercostal arteries, internal mammary arteries (int. thoracic), and the pulmonary vessels being torn to shit.

Another fun word is pneumothorax, which in this case would be an open pneumothorax. This is air in the pleural cavity, which puts pressure on the lung and works to collapse it (remember your lungs only work because the pleural space is TIGHT). Each time the patient breathes, more air is sucked inside the chest cavity. Tension pneumothorax means that air is putting pressure on the lungs and heart, which are two organs that need to be able to move to work.

Wound Presentation

Sometimes a pneumothorax doesn't present immediately. After a stab wound, for example, they may have a delay of up to 6 hours. So patients with asymptomatic chest trauma should be reexamined 4 to 6 hours after the initial exam.

Open pneumothorax are sometimes referred to as a “sucking chest wound" and is a connection of the internal air to the external atmosphere (air pressure is very important in understanding the mechanism at play here). Anyway, this will be clear in the presentation. They're going to have some respiratory distress, and eventually an inability to ventilate the lung that is affected (absent lung sounds). As the person breathes in, I can almost describe it like when you are finishing off a soda pop and you're sucking up the little drops of goodness in the bottom of the class. It's this wet-gurgle sound but coming from the wound.

The person may start coughing up blood as well, as blood makes its way from the lungs up the trachea. Sometimes they don't do this, as the blood flow is swallowed or isn't enough to effectively work its way up the respiratory tract.

Treatment

Do not probe the injury with your finger. If someone has chest trauma, they need to go to the hospital. I see in movies a lot where people will poke at an injury (such as a bullet wound). This is more likely to make things worse. Exploration is best left to the operating room.

Before you get to the hospital, the most you will probably be able to do is put on a three-sided dressing. This is a square, air-tight dressing that is sealed over the wound on three sides. This prevents air from going into the wound during inspiration, but allows air to be pushed out of the wound during expiration.

You will want to insert a chest tube to get the blood out. For the love of everything holy, do not put the chest tube into the wound (you would be surprised how many baby EMTs thought you could do that). An incision will be made around the midaxillary line at the fifth intercostal space (shortest distance from skin to cavity) for the tube to be pushed in.

Needle decompression is also an option. This is where you put a 14G IV needle into the pleural space either at the midclavicular line at the second intercostal space or around the midaxillary line at the fifth intercostal space. You will literally be able to hear air rushing out of the end of the IV catheter, it's pretty neat. This basically makes the tension pneumothorax into an open one. You need to do the chest tube after this.

Weapon Specifics

GSW are super bloody and gaping. And you may have an entry and exit wound to think about. So it's just a fucking hassle. This person is bleeding everywhere, so sometimes it's hard to get dressings on. Also, if you have to give this person CPR, blood will rush out of the wound with every thrust, so it's just awful.

If the patient has been shot with a shotgun, there will most likely be damage to the surrounding tissues and massive damage to the chest wall. They may need to be on a ventilator until their wounds are closed.

I've never seen someone shot with an arrow, but at least that would be more likely to stay in the wound. If it doesn't you're in the same situation as the gunshot. This person will also have a lot of pain with respiration and may be unable to do it effectively, as the shaft is forcing all three layers to line up. It also depends on the head of the arrow how much damage is done. A bullet or field point will do a lot less damage than a broadhead.

[clarepreed]

My Fave Resus Stories by Other Tumblr Authors

***This list of my favorite resus stories on Tumblr is tailored to my personal taste so it is not a statement regarding the quality of stories not on the list.***

My preferences: Romance, resus erotica, happy or ambiguous endings, hurt/comfort, female victims. Not so much into super dark stuff or a lot of non-con stuff (despite my attempts at it myself, lol), very clinical stories, or male victims. I tend to prefer stories that feel active and personal vs. clinical or distant.

Stories are in alphabetical order.

I would love it if you listed your favorite stories in the comments!

STORY LINKS BELOW THE CUT.

Symbol Key:

🏳️‍🌈 (LGBTQ+ patient/rescuer)

♂️ (Male patient)

"2 girl friends resus rp" by @deviantpisces. Exactly what it sounds like. 🏳️‍🌈 CPR roleplay fantasy. Story HERE. Blog has deactivated, searching for a reblog.

"A Shocking Play Session" by @emmylousheart. Neither the first nor last story featuring William and Josephine. Defib play, CPR. Story HERE.

Anna Swift - "Intermission 2 - First Fantasy" by @intubatedangel. This is not the first Anna Swift story, but it's the first resus story I read on Tumblr, and remains one of my favorites. Drowning fantasy, CPR. Chapter 1 I Chapter 2 I Chapter 3 I Story Index

Anna Swift - "Intermission 4 - A Day Together" by @intubatedangel. One of many Anna Swift stories. Choking fantasy, CPR. Chapter 1 I Chapter 2 I Chapter 3 + Epilogue I Story Index

Anna Swift - "Shellfish Surprise" by @intubatedangel. Another Anna Swift story. A friend is exposed to a deadly allergen. Anaphylactic shock, CPR. Chapter 1 I Chapter 2 I Chapter 3 I Chapter 4 I Chapter 5 + Epilogue I Story Index.

"At the Heart of Revolution" by @onlyblue92. Resuscitation in a war zone. Hemothorax, CPR. Story HERE. 🏳️‍🌈

"Ethereal" by @heartbeatslover. The rescuer (gender unidentified) stops the heart of the victim so that they can fight something malevolent. Paranormal, dark cardiophilia. 🏳️‍🌈♂️ Blog has deactivated, searching for a reblog.

"Going Home" by @chronic-resus-needed. An asthma attack on a long car ride. Resus on men is not normally my thing, but I dug this one. Asthma attack, hospital resuscitation. 🏳️‍🌈♂️ Story HERE.

"Perspectives" by @emmylousheart. A woman goes for a solo swim and has an accident. Drowning, CPR. Story HERE.

"Pulse GRRRLs" by @emmylousheart. A punk band saves a fan. Choking, CPR. 🏳️‍🌈 Story HERE.

"Silent Songbird" by @breathlessangelrh. A wedding singer suffers a cardiac arrest. Sudden Cardiac Arrest, CPR. Story HERE. Story Archive.

"Training Collapse" by @emmylousheart. A woman experiences a sudden cardiac arrest during CPR class. Sudden Cardiac Arrest, CPR. Story HERE.

Untitled by @cmon-staywithme. Sleepwalking leads to drowning. Drowning, CPR. Story HERE.

Untitled by @resusmeplease. Gender unidentified rescuer's wife experiences illness and an accidental overdose. Agonal breathing, CPR. 🏳️‍🌈 Story HERE.

Untitled by @saphicresus. A fantasy becomes real. Choking, CPR. 🏳️‍🌈 Part 1 I Part 2.

Table of Contents

[mylifeisactuallyamess]

Chapter 8: Medcentre

A/N: Still contributing to Tech Tuesday with my meagre offerings 🥹

Warnings: Bit of a Hunter centric chapter but Tech still features heavily. Mentions of panic, stress, Tech is right there with his voice and comfort. Description of injuries and medical talk, mild assault (Stitch is grabbed). Small time jump. (I was going through a Hunter stage when I wrote this and it shows. I’m sorry 🫠)

Word Count: 5.5k+

3 months later.

“I may recharge for the night.”

“Yeah sure,” you told Beetoo. “I can clean up here.” As you gathered things to put in the sterilisation chamber you heard the door open and close. “Come tomorrow, I have no more appointments.”

“And here I thought we didn’t need them.” You whirled round to see Hunter slumped in the doorway, a hand spread on his side under his chest-plate. Long strands of dark auburn hair drifted across his face, covering the expression that spread over his features, he was in a great deal of pain and it showed.

“Hunter!” You helped him to the bed. “What am I dealing with?” Your hand hovered, ready to act.

“I don’t think it’s penetrative,” he grunted. “Possible fractured rib.” You noticed when he breathed in his entire body stuttered, like he couldn’t fill his lungs properly.

You released the gription so the armour loosened; gently putting the chest-plate on the floor, eyes exploring the broad plain of his chest. The padding was still intact and that was a good sign. You released his spaulders and removed the vambraces, followed by his gloves.

“I’m going to remove your padding now.” Gently you tugged the material away, helping him slip out of it to reveal his tanned, toned, tattooed skin. The tattoo on his face extended down his chest but it did nothing to hinder the bruise that blackened his side.

Grabbing your handheld scanner you pressed the sensor onto his skin, “Breathe,” you ordered. He sucked in a breath through his nose, face pulling as he tried not to make a noise. You watched his breathing pattern on the screen and looked for any anomalies. “I don’t see pneumothorax…lay back.” He complied, settling back on the bed so you could feel his stomach. Your fingers glided over his skin, looking for anything that wasn’t rock hard muscle. You found a soft area and he bit back a yell, his entire body reacting to the pain. “No hemothorax either, I do need to get a look inside.” You moved away to start the tomography machine, pressing the necessary programmes you needed on the screen.

You helped him take the rest of his armour off, removing his boots and greaves, placing them carefully to one side. Soon he was stripped to the waist, only his tan coloured trousers remained. He moved slowly; not the sure footed Hunter you were used to.

He hesitated, eyeing the machine like it was going to bite him. “It’s just to take a picture so I can see where the fracture is and if you have any bleeding.” Approaching him cautiously you could see distrust in the downturn of his mouth. “You’re not leaving here without this scan, Hunter.” He nodded, still holding his side as though it was making him feel better.

“I just, lay down?”

“Yes, but first…” you reached up to slip his bandana off releasing the messy top of his hair. He really had the best hair of the whole Batch.

He took the material from your grip, tossing it in the pile with his armour. “Now you’re ready.” He moved away, easing himself onto the bed with a held back grunt when the pain got almost too much. It lit up around him, the soft blue glow casting shadows across his face as he tried to get comfortable. You started it, listening to the whirring that seemed to clear your mind better than meditation.

Quickly the picture was put up before you and it was worse than Hunter was letting on. “Now I know why you didn’t want a picture,” you told him. “I see two non-displaced rib fractures in ribs eight and nine. Also, your temperature is currently sitting at 38°C which means you are now under observation.”

“No I can’t… we have…”

“And they’re going to have to do it without you,” you spoke over him, crossing your arms in a very Hunter-like stance.

“Can’t you just give me something for the pain?” Hunter asked hopefully.

“You walk out this door and go hanging off cliffs or rolling around the floor in shoot ‘em ups, those ribs are going to dislodge and then you won’t be breathing, let alone anything else.”

“Stitch…” he made that face, the one where he was going to ask you to do something you shouldn’t with those big brown eyes…

“No!” You held up a hand and turned away from him. “I am doing my job, what I am paid for, something you encouraged me to do!” Angrily you gathered up the droid's utensils and shoved them in the sterilisation chamber.

“How long am I out of commission?” Hunter grumbled the words, his posture slumped on the end of the tomography machine.

“You are banned, banned from any heavy lifting or strenuous activity for at least three weeks. You need to sleep upright for 5 days or until you feel able to lay down comfortably. If you cough hold a pillow against your chest.” While you were talking your hands were busy making a shot of painkillers to give him, loading the vial into the injector and coming to a stop at his side. Placing a hand on his bare shoulder you leaned in to find the perfect spot on his neck to administer the dose. The injector hissed but he didn’t even wince, just kept his rich, caf coloured eyes trained on your concentrating face.

“You said I’m under observation?” He was so close, you could feel the heat radiating off his skin and you made yourself back away.

“Yes. Your temperature is higher than it should be so you need to spend one night here.” He looked away, clearly mulling over the information you’d given him.

“I need to contact Echo,” said as he stood up. Nodding you bent down and picked up his comlink.

“I’ll find you some clothes.” The supply cupboard was nice and cool, the glow panels blinking to life when you walked in. You had so much in here, you really should do an inventory soon.

When you returned Hunter was waiting patiently for the fresh clothes, a grey hoodie and some loose fitting trousers. Wordlessly he took them and you left him to change, moving his armour into the small private room you had for patients staying the night. You put in an extra pillow in case he needed it in the night, smoothing out the covers and stepping back to make sure everything was perfect.

His hand caught you, stopping you from bumping into him and you jolted like he’d burnt you, “Sorry,” he muttered.

“N-no it’s ok,” hating the way your voice wavered because of the unexpected contact. “If you need anything just press this, I don’t sleep much so chances are you’ll catch me awake.” He was looking at you with such a soft expression it made your whole throat dry up and you had to cough to continue talking. “If your pain worsens or you start feeling unwell, struggling to breathe…well the sensors will alert me anyway. Goodnight,” you breathed, skirting round him when he stepped back to allow you to pass. You weren’t finished in the medbay but you had to distance yourself. Knowing that any of the Batch were hurt sent you in a spiral so you did the only thing that would calm you down.

“Havoc-2, do you read me?”

“I read you, Havoc Medic.” There…that’s what you wanted to hear.

“Are you sure this is a secure channel?” You turned the com over in your hands, still marvelling at Tech’s technical genius. He had given you these coms a couple of months ago but you’d only used them once or twice. You had held them much more than that, frightened to push the button and find him out of range or just…busy. But even holding them helped you in a way, knowing that Tech gave you this was enough sometimes.

“I programmed these coms myself, someone would have to be cleverer than me to hack them. No one alive like that exists.” Even over the com you could hear the touch of steadfast pride in Tech’s voice at his own abilities.

“I’m sure a droid could eventually crack them open,” you responded slyly.

“A droid is not a sentient and therefore, not classed as alive.” There was a pause where he waited for you to respond but you had no idea what to say. “Are we going to hold a conversation or was there a specific reason you contacted me?”

“I…I was just wondering how the big ships in the war worked?” You could just imagine the disappointed grimace on his face at your vague description, the adjustment of his goggles as he prepared to launch himself into this stream of information retelling.

“I am going to need you to be more specific, to which ships are you referring? Republic or Separatist? All ships are large to someone, are you asking about ships that house over seven thousand crew or ones that only need 200 hundred but can carry 100,000 tonnes…”

“Tech. Pick a favourite.” You rolled onto your back and stared up at the ceiling, laying the com on the pillow beside you and resting your hand behind your head.

“Ah. If you had just asked that in the first place,” there was a slight scuffle and you were sure you heard the buzz of his tools as he spoke. “What systems were you interested in?”

“The engines, tell me about the engines.”

“Very well. My particular favourite is the Venator class star destroyer. Primarily used as flag ships for the Jedi Generals during the Clones Wars era. These ships had 4 primary drive engines…” closing your eyes you breathed in deeply, letting it out in a controlled way as Tech emptied his mind of every scrap of information about these ships you really had no interest in. You weren’t even sure how long he talked at you, not even bothered if you were still listening, he was just happy someone had asked for information he could give. It wasn’t until you realised he’d stopped and your heart picked up at the idea you could have fallen asleep and it might offend him.

“Havoc-2?” You whispered.

“I had assumed you’d fallen asleep.”

“Sorry.”

“Do not be, it is late and your appointments are rather full for the next few weeks.”

“Tech, did you download my appointments?”

“Well I…” he cleared his throat and again you imagined the quick goggle adjustment probably a finger to the middle of them this time. “Yes. That is how Hunter knew you were done for the day.”

“How long did he wait until he came to see me?”

“He did not seem that injured, so he decided to complete the mission before seeking your assistance.”

“Tech.”

“He waited approximately 15 standard hours and 48 standard minutes. I understand now that might not have been the best course of action.” Pinching the bridge of your nose you wondered why the Galaxy had thrown you in the path of these reckless maniacs.

“I should get some sleep. Thank you Tech.”

“I should hope, next time we meet, you can tell me the fuel consumption rate of a Venator at full light speed.”

“Maybe I will,” you teased.

“Goodnight, Havoc Medic.”

“Night Havoc-2. Medic out.”

You woke the next morning, groggy and heavy lidded. Another night of restless sleep haunted by deep voices with no name and painful reminders. You changed, moving to the kitchen and making two cups of caf. You could never eat in the morning, whether it was a habit because you were used to rations or it was just who you were as a person—you couldn’t tell anymore.

You knocked on Hunter’s door but got no response so you left the cup on the floor to the side and went to set up for the day. Beetoo woke up, her receptors blinking like a tired human and you appreciated that touch from Tech.

“Good morning Stitch,” he said in her melodic voice. “Another full day ahead.”

“So it would seem,” you replied as you emptied the sterilising chamber.

“We have a guest,” the droid stated. “And yet there is nothing on my records.” That you didn’t appreciate, she really sounded like Tech sometimes.

“He came in late. I’ll do it today.” Which reminded you, he needed some meds. “Make me a dose of this please?” You showed the droid the meds you gave Hunter last night and she instantly went to work.

“How long is his observation?” The headpiece swivelled around to look at you, the arms still flawlessly doing their job.

“Just for 24 standard hours, as long as his temperature comes down.” You took the injector off her but this time you didn’t knock. The door slid open and you expected to see him sitting up or waking up with the noise. Hunter didn’t move, staying slumped in his semi upright position.

“Blast it!” The sensors hadn’t been switched on because you were too distracted last night and now his condition had deteriorated. “Beetoo! Bring me the kit!” Your instincts kicked in, checking his pulse, watching his breaths, listening for any wheezing and noticing the fine sheen of sweat that covered his marked face. “Hunter. Hunter, can you hear me?” He groaned softly, his brow wrinkling at your loud, firm voice. The torch flickered over his eyes and you saw a good reaction from both, next you pressed the scanner to his chest, watching the lines on the screen as it registered his breathing and heart rate.

He showed no obvious signs of distress aside from the elevated temperature and a racing heart so you went ahead and gave him the shot, smoothing down his damp hair as you did.

“Should we move him to the bays?” The droid asked but you shook your head.

“We are full today, leave him here and we’ll keep checking on him. Set a timer for the next lot of meds he needs.” The door com sounded and you groaned, your day was going to be a whirlwind.

Beetoo and you checked in on Hunter often. His temperature dipped and he stopped sweating but he didn’t wake up fully, only managing to open his eyes for some water before passing out again. If he didn’t improve you were going to have to scan him again.

Beetoo was clearing up after the busy day while you dealt with the last patient. A Rodian, bright green skin and brilliant starry eyes. He had a nasty slice in his forearm but refused to tell you how he’d acquired such a laceration. Still, you took the time to numb him and sew it up, some of your best work. Bacta was great in emergencies and it prevented infection but it didn’t stop the scarring from such a deep wound. Nothing but perfect stitches could minimise that risk.

“Keep the bandage on for a week, you’ll need to come back to have it redressed and if you feel unwell or the pain doesn’t subside you’ll need to return.” You grabbed the datapad that Tech had modified for your use in the medcentre and held it out. “If you could just enter your chaincode, payment will be taken automatically.” You had rules, if Cid sent someone to you they made it known and you used a modified code for their payment, otherwise everyone else had to input their own code in. You weren’t a charity, you needed to survive.

“No.” Instantly you were on the defensive, trying to ignore the sinking feeling in your gut.

“I just need your code…”

“I said, no.” Before you could react the Rodian jumped you. His hand clamped over your mouth to stop you screaming and to your horror, you froze. Eyes rolling, mind shattering at the sensation of confinement, the squeezing of his arms, the ragged breath, it brought forward all your demons.

Your heart throbbed in fear, your legs sagging refusing to hold your weight so he hauled you upright; dragging you towards the door. Small whimpers passed involuntarily through your lips, tears wetting your face but still the Rodian kept his tight grip on you.

“Going somewhere?” A deep voice penetrated the hazy fog you’d fallen into and it kicked you to react. If the Rodian got hold of Hunter he could seriously hurt him. You brought a heel down on his foot, an elbow jab to the solar plexus had him loosening his grip and you managed to free yourself gasping wildly for air. Thankfully your patient took one look at Hunter glaring at him from the doorway and fled outside.

You used the wall as support, trying to calm yourself and concentrate on Hunter who had gone to check everything was clear. When he came back his attention was on you.

“Stitch? Are you still with me?” Tentatively he reached for your shoulders, putting his concerned face right in your unfocused eye line.

“Y-yes! Y-you shouldn’t b-be out of bed y-yet.” Get a grip, Needles. Closing your eyes and swallowing down the excess fear only to move it from your throat to your insides.

“I felt something was wrong.” Hunter and his senses. Of course he did. Your hand was shaking badly when you reached for his neck and tried to take his pulse. Most people would have frowned, told you not to do that, ushered you somewhere else and made you sit down, but not Hunter. He gazed at you with those beautiful eyes, letting you feel the beat of his body through his skin, watching your lips mouth silently as you counted.

It calmed you, centred your mind and gave control of your body back. With a quiet exhale you rested your hand on Hunter’s shoulder, feeling the softness of his hair brushing over your fingers.

“Thank you,” the words were barely a whisper but he gave you a small smile, just in the corner of his mouth. He turned back towards the door, hauling you roughly behind him as it opened to reveal the rest of the Batch.

“Hunter! Oh…” Omega drew up quickly, bringing Tech, Echo and Wrecker to a halt. Hunter dropped his defensive stance straight away and moved aside.

“Is everything all right?” Tech shoved his goggles up his nose a little harder than necessary as he peered at you both.

“What’s happened?” Echo demanded with a frown.

“It’s fine,” Hunter held his hands out to try and calm the squad before they ran off to find whoever had upset you. “It’s been dealt with.”

“You’ve been crying,” Omega innocently pointed out, her look of concern almost a mirror of Hunter’s.

“I’m fine. Just someone refused to pay…” you told them, wiping at your eyes.

“Are you hurt?” Tech stepped forward and you gave him a shaky smile, appreciating the softened tone when he spoke to you.

“Who was it?” Wrecker snarled from the doorway. “Want us to find ‘em?”

“I really don’t think they will be back.” Turning your attention back to Hunter you saw him favouring his side. “Sit down at least, medics orders.” You went to help him but Echo was already there, taking Hunter’s weight on one side and leading him back to the bays. Omega followed, her deep hazel brown eyes watching her brother closely.

“Did you want me to pinpoint who had registered to the medcentre and trace them that way?” Tech was already tapping on his datapad, probably hunting down whoever it was.

“No, Tech. I can lose the payment for this one.”

“Logically, you can’t afford to lose any payments, not only does it support you, it repays Cid and the small amount of our debt you so selflessly offered to cover.”

“Tech,” Echo scowled slightly and tried to convey a silent message, which was not received.

“I was just stating the truth,” Tech replied.

“Not the best time,” Echo started, pushing you to step between them.

“He’s right though,” you started, holding out a hand to placate Echo before turning to Tech. “Maybe it’s something I can think about tomorrow, hmm?”

“Yes, I suppose that is acceptable,” Tech conceded with a quick nudge of his goggles. Hunter chose that moment to moan, his effort to hide it was caught by you and it hit you that he hadn’t been given his last dose.

“As lovely as it is for you all to visit, Hunter is still under observation and I need to give him some meds.” You winced as Wrecker clapped Hunter on the shoulder, making him gasp in shock from the pain.

“Oops. Did I break more ribs?”

“No. Not quite, Wrecker,” Hunter curled a hand around his side, leaning heavily on his wrist that was perched on his knee.

“See you soon Hunter,” Omega sadly waved as she followed Echo to the door. Wrecker went next and then Tech almost reluctantly followed.

“I need to find my droid,” you huffed. “Go back to bed, Hunter .”

“Yes ma’am!” He called after you.

Beetoo was standing in front of the sterilisation chamber, all her tools were inside but her photoreceptors were off. Tutting softly you wheeled her over to the charging port and pushed her in until it clicked. You were going to have to ask Tech to run a diagnostic, but it explained why she didn’t come to your aid.

You filled the vial and took it straight to the private room, leaning over your patient and giving him the shot in the neck like always. “You’ve definitely improved. I would like to see another scan before you go, just to be sure.”

“I can do that.” He watched you walk to the door where you made sure the sensors were on this time. “Are you sure you’re ok?” For a second you considered spilling everything, how the Rodian had made you feel, how it just brought back all your deepest and darkest—instead you plastered on that well versed smile.

“Yes I’m sure. I’m going to lock up, get some rest,” you ordered with a finger to emphasise your point.

Reaching the front door had your mind reeling. Part of you wondered what the Rodian was going to do with you and part of you really didn’t want to dwell. With shaking hands you locked the door and retreated with hurried footsteps back to your room. Walking backwards you climbed onto your bed, eyes fixed on the closed door as your heart quickened. No no no! Not now! Gathering your legs, you began to rock, squeezing your eyes shut but that just made your feelings worse.

The tightening started in your chest, restricting your breathing enough to make you drag a gasping breath in. Your com sounded and you nearly leapt off the bed in shock. It took a few attempts to grab it but finally you did and answered the call.

“Havoc medic, do you read me?” Tech. Tech went back to the ship and called you as soon as he got there. “I repeat, do you read me?” There was an edge of urgency to his tone and your face scrunched up as you tried not to cry.

“Tech…” the waver in your voice couldn’t be disguised.

“You sound distressed. Do I need to come back? Is Hunter ok?”

“Hunter—Hunter is fine.” You sniffed and rubbed the back of your hand over your cheek.

“But you are not.” It wasn’t a question and he couldn’t see you, but still you nodded dumbly at his words. “What can I do?”

“Just keep talking,” you whispered.

“That I can do. Any particular topic or would you like a briefing of todays events?”

“Today, what happened would be good.”

“Very well. It started in Cid’s parlour of course, she told us she needed something picking up…” closing your eyes you let out a shaky breath. His voice was calming, his descriptions so detailed it allowed you to zone out and detach, to tell your demons to go away and that they wouldn’t get the better of you.

You muffled the sobbing, hoping Tech didn’t notice, if he did he chose to ignore it; continuing on to tell you about the Mantell Mix incident. Eventually you laughed, a hiccuped giggle and he did pause at the sound. Laying down and wrapping yourself in a blanket you stared at the com, wishing you were brave enough to ask him to come back.

“And that is why Cid has a rather sizeable bill for Mantell Mix.”

“Can’t deprive Wrecker and Omega of that,” you said quietly, wiping at your face as you did and sniffing slightly.

“Well, she could. But I don’t think even Cid would want to face those consequences.” There was a silence, but you were used to them with Tech, sometimes he just needed to have a think before saying anything else.

“Thanks for this, Tech. I didn’t expect to hear from you tonight.”

“I felt compelled to make sure you were all right. I deduced you might not be. Turns out, I was correct.”

“I am better now, talking to you.”

“I had hoped it would be sufficient.” There was another pause where you realised you didn’t want to cut the call off just yet. “Was it sufficient?”

“Yes, Tech. It helped more than you know.”

“Good. It is late, you need some rest.” The panic threatened to claw its way free but you managed to keep it at bay.

“Yes, Goodnight Havoc-2.”

“Goodnight Havoc Medic.” The light died before your eyes and you reached for it, curling your fingers round the small device and feeling the edges biting into your skin. It was the closest you could get to Tech right now and you didn’t want to let it go.

The fire was so hot, it seared at your skin when you threw up your hands to try and protect your eyes. Part of the ceiling came loose, dropping to the floor and adding to the burning pile that used to be the Academy library. The wet cloth you’d tied around your face was barely working anymore, the smoke was curling and burning as it entered your lungs making you cough.

You knew there was a door nearby but you were disoriented, trying not to fall into the pit of blind panic as you felt your way along. Your eyes were closing against the thick smoke, your lungs bunching in your chest with every breath and you knew you had to get out.

You didn’t see the arms as they stretched through the haze but you did feel them. Scales that pinched your skin, their sharp edges cutting in to the softness of your lips. Long black claws dug into you, drawing blood and making it ooze slowly from the wounds. You tried to fight but they overpowered you, dragging you deeper into the smog filled place only to burst out of a door and fresh air cascaded over you.

The Trandoshan threw you to the ground where you sputtered and heaved air into your suffering body, lungs squeezing and vibrating as they struggled to cope. The grass was cool on your skin and you fingers curled in the stalks, crushing them in relief that you weren’t in the building anymore.

A flat reptilian foot kicked you over, disturbing your brief moment of sanctuary and drawing you back to your predicament. There was a group of them, long serrated teeth and glowing green and yellow eyes that stared hungrily at you.

“Thisssss her?” You recoiled from them, your eyes fixating on their long tongues as they licked their teeth.

“Yessss.”

“We got what we came for. Move out.” Their pleased guttural cries rang out into the darkness, a hand grabbed your throat and hauled you upright. On instinct you spat in his face, awarding yourself a slap across the face that split your lip and rattled your brain. “Ssssseems she needsssss some manners.” When you regained your vision all you could see was the Academy burning down. The only place you had belonged and stayed in for more than a few rotations. Bodies littered the ground, just humps in the dark but you knew what they were.

You screamed, you couldn’t help it. Sounding like a wounded animal as your brain began to shut down. You tried to stop seeing but it was too much, too overwhelming. You cried until your throat gave up, your tears stopped flowing and you barely had the energy to lift you head.

The Trandoshans let you have your melt down, sniggering and pointing as they dragged you along the ground. Your eyes began to close, the fire touching the stars was the last thing you saw.

Screaming…you could hear screaming. Desperately you tried to get your body to wake up, to move but it felt like you were covered in a sheet of thick durasteel. The noise grew louder, such a noise of pure anguish, you wanted to help them.

“Stitch!!” Was that…? Hunter? “Stitch! Wake up!” Your eyes snapped open and you launched up from the bed covers straight into Hunter’s solid body. He grunted and grit his teeth when you collided with him, your breath ragged as you realised you’d been the one screaming.

You sobbed into his shoulder, your entire body shaking and he gently encircled you with his arms. “You’re safe,” he murmured over and over again, stroking your hair as he soothed you. Quickly you managed to bring yourself back from the brink, refusing to fall into the yawning chasm in your soul.

“You can let go.” Immediately he released you, sliding down the bed so he wasn’t touching you but he wasn’t leaving you either. Your lips quivered, struggling not to draw back with the anguish that stalked you all day, everyday.

You couldn’t bring yourself to look at him, choosing to stare at your hands as they shook in your lap. Get a grip, Needles. Ironic—that Cid’s voice was the one you used to shock yourself back to being…normal.

“I’m sorry,” Hunter murmured. “I couldn’t leave you.”

“No, I imagine I was pretty loud.”

“That’s not…”

“I know,” you reassured him. “I was trying to make a funny.” Glancing up you gave him a trembling smile and he gently shrugged one in return. “How are you feeling?” You forced yourself off the bed, grateful you had fallen asleep in your clothes last night.

“No temperature and the pain is, less.” Cocking an eyebrow you looked back at him.

“Are you just saying that so you can go back to the squad?” He didn’t give you an answer, twisting his mouth and looking to the side as he avoided your accusing glare. “It’s fine. I just need the scan and then you can go, someone should come and get you though. Tech or Echo, hell, even Omega so I can pass your meds on to a sensible person.” Hunter stood up, his presence large behind you but it wasn’t scary. Usually you hated people approaching you from behind but somewhere inside, you knew this man would never lay an unwanted hand on you.

“I’ll contact Echo.” You nodded, hearing him leave your room and only then did your shoulders slump. Face scrunching up as you fought a fresh wave of tears, pushing them away and breathing through the urge until it subsided. You needed to put the mask back on.

“The scans look good, you can go back but,” you locked eyes with Echo who visibly swallowed at the change in your tone. “If I find he’s been lifting things or being a hero, you will all face my medic wrath.” Lifting up a black box you handed it to Echo. “This holds his meds, the vials are all measured out exactly, he needs one in the morning and one in the evening. I will be checking.”

“Tech has already rigged up a reminder system in the ship,” Echo hastily told you. “Don’t worry, Hunter will be on light duties for the foreseeable.”

“I need you back here in a couple of weeks for another scan,” your voice softened as you addressed Hunter.

“Yes ma’am.” You noticed the amusement in his hazel rich eyes, the slight smile and it almost made him look younger in that moment, as though someone finally caring about him had shed years from the lines on his face.

“Go on, get out of here.” You turned your back on them letting Echo help Hunter into his gear.

“She sounds more like Cid everyday,” you heard Echo grumble and smirked to yourself.

Already the bays were full of people, most of them minor ailments that Beetoo could deal with while you updated your notes. You stripped Hunter’s bed, taking peace in doing it yourself rather than waiting for the droid. The rest of the day passed in a blur until, finally you flopped onto your bed and thankfully fell into a dreamless sleep.

[macgyvermedical]

Wilderness / low-resource medicine question: What can be done about misaligned/displaced broken ribs when surgery is not going to be available for a while (if at all)?

It takes a LOT of force to cause a rib fracture to become displaced, if only because there is a lot of muscle and other ribs that naturally form a nice splint. The presence of displaced rib fractures indicate that so much force was applied to the chest that there is probably significant damage below the surface.

This damage includes severely bruised or even punctured lung, pneumo- or hemothorax (blood or air building up in the chest cavity), pericardial effusion (buildup of fluid around the heart that puts pressure on it so it can't beat well), and depending on where the impact occurred, damage to the big bleedy organs (liver or spleen).

For this reason, the presence of multiple displaced rib fractures would be a "go fast" situation (usually a helicopter evacuation if one was available).

There's not a ton you can do about internal injuries in a wilderness setting. If you happen to have a 14g IV catheter and someone trained at the paramedic level they might be able to do a "chest dart" for a pneumothorax, but other than that, everything else needs surgery or something that's impossible to do without at least an EKG available.

The only thing you really can do at a lower level of training is to tape a bulky dressing snugly over the ribs. This can be a pillow or folded blanket taped just over the area of injury (not all the way around the chest). This helps decrease pain and makes breathing easier.

After this, treatment would be using any pain medication that is available (except aspirin, due to bleeding risk), encouraging the person to breathe as deeply as possible, and getting them out of the wilderness.

[she-karev]

The Night They Met (Andrew DeLuca x Alex Karev’s Sister Origin Chapter)

Age Rating: 12+

Chapters: One of One

Fandom: Grey’s Anatomy

Ship: Andrew DeLuca x Amber Karev (Alex Karev’s Sister)

Canon Episode: Season 17 Episode 6

Summary: While DeLuca is under, he dreams about the first night he and Amber met and when he started to fall in love with her.

Words:

April 30th, 2020

“Webber paged?” Teddy asks Owen as she enters the OR.

“Yeah, for me. DeLuca got stabbed.” Teddy sees DeLuca on the table under anesthesia to her shock, “He has a massive hemothorax and blood in the pericardium.”

“Sternotomy tray?”

“And Balfour. We treated a kid in Jordan who had shrapnel in the same area.”

Teddy remembers their patient from the army, “Right. Texas Hold 'Em guy.”

“And we sent him home in one piece.”

“Alright, let's do it again.” The surgeons get ready and start to cut into DeLuca who is passed out on the table. His mind takes him back to the past or it makes him dream his own version of the past. Either way it takes him away from what’s going on right here in the present where his life is on the line.

July 17th, 2017

Andrew DeLuca walks along the sidewalk of downtown searching for a bar to drink and relax after what just transpired at Joe’s Bar ten minutes ago. He was gonna talk to Jo Wilson about how he’s worried about Dr. Shepherd but she thought he was gonna confess his feelings for her again.

DeLuca learned from the first time he tried to confess his feelings for Jo that it would be for nothing. She interrupted him and told him that she doesn’t feel the same way. It hurt him but he learned to accept it and move on. But to have her outright tell him that despite everything she still loves Alex has him yearning for a buzz to kill the sour mood Jo incited in him. He left Joe’s so he doesn’t see Jo’s face as he drowns his sorrows and is on a quest for another bar to unwind in.

He spots a hole in the wall to his right called Screwdriver. The name itself tells him it’s not a high end cocktail bar and it most likely has college students and down on their luck drunks desperate for a drink. But at this point he’ll settle for a keg in a back alley instead of the usual spot for Grey Sloan staff to drink.

He pushes through the door and the smell of stale beer hits his nose, but he continues down the stairs. The walls are covered in old rock star posters, and he can hear Summer of 69 getting louder as he reaches his destination. There are tables and a stage for live entertainment in this room that could seat about 10 people. He sees a couple of men deep into their beers at one table and spots his destination.

The bar counter is tended by a large and hairy bartender who is already tending to another patron sitting on the stool with her back towards DeLuca. He can discern that it is a woman with long blonde wavy hair. She is wearing a gray sweatshirt with dark jeans and casual shoes. Andrew can guess it’s a college student trying to drink despite being below the age limit. He ignores it however and sits two stools away from the woman without glancing at her needing to be alone in his misery tonight.

“Can I get a beer and onion rings please?” Andrew asks the bartender who nods before grabbing a glass and going to the beer tap. He hears female laughter next to him which calls his attention and he looks to his left to see that his night just got worse.

It turns out the college student was actually the woman he accidentally assaulted this morning. He didn’t recognize her because instead of an expensive dress with a coffee stain and high heels she looks casual with her college sweatshirt that has Iowa State University at the front in yellow font. The sight of her here of all places on a crappy night like this has him widening his eyes at the unfortunate coincidence.

“You’ve got to be kidding me.” He says in disbelief over his misfortune causing the woman to look at him offended.

“What exactly do you have to be upset with me about?”

Andrew realizes what he said and wants to take it back and explain, “No that’s not what I meant I just-”

“Did I spill coffee on you or punch you in the face or picked up your tampons?” DeLuca’s face burns at this recap in front of the bartender who is taking this out of context, “Cause I’m a little lost on what you have against me.”

DeLuca glances at the bartender who looks mildly interested at this interaction but puts a beer in front of Andrew before walking back to the kitchen. The two of them are left alone with their respective drinks basking in the awkwardness of this chance meeting.

Andrew sighs and tries to fix his mistake, “Look it was an accident, I swear.”

It falls on deaf ears because the woman is still peeved by his presence and makes it known, “No, it was three accidents, five if you count each individual tampon.”

“I said I was sorry I don’t know what you want me to say.”

“Nothing, in fact we don’t have to speak to each other ever again.” The woman tells him in an aggravated tone that makes him respond the same way due to his own crankiness.

“Oh, that’s too bad, I was really enjoying getting to know you.”

“Well, I wasn’t.”

DeLuca rolls his eyes at that, “I was being sarcastic.”

The woman turns to him with a dark look, “I wasn’t.”

The two of them drink their alcohol in bitter silence once they made it clear they were not in the mood for idle chit chat. After he sips his beer he looks over at the woman who is drinking her scotch and soda.

DeLuca wants to go back to his drink and join the woman in her silent isolation but there’s something about her that intrigues him. Maybe it’s her being in a bad mood as well that has him curious about what made her want to unwind in alcohol too. Or maybe it’s because she’s unlike any other woman he met.

When he first met her this morning, she looked like she came straight from a fashion magazine. Now she looks dressed for a casual stroll instead of a night out in a bar. This change in persona has him intrigued on the angry woman next to him and for some reason a part of him wants to know her more and figure out what she’s really like beyond the clothes and bad attitude.

Andrew decides to ask a question, at this point he can’t piss her off more, “So, uh…what were you doing at the hospital anyway? Were you visiting a relative?”

The woman looks at him confused and he expects a sharp insult but instead he gets a medium respond, “No I was uh…there for an interview to become an intern.”

Andrew’s interest is piqued at the prospect of working with this beautiful woman, “Oh, what field?”

“Surgery.”

The coincidence wipes his sour mood and he looks at her impressed and surprised, “Oh that’s my field too, I’m a second-year resident.” The bartender puts the beer and onion rings out in front of Andrew who doesn’t notice as he continues talking to her, “How did it go? Did you make a good impression?”

He sees her signaling the bartender and pointing at her empty glass, “I think so I wasn’t socially inept as most doctors would be and they didn’t notice the coffee in boobs if that’s what your worried about.”

She gives him a mocking grin that would normally bother him but seeing it from her has him quietly chuckle to himself amused.

He shifts to where she’s coming from and makes an assumption based on her college shirt, “Are you visiting from Iowa?”

“No, I’m visiting from New York I went to Iowa undergrad.”

Andrew nods noting unlike most doctors he knows she went to state school, “That’s cool I hear Iowa State is a really great school for…aspiring doctors like you.” He admonishes himself for his stupid comment about a state he barely acknowledges let alone knows the information on universities there. Despite this she gives him a genuine grin amused by his verbal clumsiness and chuckles for the first time.

He joins her and notes her perfect smile before he continues, “Sorry I don’t really know what to say here.”

She faces him with a wide smile as the bartender hands her a new drink, “Really? I couldn’t tell.”

Andrew smiles before moving on to a new question, “So, New York are you graduating from Columbia? Or maybe Cornell?” The blonde woman frowns at that with surprised eyes that are furrowed. Andrew asks her out of curiosity, “What?”

She shakes her head, “Nothing it’s just…people look at me and hear New York and immediately assume model or actress. Ivy league is the last guess they would make about me.”

Andrew shrugs, “Well maybe that’s because they didn’t run into you after you interviewed for a surgery job at one of the top hospitals in the nation, that could be a factor.”

“True. As for the question neither, I’m graduating from NYU in May after that Match Day and then the rest of my life starts…no pressure.”

Andrew knows the feeling too well as he was a stressed out med student not that long ago, “So how long are you in Seattle for?”

“Just until tomorrow, I go back to New York by then.”

He sees an opportunity for a clean slate and takes it moving closer so he’s sitting in a stool right next to her, “Well since it’s your last night in town and we might work together in the near future how about we make a fresh start by letting me buy you a drink?”

She raises an eyebrow at him holding the glass in her hand that he remembers is her second drink for the night so he tries again, “Okay how about I buy you a meal then? And you can reimburse me for the dry cleaning.”

The woman chuckles at him, “Oh I’m still gonna reimburse you buddy.”

He doesn’t back down however as he is more intrigued by her the longer he talks to her, “Then you can reimburse me for any emotional or physical trauma I unintentionally cause tonight, what do you say?”

The woman looks at him blankly for a moment before responding, “All right.” She turns to the bartender, “Can I get a double cheeseburger please with the largest side of fries you have.”

Andrew can sees where this is going and grins at her long and expensive order, “With buffalo wings and after I want two of your most expensive desserts to go.”

She grins at him and he responds with a sly grin of his own before taking out his wallet for what will surely be a hefty bill.

“Can I get a name? Since your probably gonna bankrupt me in one night?” Andrew asks causing the woman to hold her hand out and he shakes it.

“My name is Amber.”

“Amber.” Andrew tries the name out and it feels nice saying it, “So Amber is there anything else I can get for you? Caviar? Maybe a beamer?”

Amber smiles at that, “Well it is the least you owe me after the pain and humiliation this morning. And you should throw in a whole new wardrobe straight from Saks.”

“I think I’ll have to sell my kidneys to swing that kind of cash.” Andrew jokes, “You know I grew up in Wisconsin and it’s right on top of Iowa but beyond the cities I memorized for field trips I don’t know much about your state.”

“Well I know Wisconsin is known for its massive amounts of dairy and cheese, is that accurate?”

“Very.” Andrew says with a nostalgic smile, “My mom was really into cooking, and she would try any dish with cheese on it. I joined my high school cross country skiing team so I could lose some of that fat. And I looked into healthy recipes I could make with my mom, so we don’t have as much lard in our systems as the dairy aisle.”

Amber chuckles at that image, “Well where I’m from we Iowans are known for our vast agriculture. We lead production in corn, soybeans and pork, what we lack in culture we make up for in fiber.”

Andrew is intrigues by this, “I guess it’s safe to say your kitchen was bustling with healthy ingredients unlike mine growing up.”

“No.” Amber says with a laugh, “Nobody in my family can cook to save their lives unless there’s clear instructions on the box. Basically, our family dinners consisted of tv dinners and white rice, although on occasion we would have mac and cheese with a little extra in it.”

“Extra?” Andrew asks with furrows eyebrows.

“Yeah, my siblings and I figured out about 50 different things to add to macaroni and cheese to give it a little something for taste.” Amber sips her drink, “Let’s see hot sauce was my favorite, hot dog too and out of some sick curiosity there was also peanut butter in the mix.”

Andrew groans in disgust and smiles in amusement, “Oh god that sounds disgusting.”

Amber smiles in agreement, “Yeah well my brother could eat anything that wasn’t nailed down so he finished it for us both thank god. Not much has changed since then, about three nights a week I have cereal for dinner and other nights I swindle my money for a hot dog from a cart that’s ten steps away from the next one.”

Andrew chuckles, “Well I’m lucky if I have the energy to pour cereal and milk together after a nightmare shift so I think I have you beat there right now.”

“Did I mention my cereal has dehydrated marshmallows?”

“Okay that is a problem.” He teases Amber who chuckles with him before he asks another question, “So what made you decide you were gonna be a doctor? I decided after four years as an EMT plus my whole family are doctors so that was motivation too. Do you have a family of doctors too?”

Amber winces at that, “Um…sort of. My brother is a surgeon, but he wasn’t the reason I decided to get into medicine. I challenge myself because nobody thought I was smart enough or determined enough to do a minimal task let alone past the MCAT. So, I made it a point to hit the books, get a 3.8 GPA and graduate with honors. After that it became kind of like a habit of mine to succeed and be the best I can be at the hardest thing possible.”

Andrew nods understanding her more, “And what could be harder than cutting into people and sewing them back together?”

“Exactly.” Amber confirms with a smug grin, “I thought I wanted to be an engineer growing up, but I figured out quickly that me and machinery are like lighting a match at a dumpster fire. Plus, those reflective vests are ugly.”

“True and what’s more trending than scrubs?” Andrew is very impressed at the woman next to him and makes it known, “It’s admirable, you pushing yourself like that. Med school for me was filled with legacy kids who expect shortcuts so hearing how you worked hard to earn everything you got is refreshing.”

Amber grins flattered, “Well I like to think we live in a meritocracy where people rise and fall based on how hard they work.”

Andrew is taken back by her vocabulary, “I think this is the first time I’m hearing the word meritocracy. Was politician your career goal too?”

“No, I practically grew up in a library.” Amber elaborates further, “We had basic cable, and I didn’t have enough money for a bookstore so checking out books was my best and cheapest option.”

Hearing about how she’s a bookworm too has Andrew’s interest in this woman reach higher and his attraction to her grows, “What did you like to read?”

“Fantasy mostly, I’m a sucker for magical worlds that turn into big movie franchises.” Andrew grins as his previous perception of her fades the more he knows about her, “I also like horror, reading about scary situations is so much better than seeing it on the big screen and…” Amber sips the last of her drink telling Andrew she has an embarrassing secret that requires alcohol to tell, “I also like graphic novels.”

Andrew’s eyes widen at the image of her reading Superman or Batman in the back of a comic bookstore, “Wow, I did not peg you for a comic book nerd.”

“Graphic novels.” Amber corrects with a serious face, “If you’re gonna make fun of me at least do it right. And I’m not a nerd, I haven’t read every single graphic novel in the world, just the ones that pique my interest. I have specific tastes.”

Andrew sips his beer, “Like what?”

Amber thinks for a moment, “Like Punisher, Old Man Logan, The Walking Dead those are my favorites. I like the dark and gory stuff with tortured antiheroes set in apocalyptic worlds.”

Andrew smiles at this, “Well when you put it like that I might have to give one of those a read.”

Amber chuckles at that before she pauses as a new song plays, “God I love this song.”

Andrew listens to determine what the song is and figures out it’s Leather and Lace by Stevie Nicks, “You like Fleetwood Mac?” He asks Amber who he thinks is the coolest person he’s ever met right now.

“Doesn’t everybody?” Amber asks back with a smile that stops Andrew dead.

“As far as I know right now yeah.” Andrew says after his peds rotation that lets him know the latest trends among the youth, “But it’s mostly because of that new Guardians of the Galaxy movie that had that one song that was already-”

“Overrated to begin with? I know!” Andrew is surprised at this shared point of view, and he almost wants to pinch himself to see if he’s dreaming the perfect girl right now. However, he doesn’t as he listens intently while she continues venting.

“It’s like ‘there’s a whole album with so many songs that are so much catchier, go on your spotify now’ Also it’s not the band that makes the songs great it’s the singer. Stevie Nicks went solo after Mac but nobody put her masterpieces on the charts.”

“Exactly!” Andrew agrees full heartedly, “I mean they worked on Rumours while there was affairs and divorces and so many other things that make good bands breakup. They put all that drama into a great album and yet everyone is focused on that one song because it goes with one scene in that one movie. It’s just…” Andrew stops when he notices the furrowed eyebrows and her hand over her lips that tells him he’s elaborating too much, “Sorry, my mind goes somewhere else when Mac is involved.”

Amber moves her hand revealing a grin, “I get it, I’m passionate about that band too, mainly because of Stevie. I mostly got into it because my middle name is Stevie, but I learned to appreciate the artistry and the history of it.”

DeLuca raises an eyebrow at that weird fact, “Your parents named you after Stevie Nicks? Not Christine or Lindsey?”

“Shut up.” Amber chuckles at that question that makes Andrew grin, “My dad was really into blues music. But hey I’m lucky I didn’t get B.B. or Muddy.”

“Or Fats Domino.” Amber chuckles at that sipping her drink before she closes her eyes bopping her head at the song.

“Here comes my favorite part.” Andrew sees her tapping her fingers against the counter according to the rhythm and is struck by lightning at what he hears next, “Lovers forever, face to face”

Andrew hears Amber singing the chorus and he knows he isn’t doing anything because the sound of her bedroom voice singing one of his favorite songs has him frozen in place. He begins to understand that Italian phrase he heard growing up ‘colpo di fulmine’ in English translation its interpreted as either ‘love at first sight’ or ‘lightning strike’. He can guess the latter interprets it correctly because the second he heard this beautiful woman start to sing it’s like something struck him.

Something so powerful and intense he can’t comprehend it but he knows it’s because of this smart, beautiful and independent woman next to him that has his full attention while she sings perfectly in tune and harmony.

“My city, your mountains stay with me, stay” Amber doesn’t notice Andrew staring at her as she sings too enthralled by the song, “I need you to love me, I need you today. Give to me your leather take from me my lace”

When she finishes singing, she opens her eyes and notices the staring next to her that makes her blush as he sees a red hue across her cheeks. He stops his staring looking at the beer instead hoping he didn’t ruin this by leering. She clears her throat; he fully expects her to say good night and walk out of the bar, but her next words catch him off guard.

“Do you want to sit at a table? I’m getting a crick at my neck facing you at this angle so…”

Andrew nods, “Yeah sure a table is fine, lets go.” Andrew lets Amber stand first and pick out a table while he says a silent thank you to the lord for not screwing up his chance with this dream woman.

[mecub]

I will explain any of these

[skyloftian-nutcase]

How would the Healthcare Boys deal with somebody passing off a case with the words "have fun with this one"? I've heard that's another thing you don't really want to hear from a coworker in healthcare.

Four took a breath to center himself before the phone rang. He'd just moved his one patient to the floor, so he was the one to take the first hit for an admission. The charge nurse had warned him that he would be receiving a patient who sounded rough, a direct admission from the ER who was currently too unstable for surgery.

After the third ring, Four answered the phone. "STICU, this is Four."

"Hey, Four." The ICU nurse immediately smiled, recognizing Legend's voice before he registered how worn out his friend sounded. "You ready for report?"

Four took another breath and clicked his pen. "Yes."

"All right, this is what I've got. Jane Doe, approximately mid-twenties in age, motorocycle crash into a tree. No medical ID tags, we're still trying to work out info and get her into the system. She was going approximately 50mph when she went off the road into the tree. Was wearing a helmet. She's been altered since EMS got to her on scene. They RSI'd her and did fluid resuscitation. She also got 2g of ancef. We gave her 3 units of reds and 1 FFP upon arrival. CT showed open book pelvic fracture, several rib fractures, she's got an open right femur fracture. FAST was negative, surprisingly. Head CT didn't show any major bleeds - chest, not so lucky. Possible cardiac contusion, her output is garbage, they've already done an ECMO consultation but they don't want to hold her here while they deliberate the issue. Your access is an 18G in the L AC and 16G in the R upper arm. We're going to pop an arterial line in her before we send her up to you, but that's about all that's left for that. Intubated, sedated, she's on propofol at 40, epinephrine at 8, levophed at 14, we've just been climbing higher and higher with that. She's finishing her FFP now. Oh, almost forgot, got a hemothorax on the L side, they put in a chest tube and she's drained out 300mL in the last hour."

"Coags?"

"Haven't had a chance to look, Four, I've been busting my ass down here. I know you have time to look at the labs. I'll get a gas as soon as we get the arterial line in, but the sooner we kick her to you the better. Have fun with this one."

With that, Legend hung up, just in time for Four to hear alarms blaring in the background before the succinct click and deafening silence.

Four took another breath. Well... this was going to be interesting.

XXX

Hyrule smiled as he brought in the stretcher. The patient gave a lopsided smile as well.

Ah. Well, that was problematic.

Warriors raised an eyebrow. "When was the last known well?"

"Literally right in front of us," Hyrule answered as he worked to move the patient to the bed with some help from other ER staff. "Probably about twenty minutes by now. She's down on her L side, completely confused, can kind of follow commands but her attention doesn't last. BG was 89, BP 182/79, HR 88, SpO2 in the upper 90s on room air. She's just been pleasantly out of it."

"She said he was cute," Mo chuckled as he rolled the stretcher out of the room. "Better watch yourself, Wars, she'll charm you."

Warriors snorted cheerfully as he signed out for report and got to work.

Hyrule gave a wave. "Have fun with this one!"

"Will do," Warriors laughed. Then he turned to his coworkers. "Let's get labs and get her ready for CT."

[mcatmemoranda]

Mechanisms of injury – Rib fractures are common injuries that occur most often following direct blunt thoracic trauma but can also result from severe coughing, athletic activities (eg, rowing, swinging golf clubs), child abuse, and bone metastases.

●Clinical features – Patients with rib fractures typically describe a history of a minor to moderate chest wall injury. Frequently, they can localize the pain to one or two ribs. Examination reveals point tenderness on a specific rib or focal tenderness caused by compression of the ribcage distant from the site of pain. A deep breath typically elicits pain at the fracture site. Rib stress fractures present with a gradual onset of activity-related chest wall pain.

●Diagnosis and diagnostic imaging – Rib fractures in victims of blunt trauma are generally identified clinically or by chest radiograph (CXR). A definitive diagnosis of rib fractures is not always necessary. The presence of isolated rib fractures does not have to be radiologically confirmed in all patients once associated injury has been adequately excluded, typically with a CXR, which is obtained primarily to identify pneumothorax, hemothorax, and other signs of intrathoracic injury.

•In most cases when CXR is not sufficient for the identification of rib fractures, chest computed tomography (CT) should be performed. Chest CT demonstrates greater sensitivity and specificity for rib fractures compared with plain radiographs but should not be performed for the sole purpose of assessing potential rib fractures since the clinical significance of these additionally discovered fractures is generally minimal. When expertise and technology is available, emergency physician-performed bedside ultrasound is an emerging modality with test characteristics comparable to CT for identifying rib fractures. Rib radiographs have very limited utility when CT is available.

•In patients with concern for stress fracture in whom definitive diagnosis will change management, magnetic resonance imaging (MRI) has become the modality of choice. Both bone scintigraphy and MRI have traditionally had better sensitivity for fracture than CT but are limited by resource availability. Bone scintigraphy requires large doses of ionizing radiation and has poor specificity.

•A skeletal survey should be obtained in infants with rib fractures, especially multiple fractures in various stages of healing, since this raises suspicion for abuse.

●Fracture patterns associated with internal injuries – Liver or spleen lacerations, mediastinal injury, pneumothorax, hemothorax, flail chest, and pulmonary contusion may occur but are uncommon with isolated rib injuries. An increasing number of rib fractures correlates with serious intrathoracic and intra-abdominal injuries. Displaced fractures increase the risk of internal injury and delayed bleeding.

•First rib fractures are associated with greater overall injury severity and life-threatening internal injury (including injuries to the brain, spine, lungs, and pelvis).

•Fractures of superior ribs (numbers 1 to 3) reflect trauma involving significant force and the potential for injury to mediastinal structures, major blood vessels (eg, aorta), and lung parenchyma.

•Fractures of ribs 9 through 12 may be associated with intra-abdominal injury. Right lower rib fractures may be associated with hepatic injury and left lower rib fractures with splenic injury. Fractures of the posterior portion of the lower ribs can be associated with renal injury.

•Three or more adjacent ribs each fractured in two places (ie, flail chest) (figure 4) is often associated with significant morbidity from pulmonary contusion as well as injuries elsewhere.

●Management – Treatment of rib fractures should be focused on early and adequate pain relief to avoid complications (eg, pneumonia) from splinting and atelectasis. Analgesia for isolated rib fractures includes nonsteroidal antiinflammatory drugs (NSAIDs) with or without opioids. Encourage incentive spirometry to prevent atelectasis.

For more severe injuries, intercostal nerve blocks are an effective approach but typically require admission.

Rib stress fractures are treated similarly to other low-risk stress fractures. Treatment begins with restriction of the inciting activity for four to six weeks followed by a gradual return to the activity as tolerated.

●Disposition – We typically hospitalize patients with three or more rib fractures and use a more conservative threshold for admission in older or frail adults and those at increased risk for pulmonary complications. An algorithm to assist clinicians with the disposition of patients with isolated rib fractures is provided (algorithm 1).

●Follow-up care – A follow-up evaluation six to eight weeks after the injury is reasonable, especially if the patient has persistent pain or any questions regarding ability to return to sports or work. Virtually all rib fractures heal well within six weeks. Follow-up chest radiographs are unnecessary unless indicated by clinical symptoms (eg, new shortness of breath, new or severe pain). (See 'Follow-up care' above.)

●Return to sports and work – Some patients are able to return to work within a few days, depending on their occupation, while some patients may experience prolonged pain and disability. (See 'Return to sports and work' above.)