#hemothorax

[nightingalesandnorco]

Can you say more about the cardiac injuries from your flail chest post? Contusion, tappenade. What are these like and how are they treated, and if someone has these on top of other injuries, what happens?

I got you! I wrote that post after a 10-hour hospital shift followed by an 8-hour school day so I just wanted to finish it and go to bed, but I'm rested now so let's get into it!

Pulmonary contusion: This is a bruised lung but can be mild or severe. If mild, it may have no immediate symptoms, but a severe pulmonary contusion can present with chest pain, difficulty breathing, coughing up blood-tinged sputum, and possible respiratory distress (fast breathing, wheezing, fast heartbeat, using chest muscles to breathe, pallor) or failure (normal or slow breathing, low blood pressure, slow heartbeat, lethargy, confusion, blue-tinged skin). Symptoms can present up to 24 to 48 hours after the injury in mild cases but can appear within hours in severe cases. When combined with other lung injuries, pulmonary contusion may require CPAP/BiPAP or ventilation. The patient will also receive pain medication and diuretics (medications that increase urine output) to reduce excess fluid in the lungs.

Myocardial contusion: This is a bruise on the heart muscle. Since the cells in the heart muscle don't regenerate like other body cells, myocardial contusions can lead to death of parts of the muscle and produce a syndrome similar to a heart attack. A patient will likely present with chest pain, shortness of breath, dizziness, stomach discomfort, low blood pressure, fast heart beat, palpitations, and distended neck veins. Myocardial contusions are treated with oxygen; IV fluids; and medications to raise the blood pressure, lower the heart rate, and control pain. Severe cases may be treated with cardiac bypass surgery or heart valve replacement.

Diaphragmatic injury/rupture: This is a tear in the diaphragm, the muscle under the lungs that causes them to inflate and deflate. This presents with respiratory distress. A herniation of the intestines into the chest can also occur, which can lead to loss of blood flow to and death of that section of intestine if left untreated. Diaphragmatic injury/rupture requires surgical repair, and the patient will have a chest tube (shown below) for a few days postoperatively.

Injury to the great vessels: The great vessels are the aorta and vena cava and injuries to them include tears/ruptures and aortic pseudoaneurysms, which may rupture. These are often asymptomatic until internal bleeding is substantial, in which case the patient will present with pallor, low blood pressure, and dizziness. A ruptured aortic aneurysm will present will tearing abdominal pain. These injuries are treated with surgical repair, blood transfusions, or endovascular repair (minimally invasive).

Tension pneumothorax/hemothorax/punctured lung: A tension pneumothorax occurs when a tear or puncture in the lung or pleural sac (membrane that surrounds the lung) allows air into the pleural space (between the lung and pleural sac) and compresses the lung. A hemothorax occurs when blood fills the pleural space and compresses the lung. These might sometimes be called "sucking chest wounds." Tension pneumothorax/hemothorax presents with respiratory distress or failure, asymmetric chest shape and expansion, the trachea being off-center in the throat, fast heart beat, low blood pressure, and distended neck veins. This is initially treated with needle decompression, in which a needle is used to puncture the pleural sac to let air or blood out, followed by insertion of a chest tube. If there are two simultaneous pneumothoraces/hemothoraces, surgery is indicated.

Cardiac tamponade [tam-po-NOD]: This like a hemothorax but in the sac that surrounds the heart (pericardial sac), and can present with chest pain, palpitations, and shortness of breath. Severe cases can present with dizziness, syncope, and confusion or lethargy. Cardiac tamponade is treated with pericardiocentesis, which is a needle inserted into the pericardial sac to drain the accumulated fluid. If this doesn't work, the sac is drained surgically.

Clavicular fracture: This is a fractured collar bone and presents like any fracture, with pain and swelling. In this case, the arm on the affected side will be displaced downward slightly. These are treated with immobilization with a sling for 6-12 weeks. If the bone protrudes through the skin or multiple displaced fractures are present, surgery is indicated.

Sternal fracture: This is a fracture of the sternum, or breast bone. These present with chest pain, pain with deep breathing and coughing, and swelling. Surgery is not required unless there are displaced or unstable fractures. Deep breathing exercises with pain management are encouraged.

Happy whumping!

[cpericardium]

link

Alt text: Sam had been on the set of "Beast Games" for only a few hours when disaster struck.

It was his first day as a freelance crew member on the Toronto set of the new game show from the YouTuber MrBeast. He was helping break down the set labeled Beast City — a miniature town with a basketball court, tables, cabins, and a tower on the northern side.

He weaved in and out of the set props while wrapping up cables. At one point, he walked into a section of the tower — a giant rectangular four-story structure that looked like it was made of concrete.

When he exited the tower, he collapsed and hit his head. He couldn't move his arm and felt a searing pain in his shoulder.

He started coughing up blood. "I don't want to die," a witness recalled him saying.

Sam didn't know it at the time, but workers had been disassembling the tower above him, and a dislodged section had fallen and sliced his left shoulder. He spent eight days in the hospital, where doctors removed his spleen and performed reconstructive surgery on his shoulder. He suffered a lung contusion, a hemothorax, and damage to his ribs, scapula, spine, and clavicle, medical records show. He said that it took months of physical therapy to regain use of his arm and that his surgeon said he couldn't return to work until spring at the earliest.

An executive producer visited him in the hospital and provided an envelope containing DoorDash and Uber gift cards totaling roughly $1,000, he said. A person close to the production said that it was something he'd asked for and that he was repeatedly offered other forms of support. Sam said he didn't remember asking for the gift cards and was underwhelmed. "Accidents on sets happen, but this one seemed preventable," he told Business Insider in an interview.

[bi4demibuddie]

The thing is that i'm not even mad that Bobby is dead. I'm mad that he is dead because apparently Tim Minear got it in his head that he wanted to kill an important character. He was going to kill Ravi but then i guess he thought "go big or go home" and changed it to Bobby. So this was a last minute decision as apparently everything he does is.

I'm pissed of that Bobby dies in a two parter plotline that makes absolutely ZERO fucking sense if you think about it for more than 5 minutes. Still asking myself how the fuck Hen is not dead, seeing that the virus was airbone (which btw that virus doesn't work like that but...well) and Bobby performed surgery on her. Her blood was exposed, she should have been infected and also she should have been the first to die since she was suffering from a hemothorax (she would have bled out really fast). So how is she alive?

The answer is because Tim Minear wills it, i guess. So Hen miraculously doesn't get infected but then Bobby gets infected because of faulty equipment and dies. A character that's finally accepting life and bulding his dream house with his wife. What a way to kill of a main but you did it. Yaaaaaaay... And his death got leaked weeks in advance so it's not even a shock anyway.

It's not that i can't see how Bobby dying could end up in really good storylines for the rest of the characters. It's just that the way it's been handled is just not it, so i'm not excited about anything surrounding his death.

All of this IF he is dead. Because he very well could not be dead. But even if that is the case, then what. I'm still gonna be pissed about how all this is going down. Bobby being alive is not going to remedy that, this was the last straw for me when it comes to Tim. It's been questionable decision after questionable decision and i do not have any more trust in me to give him.

It's the way he keeps sending character driven plotlines to the back to focus on flashy two parter episodes because yayyyy drama and explosions. Fuck off with that. I fell in love with this show because of the character interactions and the emergencies woven into them, not the showy action.

And I'm over all pissed off because i love this show and this whole mess is going to badly affect it, no matter what.

[rustyr3dhe4d]

love on call - ln4 - 1/?

summary: you are the new trauma director with a past you won't share. dr. norris, the sharp-witted ER physician, doesn't let mysteries go unanswered. what starts as tension and rivalry shifts into something neither of you can ignore - but letting him in means risking everything.

pairing: doctor!lando x doctor!reader (fem)

warnings: none for this chapter just a lot of medical terms 💋

wc: 927

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hospitals were all the same.

no matter the city, no matter the state, they all carried the same undercurrent - antiseptic and blood, coffee that had been sitting out too long, the hushed murmurs of nurses passing updates in the halls. every ER had its own rhythm, its own chaos.

and now, this one was yours.

you adjusted the strap of your bag as you stepped through the main entrance of westhaven medical center, the sliding glass doors hissing shut behind you. the morning rush was already in full swing - nurses pushing carts, residents scrambling for coffee, the steady beep of monitors filling the space between movement.

it was a routine you had memorized in more places than you cared to count. a new town, a new hospital, new colleagues who would eventually stop wondering about the past you never talked about. this wasn't the first time you'd stepped into a position with too many eyes on you. it wouldn't be the last.

you made your way to the trauma department without hesitation, your freshly minted ID badge clipped neatly to your coat. dr. y/n l/n, trauma director.

you rolled the title around in your head as you walked, ignoring passing glances from staff you hadn't met.

it didn't matter who you used to be

you were here to work.

and work, apparently, found you first. a voice crackled the intercom overhead.

"code trauma, ETA three minutes. multi-vehicle collision, injuries unknown."

you didn't slow your pace, already changing course toward the ER. when you stepped through the main doors of the emergency bay, the controlled chaos had already begun. nurses prepped beds, techs checked monitors, and the sharp smell of antiseptic filled the air.

a young resident standing nearby did a double take when he saw you. "uh- can i help you?"

you didn't bother with introductions. "how many incoming?"

"five, so far. first ambulance should be here any second."

"page surgery for standby, make sure we have two units of o-neg ready."

the resident hesitated, and you could see the question in his face - who are you to start giving orders?

before he could ask, the double doors burst open.

the first patient was wheeled in, the paramedic calling out vitals as he pushed the stretcher forward. "male, mid-forties, restrained driver, steering column impact to the chest. bp's dropping- 90 over 60 and failing.

your coat was off in an instant. "get him to trauma one."

there was no time for formalities, no time for second-guessing. the moment you stepped to the bedside, your voice was steady, your movements quick. you took over the moment the paramedic moved aside, hands gloved, assessing the damage as the team scrambled into motion around you.

"decreased breath sounds on the left," a nurse reported.

you reached for the ultrasound probes and confirmed the worst - hemothorax.

"he needs a chest tube now," you said. "get a 28 french."

the resident from earlier hesitated again. "should we wait for dr.-"

"no," you cut him off, reaching for the scalpel yourself. "he doesn't have time to wait."

the tube was in within seconds, blood draining from the pleural space. the monitors steadied, just slightly, enough to tell you you had bought the patient more time.

a beat passed.

then, from behind you-

"not bad for the new girl."

the voice was smooth, casual- but there was something in the tone that made your pulse tick up half a beat.

you turned, peeling off your gloves, and found him standing in the doorway, arms crossed, watching you with an expression that was equal parts amusement and assessment.

dr. lando norris.

you knew who he was. you had already done your research before you got here. he had been at westhaven for years, his reputation well-earned- quick, skilled, cocky as hell.

the kind of doctor people either loved or barely tolerated.

he was also, unfortunately, the one person you were going to be dealing with the most.

you arched an eyebrow. "not bad?"

his smirk deepened, stepping further into the room. "patient's alive, isn't he?"

your lips pressed together. "you always grade trauma cases like a b-minus paper, or just mine?"

that earned a chuckle. lando leaned against the counter, watching you like he was trying to figure something out. "just making an observation. you didn't even say hello first."

"we're in an emergency department," you said flatly. "not a dinner party."

"still." he tilted his head. "most people introduce themselves before taking charge of an entire trauma bay."

you could feel the weight of other eyes in the room now - nurses, residents, waiting to see how this played out.

you take a step forward, meeting his gaze head-on. "if you wanted a handshake first, dr. norris, you should've met me in the parking lot.

for a half second, his lips parted- like he wasn't used to being challenged like that. but then, just as quickly, his smirk returned.

"duly noted." he said, stepping aside. "welcome to westhaven, dr. l/n."

the sarcasm wasn't lost on you, but you didn't give him the satisfaction of a response. instead, you turned to the team, nodding towards the patient.

"get him up to the OR."

the conversation was over... at least for now.

as you left the trauma bay, you could still feel his eyes on you.

and something told you this wasn't the last time you'd be on the receiving end of dr. norris's curiosity.

but he'd figure it out soon enough - you weren't an open book.

and you weren't here to be read.

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!authorsnotes! i'm baaaaaack. decided to try something new for my comback era (this is series is the something new) so yall let me know how we like it :) (can you tell like i like medical dramas)

[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?

[chiyobot]

chiyo's personal mari autopsy

i am not a medical professional, my writing is done as a conclusion of personal research & a curious dissection; so please disregard errors i will kill myself at the first sign of them. potential inaccuracies.

red for instantly fatal, confirmed with enough image comparison,

blue for survivable as superficial/low chance of fatalism -> low chance not to be equated as impossible for demise,

orange for moderately fatal, large contributor but not primary.

s3ep10 full circle spoilers below;

17-18 y/o female, 5’7”, approx. 60 kg (est bmi) 6-7 ft pit trap with sharpened wooden spikes (diameter ~1.28 in -> at first i tried measuring the stakes to the size of a standard water bottle -> didn't work -> 16dram pill bottle came closest) while running on injury (~2.5 m/s).

see math above; force she hit spikes at was akin to that of a moving car at slow speed, hence full puncture (take into acc bodyweight, speed, height)

the pain she felt would have to be EXCRUCIATING, in consideration of the size of the stakes, the amt, and the specific positions. fortunately/unfortunately, it would have only been felt for a few seconds as she sustained many fatal wounds at heavy impact.

in case you were wondering, no she most likely did not have the time to imagine cheeseburgers or slurpees @ time of fatality, as the time between injury and death was far too quick.

injuries sustained

1. puncture right cheek (through-and-through)

penetrating facial trauma (ICD-10: S01.451A) + potential oral cavity perforation (ICD-10: S01.511A)

potential airway obstruction (if bleeding into pharynx), maxillary sinus breach

contribution to death : cheek wound was survivable in isolation. death resulted from cumulative injuries (aortic rupture, liver laceration). would cause instant death only if targeting carotid artery or brainstem.

2. puncture right shoulder (near clavicle)

subclavian artery laceration (ICD-10: S45.001A) + potential hemothorax with massive blood loss (ICD-10: J94.2)

hemorrhagic shock; hypovolemic cardiac arrest

contribution to death : significant; combined with other injuries, it accelerated hypovolemic shock and cardiac arrest; not instantly fatal alone

3. puncture left lung (mid-position)

tension pneumothorax (ICD-10: S27.0XXA) + hemothorax (ICD-10: J94.2)

hypoxia (collapsed lung → respiratory failure), mediastinal shift, air/blood in pleural space compressed the lung and mediastinum → impaired cardiac output.

contribution to death : critical. tension pneumothorax alone causes rapid death; combined with hemorrhagic injuries (e.g., liver/aorta), synergistically lethal

4. puncture liver

grade iv liver laceration (ICD-10: S36.115A) + massive hemoperitoneum (IDC-10: R57.1)

exsanguination (spike transected hepatic parenchyma + portal vein → intra-abdominal hemorrhage

contribution to death : significant. combined with aortic/subclavian injuries, accelerates exsanguination.

5. puncture right kidney (upper)

renal artery rupture (ICD-10: S35.001A) + retroperitoneal hemorrhage (>1l blood loss).

exsanguination (rupture of the right renal artery → rapid blood loss → hypovolemic shock; coagulopathy + aki.

contribution to death : significant. combined with aortic/subclavian punctures, accelerates blood volume depletion.

6. puncture beneath left kidney (lower)

descending colon perforation (ICD-10: S36.50XA) + jejunal perforation (ICD-10: S36.40XA) + retroperitoneal hemorrhage (ICD-10: S35.89XA)

aortic rupture typically causes immediate exsanguination; below-kidney trajectory more likely involves para-aortic vessels.

contribution to death : primary cause. aortic rupture is unsurvivable without immediate surgical repair. colonic/small bowel injuries would contribute to mortality only if survival occurred (sepsis). retroperitoneal hemorrhage amplifies circulatory collapse

7. puncture right elbow

brachial artery transection (ICD-10: S55.001A) + compartment syndrome risk (postmortem irrelevant).=

brachial artery injury causes severe blood loss (~1L/10 mins) but not instantly lethal

contribution to death : non-fatal in isolation but indicative of defensive posturing (e.g., bracing during fall)

8. puncture right palm

superficial palmar arch injury (ICD-10: S65.201A)

superficial palmar injury causes minor blood loss (~100-200 mL total)

contribution to death : negligible; fatal injuries (aortic rupture, liver laceration) caused death before palm hemorrhage became significant. indicates defensive action (e.g., gripping spikes during fall)

9. puncture left inner elbow

brachial artery laceration (ICD-10: S55.101A) + median nerve contusion (ICD-10: S54.30XA)

hematoma, potential nerve dysfunction (non-fatal), brachial artery injury causes moderate blood loss (~1L/10 minutes), insufficient for immediate death

contribution to death : non-fatal alone, insignificant contributor; minor contributor to overall hypovolemic shock in conjunction with lethal injuries

10. puncture left palm (near knuckles)

metacarpal fracture with flexor tendon laceration (ICD-10: S61.442A)

tendon laceration (non-fatal), minor blood loss; no critical vessels/nerves severed

contribution to death : non-fatal alone, insignificant contributor; fatal injuries (aortic rupture, liver laceration) caused death before palm injury exacerbated blood loss

11. puncture right outer thigh (upper)

femoral artery rupture (ICD-10: S75.001A)

femoral artery injury causes severe blood loss, survivable with immediate intervention

contribution to death : non-fatal alone; moderate contributor to hypovolemic shock in conjunction with lethal injuries

12. puncture left inner mid-thigh

great saphenous vein laceration (ICD-10: S85.301A) + saphenous nerve contusion (ICD-10: S84.20XA)

GSV rupture → moderate blood loss. GSV injury clinically irrelevant; fatal hemorrhagic shock occurred within <1 minute from aortic/abdominal injuries.

contribution to death : non-fatal and a negligible contributor to death. primary cause remains hemorrhagic shock from aortic rupture/abdominal injuries.

13. puncture right knee (below patella)

open knee joint injury with traumatic arthrotomy (ICD-10: S81.051A).

joint capsule breach causes septic arthritis/osteomyelitis risk but no acute lethality. limb ischemia (non-fatal in acute phase).

contribution to death : minor; fatal injuries (aortic rupture, liver laceration) caused death before knee complications developed.

14. puncture left inner knee

open knee joint injury with traumatic arthrotomy (ICD-10: S81.051A).

joint capsule breach causes septic arthritis/osteomyelitis risk but no acute lethality. limb ischemia (non-fatal in acute phase).

contribution to death : minor; fatal injuries (aortic rupture, liver laceration) caused death before knee complications developed.

15. puncture left foot (beneath toe joints)

metatarsal region puncture wound (ICD-10: S91.342A)

minor blood loss (~50-100 mL); no critical vessels/nerves severed

contribution to death : non-fatal alone; insignificant contributor to death. fatal injuries (aortic rupture, liver laceration) caused death before foot injury exacerbated blood loss.

16. laceration right foot sole

plantar laceration with foreign body retention (ICD-10: S91.331A)

minor blood loss (~50-100 mL); no critical vessels/nerves severed, foot wound contributed <1% to total blood loss.

contribution to death : negligible; fatal injuries (aortic rupture, liver laceration) caused death before foot wound exacerbated blood loss.

hand twitch is a normal post-mortem activity. would not suggest that mari was alive at time of butchering; rather involuntary body function.

[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)

[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.

[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.

[yourentity06]

Hi! Are you still taking EMT related questions? Is so then I have a situation I'd like your insight on.

The scenario is a young woman who's taken a large spike to the lower-right side of her chest. It didn't penetrate deep enough to damage any organs, but it broke a rib on entry, which proceeded to puncture a lung. The spike was removed immediately after impalement, and she was still able to move on her own for about a minute before coughing up blood and fainting from blood loss.

Now she is fictional, so she does end up surviving because I say so, but realistically what would initial treatment look like if you only got to her after she collapsed and how good is her chance of making it?

Hi diddly ho! I hope you find this helpful, friend :) The formatting for these explanations is not consistent, lol Penetrating chest injuries can be pretty intense. Not only is there a hole in your character's chest, which makes it hard for the diaphragm to work and inflate the lungs, but she also has a punctured lung which brings internal bleeding into the picture. Me explaining what is happening inside the body is for my studying purposes, so if you don't need the info, feel free to skip this paragraph! :) Bleeding around the lung (the space around the lung is called the pleural space) is called a hemothorax. External air filling up the pleural space is called a pneumothorax or a sucking chest wound. Since you character has both blood and external air filling up the pleural space, she is experiencing a hemopneumothorax (I'm sorry for the big word lemme break it up. HEMO means blood, PNEUMO means in relation to the lung or in relation to air and gas, and THORAX means the chest area). In perspective of someone who has no medical training, the best thing they can do is put pressure on the wound and get her to a medical facility. This kind of injury can only be fixed with surgery or funky healing magic if you've got that in your story. In the perspective of someone who is medically trained and who has the equipment, they'd first apply a cervical caller to her neck because they didn't see whether or not she fell and spinal injuries should always be taken into account, then they'd check her XABC's (X: Bleeding, A: Airway, B: Breathing, C: Circulation/pulse). They'd put pressure on the wound and apply a special bandage called an occlusive dressing. An occlusive dressing prevents air from getting in, but makes it able to escape since only three sides are adhered to the skin. Next, they'd suction her airway to get rid of the blood obstructing it. Once her airway is suctioned, they'd keep her airway open with an oropharyngeal airway (called an OPA, you can look it up, it just slides into your mouth and down your throat a bit) and provide oxygen via bag-valve-mask. They'd transport her immediately, taking her vitals in the ambulance/whatever they're transporting her in. They'd also give her a comfy blanket :))

Without immediate medical treatment her chances of making it are low because she would go into hypovolemic shock (shock caused by the loss of fluids in the body).

[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.

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