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Discussing: And even more Medical questions and terminology

And even more Medical questions and terminology

I decided to start a new topic since the old one was somewhat unwieldy and slow with its more than 70 posts. That said, here is my question: In my forever-WIP Doomed to Live I have Boromir suffer from two arrow-wounds (one to the shoulder, one to the side), none of them life-threatening but severe enough for pain, light-headedness and general weakness. Upon finding Boromir, Legolas removes the arrows, stanches the flow of blood and bandages the wounds (I assume that Legolas has no training as a healer, but some knowledge about treating wounds that occur on a battle-field, but he has never treated a human before). Then Boromir is granted some hours of rest before he, Legolas and Gimli go Orc-hunting. As is not too surprising, Boromir has some trouble staying on his feet, so Legolas calls for a break and examines Boromir's wounds. In doing so, everybody's favourite elf has to realise that mortals heal less quickly than elves and that it would have been a good idea to suture the wounds, which he then does. My question now is whether it is reasonable to suture wounds at this point. Boromir was wounded in the late hours of morning (about 10am), gets his wounds treated for the first time maybe an hour later (11am), gets to sleep until 4pm (roughly) and gets his wounds treated again at maybe 9 or 10pm. So I have Legolas attempt to suture the wounds roughly 12 hours after Boromir was wounded. If the whole scenario does not make any sense at all, I would be more than grateful for suggestions on how to fix it. The respective scene can be found in Chapter 5 of aforementioned story. TIA fliewatuet

 

 

Re: And even more Medical questions and terminology

My question now is whether it is reasonable to suture wounds at this point. Boromir was wounded in the late hours of morning (about 10am), gets his wounds treated for the first time maybe an hour later (11am), gets to sleep until 4pm (roughly) and gets his wounds treated again at maybe 9 or 10pm. So I have Legolas attempt to suture the wounds roughly 12 hours after Boromir was wounded. You are just at the limit of what modern medicine would find acceptable, but that's fairly recent, relatively speaking. Closing a wound after 8-12 hours increases the risk of infection greatly. If it's a contaminated wound, which it would be if there bits of arrow left in, or lots of dead tissue, it would be even more unwise. But that wasn't known until roughly 25 years ago. More to the point is what he expects to accomplish with the suturing. It won't help Boromir in any immediate way, unless it's to stop continued blood loss. It will help by reducing the number of days until he heals, otherwise he's likely to have open wounds for many days. As a modern aside - Legolas should wash out the wound before suturing. Lyllyn

 

 

Re: And even more Medical questions and terminology

Thanks a lot. That was what I wanted to hear You are just at the limit of what modern medicine would find acceptable, but that's fairly recent, relatively speaking. Closing a wound after 8-12 hours increases the risk of infection greatly. If it's a contaminated wound, which it would be if there bits of arrow left in, or lots of dead tissue, it would be even more unwise. But that wasn't known until roughly 25 years ago. Good, I can live with that, given that Legolas is no trained healer and has no experience treating wounded mortals. And I assume that the wound is not contaminated, that the arrows came out without problems (should I point that out more clearly?). More to the point is what he expects to accomplish with the suturing. It won't help Boromir in any immediate way, unless it's to stop continued blood loss. It will help by reducing the number of days until he heals, otherwise he's likely to have open wounds for many days. Legolas hopes to reduce continued loss of blood (I doubt that Boromir's wounds would no longer bleed, since he is not resting, but I don't want them to bleed heavily) and speed the healing. Do you think I should state that explicitely? As a modern aside - Legolas should wash out the wound before suturing. Yes, good point. I will add a hint that he does wash out the wound. Thanks for the help fliewatuet

 

 

Re: And even more Medical questions and terminology

And I assume that the wound is not contaminated, that the arrows came out without problems (should I point that out more clearly?). I don't see why you need to, unless it helps your story in some way. By the same token, I don't see that you have to state Legolas' reasons for suturing - most people won't question it anyway. Lyllyn

 

 

Re: And even more Medical questions and terminology

I don't see why you need to, unless it helps your story in some way. By the same token, I don't see that you have to state Legolas' reasons for suturing - most people won't question it anyway. Too late I managed to find a place where I could add the information that the wound is not contaminated but that suturing would be a good idea. The way I put it serves rather to give some further insights into Boromir's thoughts about the whole procedure (at least that's what I hope it does). Thanks again for taking the time to answer my amateurish questions, fliewatuet

 

 

Re: And even more Medical questions and terminology

Lyllyn, if you get a chance, I'd greatly appreciate it if you'd look over a few scenes in my story Theodred's Tale" where I describe an amputation. The injury is at the end of Chapter 16, and the operation is in Chapter 17. (For anyone wanting to read it, I do describe it pretty graphically, so be careful if you're squeamish. This part is why I rated the story Adult.) I based my description on a website I found describing amputations during the Civil War. The level of technology (aside from the anesthetic, which I was surprised to learn was widely used then) seemed about right. Is it plausible that Theodred would remain unconcious due to pretty severe blood loss that long? Is my description of shock reasonable? Is it reasonable that he would not bleed to death in the time before Grimbold gets the tourniquet on him? (I could have him fall in such a way that his leg is compressed under either him or the dead orc, if neccessary.) Are Haelan's actions believable? I wrote this before reading your articles in Research here; now I think perhaps I should have her strip him before she operates, and check the rest of him over for other wounds as well. I added having her sterilize her instruments because I wanted something she could have learned from the Elves. Would that have a significant effect in lowering the chances of infection? The Civil War site said that if the amputation was done within 24 hours of the injury, in conditions a lot less sanitary that what I've written, that the amputee would have about a 50% chance of survival (which is plenty for me, makes it quite believable that he could survive it). I looked for websites for amputees, trying to find people talking about their feelings and experiences with amputation, but couldn't find much (mostly lots of talk about the latest and greatest technological advances in prosthetics - very interesting, but not very useful to my story - though any information about historical prosthetics would be useful, because he's going to have a wooden leg eventually, and I've been trying to figure out exactly how it would be constructed and attached). How long after such an injury would he be able to be up and around? I saw a news report of a girl who lost an arm in a shark attack and was competitively surfing 10 weeks later. For the story I need him awake and aware about 4 days later, enough to have a confrontation, which could be physical if needed for him to be re-injured, because then he has to be out of commission, either unconcious or feverish or heavily drugged, for about a week. How soon would he be able to be up and around, learning to walk with a wooden leg and crutch? That part of the story is very flexible; I can work with whatever is realistic. Anything else that catches your eye as wrong or unbeleivable? This is the major plot point that the whole story turns around, so it's got to work. Thanks again for your help!

 

 

Re: And even more Medical questions and terminology

Elana, I apologize, I've been swamped and not had a chance to check this. I promise to do it this weekend. Most sorry for the delay! Lyllyn

 

 

Re: And even more Medical questions and terminology

No problem. Whenever you get the chance. Elana

 

 

Re: And even more Medical questions and terminology

Again, sorry to be so late! Some of this is technical stuff that non-medical people are unlikely to spot as a problem, so take what's useful and don't worry about the rest. Is it plausible that Theodred would remain unconcious due to pretty severe blood loss that long? The problem you run into here is a common one for authors. If the blood loss is so severe that he is unconscious a long time, he's really in bad trouble, and his chances of dying are much higher. It's surpising how many people with devasting injuries are conscious. Also, it will take him a lot longer to recover if the blood loss is so severe. I see a few alternatives: either he is awake for this, or he sustains a head injury to knock him out, or someone gives him something - in a preanesthetic era alcohol or laudanum (from the opium poppy) are the only choices. Is my description of shock reasonable? The pallor and cold and damp is perfect. Is it reasonable that he would not bleed to death in the time before Grimbold gets the tourniquet on him? (I could have him fall in such a way that his leg is compressed under either him or the dead orc, if neccessary.) How much blood he has lost can vary, especially since it is not a complete amputation. Where the axe hit can help define this. You want the bone to be broken and muscles cut, but this can happen without hitting the big blood vessels. If it was only attached as you describe, it would mean the several large blood vessels were cut through. You might consider setting it up differently. If the bone is shattered, and the muscle is cut up by the axe and the bone shrards, that's a reason to amputate but Haelan can cut the blood vessels in a controlled situation. He'd still bleed a fair amount from the cut muscle of the injury, but you would have more time to take action. Are Haelan's actions believable? I wrote this before reading your articles in Research here; now I think perhaps I should have her strip him before she operates, and check the rest of him over for other wounds as well. You did very well with the flap and repeated flushing. An experienced healer would check him over, to make sure she wasn't treating one thing while an unnoticed stab wound was killing him. It doesn't have to take long. I added having her sterilize her instruments because I wanted something she could have learned from the Elves. Would that have a significant effect in lowering the chances of infection? The Civil War site said that if the amputation was done within 24 hours of the injury, in conditions a lot less sanitary that what I've written, that the amputee would have about a 50% chance of survival (which is plenty for me, makes it quite believable that he could survive it). Very well done; the sterilization would help greatly to reduce the risks. I'd also suggest that you specify the thigh injury as towards the lower end, as the survival rate is much higher. I looked for websites for amputees, trying to find people talking about their feelings and experiences with amputation, but couldn't find much (mostly lots of talk about the latest and greatest technological advances in prosthetics - very interesting, but not very useful to my story - though any information about historical prosthetics would be useful, because he's going to have a wooden leg eventually, and I've been trying to figure out exactly how it would be constructed and attached). There are some good articles about the psychological aspects here: Suite101 and a few bits on historical prostheses here, here, and here. How long after such an injury would he be able to be up and around? This depends somewhat on his blood loss. With severe loss, it's going to take him about 10 days to start making new blood, and about a month before he's back to normal in terms of blood. For the story I need him awake and aware about 4 days later, enough to have a confrontation, which could be physical if needed for him to be re-injured, because then he has to be out of commission, either unconcious or feverish or heavily drugged, for about a week. How soon would he be able to be up and around, learning to walk with a wooden leg and crutch? That part of the story is very flexible; I can work with whatever is realistic. He would be conscious fairly fast as there's really no reason for him to be unconscious. In RL they start physical therapy for amputees pretty early, like a few days. He could be drugged or just very weak from blood loss. Anything else that catches your eye as wrong or unbeleivable? This is the major plot point that the whole story turns around, so it's got to work. A few other comments. Haelan would only be experienced in amputations if she'd been around battle - I wouldn't think it that common otherwise. She might have seen occasional amputations if, for example, a horse fell on someone and caused a shattered femur. You mention that she spent some time in the Houses of Healing; that should give her some battle medicine. You might consider Hamm mentioning that, or I doubt he'd convince them to take Theodred to her. You also mention that a surgeon in Minas Tirith gave her his own instrument set. That seemed unlikely to me unless he was retiring as he'd then have no instruments to use. He could retire, of course, or he could give her the instruments of some previous healer he admired. If you want to mention everything she'll need, I'd add a forceps and possibly a retractor. It's almost impossible to sew without something to hold the tissue in place while the healer is sewing, which is where the forceps come in. Finally, this has nothing to do with the medical parts, but would Elfhelm and Grimbold accompany Theoden? I don't think both commanders would go and leave their men to less experienced captains. More likely they'd detail a trusted aide or lieutenant and some men to accompany him. At most, one of them would go, leaving the other in charge. Anyway, hope this helps. Lyllyn

 

 

Recovery time

I am wondering how long a strong man (Boromir) would need to recover from a wound (or rather wounds). The wounds in question are two arrow wounds, one in the left shoulder one in his side. The arrows did not cause much damage - mostly to muscle and skin - the wounds are sutured, blood loss was moderate (maybe around 1000 - 1200cc) and there is no infection. But Boromir has not much chance to get some rest (other than to sleep through the night), but he gets his fair share of Lembas and water. I'd basically like to know how he felt during the four to five days following his injury in terms of pain, discomfort and dizziness. TIA fliewatuet

 

 

Re: Recovery time

The arrows did not cause much damage - mostly to muscle and skin - the wounds are sutured, blood loss was moderate (maybe around 1000 - 1200cc) and there is no infection. But Boromir has not much chance to get some rest (other than to sleep through the night), but he gets his fair share of Lembas and water. I'd basically like to know how he felt during the four to five days following his injury in terms of pain, discomfort and dizziness. He might feel dizzy if he stands up fast, but it could go either way. He also might have less energy and stamina than usual - needing more frequent rests, getting out of breath a little more easily. Again, it's very borderline, and it would only last a few days if he's eating well. (Since we don't know exactly what's in lembas, we can assume it's very nutritious.) This is something you can set up to serve your plot - loose more blood and these things will happen. Lose a little less and he'll only be very sore in the area of the wounds, but that is something he's likely to be used to. Lyllyn

 

 

Re: Recovery time

He might feel dizzy if he stands up fast, but it could go either way. He also might have less energy and stamina than usual - needing more frequent rests, getting out of breath a little more easily. Again, it's very borderline, and it would only last a few days if he's eating well. (Since we don't know exactly what's in lembas, we can assume it's very nutritious.) Good. A little dizziness and less stamina is what I had in mind for him. Not too much, but enough that crossing Rohan on foot becomes quite an act of willpower for him. I will also take the liberty to assume that Lembas is quite nutritious and helps to build new blood (though Boromir has already made it known that he would prefer a steak over Lembas at this point in the story). This is something you can set up to serve your plot - loose more blood and these things will happen. Lose a little less and he'll only be very sore in the area of the wounds, but that is something he's likely to be used to. Yes, I can well imagine that this is not the first time Boromir was wounded. Thanks a lot! fliewatuet

 

 

Medical Question Regarding Premature Infants

How many weeks gestation are required before an infant has a 60-65% chance of surviving outside the mother without modern medicine? The infant in question would be smaller, weaker, and more vulnerable to illness than normal, but other than that have no major problems. How early could this infant be? Beruthiel

 

 

Re: Medical Question Regarding Premature Infants

How many weeks gestation are required before an infant has a 60-65% chance of surviving outside the mother without modern medicine? The infant in question would be smaller, weaker, and more vulnerable to illness than normal, but other than that have no major problems. How early could this infant be? This is all very approximate, as I had a hard time tracking down good statistics before modern medicine. Today, anything below 37 weeks is considered preterm. 34-36 weeks is considered mild preterm. 32-33 weeks is moderate preterm. With no modern medicine, an assessment based on limited knowledge (any obstetricians, pediatricians, neonatologists or NICU nurses out there?): Under 32 weeks: forget it. 32-33 weeks: high mortality rate: some will survive, but most would die. Before the invention of "isolettes" the neonatal death rate was 66% among infants with birth weights less than 2,000 grams. As a very rough average, 2000 grams would correspond to 32 weeks. 34-36 weeks: reasonable chance. So in answer to your question, a rough guess would be 34 weeks as the minimum to give the kind of chances you need for the story. In case this is helpful, I'll toss this in. Your healer or midwife should: Keep the risks of infection to a minimum. Everything clean or sterilized, limit visitors to parents or caretakers. Keep the child warm; premature babies can't regulate their temperature as well as term babies. Start feeding the child immediately if at all possible. Mom likely isn't producing breast milk initally, so use a wet nurse. Feed with a dropper, tiny spoon, syringe, whatever if the baby can't suck. Hope this helps. Lyllyn

 

 

Re: Medical Question Regarding Premature Infants

This is very helpful. Thanks. Beruthiel

 

 

Re: Medical Question Regarding Premature Infants

Also, google "kangaroo care" to learn more about non-technological ways to care for premies. Basically, baby is put skin-to-skin on mother's bare chest, between her breasts, and both are wrapped warmly. The skin-to-skin contact is very important; it seems to help the babies thrive. Baby is nursed as often as they show the slightest interest. I disagree with using a wet-nurse; the colostrum a mother makes in the first days after birth is very important immunilogically - it has many more immune factors than even mature milk, and is specifically designed to prepare the digestive system for later milk. In fact, mothers of premature babies make different milk than mothers of full-term babies, more suited to the needs of the premie. The story of how kangaroo care was developed is interesting. The way I've heard it, somewhere in South America in a very poor community, a hospital only had a few incubators, and had more premies than they could house in them. So, essentially giving up on those babies, they had their mothers care for them in this way. Surprisingly, they had just as good results with those babies as the ones in the incubators. I do agree that 33-34 weeks would be the earliest for the kind of chances you've described. Remember, that's dating from the last menstrual period, not from conception. LMP is usually, though not always, about 2 weeks before ovulation/conception. So when the average pregnancy is said to be 40 weeks, that's including 2 weeks before the baby is actually concieved. (Of course, a baby can be concieved by sex up to 5 days before ovulation, and 40 weeks isn't really average, it's more like 8 more days for first time mothers, and 3 more days for later pregancies, but I doubt that will have any impact on your story.) Elana

 

 

Re: Medical Question Regarding Premature Infants

Also, google "kangaroo care" to learn more about non-technological ways to care for premies. Basically, baby is put skin-to-skin on mother's bare chest, between her breasts, and both are wrapped warmly. The skin-to-skin contact is very important; it seems to help the babies thrive. Good point! I disagree with using a wet-nurse; the colostrum a mother makes in the first days after birth is very important immunilogically - it has many more immune factors than even mature milk, and is specifically designed to prepare the digestive system for later milk. In fact, mothers of premature babies make different milk than mothers of full-term babies, more suited to the needs of the premie. This is an area I don't know that much about - will there be sufficient colostrum and milk available initially in these circumstances? Lyllyn

 

 

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