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First Aid/Fiction - broken bones in upper body

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QUESTION: Hi there! First off, I want to let you know that this is fictional, so no worries. Anyway, I was just wondering about the logistics of a character shattering a lot of the bones in his torso (at this point I'm thinking several ribs, clavicle, and maybe the sternum. Also possibly the shoulder/upper arm) and having a severe spiral fracture in his arm. Everything but the arm is a crushing injury, so what type of fracture would that cause? What would it feel like - specifically - how much pain would the character be in (17 yo male) and how would he react? (I mean in terms of throwing up, dizziness, fainting, shock, whether he's able to think and talk coherently, etc.) Also, since this takes place in the woods, how could he be safely moved back to a house that's probably a dozen miles away or so? The people he's with are easily strong enough to carry him, but I'm wondering what position would cause the least pain and shifting of bones - or whether it would be possible for him to walk with someone's support, seeing as his lower body is undamaged. Finally, is there anything that could be done to ease his pain (other than medicine, which he can't ingest) and when the doctor arrives an hour or so later, what would treatment be like? No hospitals, but the doctor's an experienced surgeon and there's some medical equipment at the house. I guess I should add that the boy's supernatural and heals quickly (yeah... sorry) so there's really no chance of him dying or having long-term damage, but I'm trying to make the immediate reactions and symptoms as human as possible. I guess the most important part is the details of how he would feel and act after the injury, what would would hurt the most, what he could move (given that I've never had an injury of this magnitude before, and I'm trying to make it realistic.)

Thank you so much for your time, and I look forward to your response!

ANSWER: Hello Jess,

Severe trauma in young adults usually follows the same request "AAAH!...AAAH!... NO.. WAIT... DON'T MOVE ME.. PLEASE DON'T MOVE ME!... JUST WAIT...AAAH!" Once bones are splinted there is usually a reduction in pain. (see this quick video-->  https://youtu.be/Ot7c3syPtr4 ). I'm glad you mentioned that the character is supernatural and win't die because "crush injuries" can be very serious and if not managed by a qualified team can easily be fatal (see this -->  https://en.wikipedia.org/wiki/Crush_syndrome )

Your character will be in a great deal of pain and he will want to stay as still as possible as to not aggravate any fractures in movement. Like I said earlier, place the fractures in snug splints and he will likely feel less pain, enough to move him anyways. A blanket litter is easy to make and would work well to carry the injury over a distance (see here -->  http://armyintelligence.tpub.com/IS0871/IS08710186.htm )

Actual feelings the character may feel: extreme pain, throbbing, unbearable pain, a sharp feeling of glass moving around in the area of the fractures. The pain may be so intense that he begins to breath fast, breathing through pursed lips. shaking (shivering like shaking). You can move a fractured arm if needed, but it will hurt much more and most people will do whatever they can to avoid movement.

I hope this shed some light on injuries, somethings to think about anyways. Good luck writing.

Marc

---------- FOLLOW-UP ----------

QUESTION: Thanks so much for your incredibly fast response! I just have a quick follow-up to clarify some points, if you don't mind. From what you said it seems like it's more about the pain than anything else, so are reactions like dizziness, nausea and/or shock unrealistic? Would he be slipping in and out of consciousness or passing out altogether, or would the pain keep him awake? I know it would be painful, but would he be physically capable of standing and walking at all? Unfortunately I think a blanket litter is out of the question under the circumstances, so if he's unable to walk then what position would be safest to carry him in? Finally, in terms of coherency, how would he be - I mean whether he'd be able to hold a conversation or whether he'd be unable to concentrate. Sorry for bothering you so much about this - I'm really just trying to make it as detailed and specific as possible. Thanks a lot!

Answer
Hello again Jess,

The character may have nausea/ vomiting from pain especially in the pain involved the abdomen. He would be less likely to "pass out " from the pain (I've rarely seen anyone pass out from pain in my practice). If his legs weren't fractured me would likely be able to walk with some increased pain due to movement. Even a fracture/ dislocation of some of the smaller bones in the lower leg/ foot he may be able to walk a short distance with some increased pain. The best way to carry the patient would be with him laying on his back. supported by something under him (like a stretcher). google improvised stretchers, there are numerous possibilities to carry someone. If he is being carried a long distance (miles) a improvised stretcher is the way to go. Even a blanket carry is better than just throwing him over someone's shoulder. As far as pain and consciousness, yes, he should be able to remain fully conscious and able to answer questions though he may be somewhat distracted by the pain.

Good luck again.

Marc

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Marcus LaBarbera

Expertise

I am available to answer most questions related to: first aid, pre- hospital medicine, EMT and Paramedic questions, medical transport, critical care transport, ICU/CCU care, sedation, and medicine in general.

Experience

I have worked as a NYS Paramedic since 1993 for both community based ambulance companies and large commercial agencies. I Have experience as bike team commander, and shift supervisor for a commercial ambulance. As a member of the Disaster team I was deployed to Louisiana for 20 days following hurricane Katrina. I worked along side the county Haz-Mat team as a "Tox-Medic" with advanced training in treating injuries from chemical agents. Besides my experience on the on the ambulance I have worked in a number of hospital based offices including dialysis and a sleep lab.

Education/Credentials
I started my EMS career as a NYS CFR (Certified First Responder)in 1989, an EMT in 1991, a Paramedic since 1993, and a CCU transport paramedic since 2005. I currently hold certification as a: NYS Paramedic, Critical Care Transport Paramedic, ACLS/CPR/PALS certified. Advanced Haz-Mat Life Support certified (AHLS). In the past I have taught CPR and ACLS to my coworkers and the local community.

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