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First Aid/Pneumothorax and hand injuries

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Question
Hi Marcus!

I am researching a fictional story and have a few different questions for you.

Firstly, one character is shot in the back and sustains a partial pneumothorax. The bullet is later removed via surgery.
- What would the treatment in hospital be for this wound? What kinds of drips, medications etc would the person be put on? Is 2-3 weeks a likely recovery time to be back out in the world?
- What would this wound look like over time? In 2-3 weeks, would there be stitches, or could the wound be reopened accidentally? What would it look like in 2-3 months?

Secondly, another character smashes the bones in their hand in order to escape from a steel manacle. Later, the hand is so damaged that the character amputates it himself with a saw.
- Would it be possible to break your hand in a way that would allow escape from a handcuff? E.g. if the knuckles and bones were shattered.
- What would be the lasting effects of this, if the person didn't seek medical help? Would there be any serious resulting problems? Would the hand begin to heal, or would it die? Our character lives with the injury for a period of over two months.
- If a person was to amputate their own hand, again without medical help, is it plausible that they could live (for at least 24 hours)? Should they cauterise the stump, or would bandaging be sufficient? When they took off their tourniquet, would they immediately lose too much blood? How would this wound develop over the course of 24 hours?

Thanks in advance for giving these your best shot!

Sarah

Answer
Hello Sarah,

Your first character who is shot:
He is seen in the emergency room, chest X ray shows a partial pneumothorax and a chest tube is placed. at that time or before (if possible) cephazolin 1g IV and a Tetanus booster are also given. The patient is admitted to a floor (possibly a Med/Surge floor) for continued monitoring and recovery. On the floor he receives Tigecycline 50mg every 12 hours for 5-14 days, Demerol 50-100mg IV/IM every 3-4 hours for the first couple days, then Oxycodone 5-15mg by mouth every 4-6 hours. after 3 days the chest tube is removed and after 7-10 days the patient can be discharged to home. Take Acetaminophen 650mg every 4-6 hours for pain at home, stitches removed 5-7 days after discharge.

After 2-3 weeks the site of the chest tube is pink/ purple with a dark crust where the incision was. after 2-3 months there is still a red/ pink line which is slightly raised. There may be a little tenderness or loss of feeling around the site. After 1-2 weeks there is little chance of the site opening back up.

Your second character who has his hand crushed:
Yes, it would be possible to smash your hand to get out of chains (here is a video of guys snapping standard hand cuffs in case you wanted to try this instead:   https://youtu.be/p82ypGazlRc
the hand may or may not be useful after it was crushed, it would heal on it's own though there would be a lot of pain. Any open wounds would need to be cared for to prevent infection.  There may be continued pain dysfunction for the rest of the patient's life even with proper medical treatment. Yes you should be able to cut your own hand off. I recommend a wide tourniquet (2-3 inches). If possible cut the skin, peal back the skin and then cut the bones and joints so you have a skin flap to sew back over the wound. I'm not a fan of large area cautery. I believe it will be harder to prevent infection if you're also dealing with a burn on top of the soft tissue wound. During early wars (I'm thinking of the American civil war 1861-1865) there were countless field amputations and many of those people survived.

I hope that answered your questions well enough. Happy writing,

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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