What injuries kill you slowly?

September 17, 2009 4:46 PM

What kinds of injuries can still kill you long after you've entered intensive care in hospital?

It had always been my assumption that if you had a serious injury and were taken to hospital quick sharp then your chances were good. Especially if you were alive several days later. However, this story tells of a guy injured on Saturday who died the following Wednesday. Perhaps I'm being naive, but I had assumed that serious trauma injuries either killed you outright or pretty quickly. It seems weird to me that he lived four days before dying.

posted by Biru to health & fitness (23 comments total)

Hepatic bleeding can result in delayed death. It's not uncommon that patients are opened up in surgery and once the extent of injury is discovered, nothing really can be done. Bleeding can't be stopped and all that can be done is make patients comfortable while they bleed out. You can't live without a liver and stopping bleeding is really hard.
posted by Brennus at 4:49 PM on September 17

Yeah, I thought that something like the gradual and inevitable failure of a major organ might be behind it, but would have thought that if it came down to finding a suitable donor in that particular case they would have pulled out all the stops.
posted by Biru at 4:55 PM on September 17

Also, that person may have been on life support hence the delay of actual death. A friend of mine's son was in a car accident. Said friend was out of the country and quickly returned home - but it took a day or two. The son was kept "alive" for that time until friend could say his goodbyes and allow him to be removed from life support.
posted by Sassyfras at 4:55 PM on September 17

Several abdominal organs are susceptible to delayed bleeding or delayed perforation. A brain bleed may occur after some time has passed. A clot may form and send a chunk (called an embolism) to your lungs or to your brain.

Your chances of a complication of this type being found and treated are much better when in a hospital, but there is nothing perfect in this world.
posted by megatherium at 4:57 PM on September 17

Head injuries are known for this (c.f. "Talk and die" syndrome), as well as anything that leads to serious infection or other undiscovered complications.
posted by dersins at 4:57 PM on September 17

You can also get an infection in the hospital, from the hospital (google "nosocomial infection").
posted by holyrood at 4:58 PM on September 17

Everything.

If you're in intensive care in a hospital, you're on the verge of death, but there's still a chance you'll recover.

Intensive care "beds" (not just the bed, all the gear, the staff, etc etc) require massive resources (relative to other hospital beds).

You're only going to intensive care as an absolute last resort.

I can't recall the source, but I'd read somewhere that less than 50% of people who go into intensive care make it out.
posted by jjderooy at 5:02 PM on September 17 [1 favorite has favorites]

Burns. Crush syndrome.
posted by sanka at 5:07 PM on September 17

I believe acetaminophen\paracetamol overdose can go this way.
posted by !Jim at 5:17 PM on September 17

The body is not so simple as to just require timely patch up of the holes and breaks, and replacement of the blood lost, and bam -- back in business.

Any severe injury, even if it doesn't kill you outright (due to things like blood loss, direct injury to the heart/lungs/brain) still has the potential to precipitate a massive dysregulation of multiple organ systems which over the course of sometimes days or even weeks can lead to death. Look up: systemic inflammatory response syndrome, acute respiratory distress syndrome, or disseminated intravenous coagulopathy. Add to those the risk of subsequently developing life threatening infections (typically either at the site of injury/wound, through a mechanical ventilator or via and indwelling catheter or IV), or any of a number of other potential complications and patients can have a long and sometimes protracted course that may ultimately lead to death after trauma.
posted by drpynchon at 5:27 PM on September 17

I worked as an x-ray clerk in a hospital for several months. We were responsible for radiological records for all departments except ER.

My experience is pretty similar to what jjderooy describes. The "path" of a trauma patient was usually ER to surgery to ICU, where they either died after a few days or were moved to a bed on another unit. I can recall several patients who lasted 1-2 weeks in ICU before succumbing to the inevitable. For example, one young man was hit by a motorcycle and split open from groin to naval. He had no chance of long-term survival but the surgeons sewed him up and he lasted a week or two on life support (thankfully, in a coma).

Lots of trauma patients didn't really make it to the ICU - they died in the ER or in surgery or in post-op. That sort of weeds out the ones who can't last a few days.

Our hospital also had a Cardiac ICU unit. The story there is a bit different.
posted by muddgirl at 5:28 PM on September 17

After a heart attack, you're at peak risk for a rupture 3-5 days after when the body starts clearing out the dead tissue which was structurally important. Wiki. Anything that causes heart failure also can send you into a downward spiral of organ failure which takes a while to play out.
posted by a robot made out of meat at 5:52 PM on September 17

Sepsis is the leading cause of death in ICU and is often acquired in ICU. It takes a long time to kill you.
posted by DarlingBri at 6:00 PM on September 17

A fraction of thromboembolic strokes, that is, strokes caused by blood clots or fatty plaques, actually can lead to hemorrhage from a day to a few days after the initial blockage. Brain bleeds can put you on a path of irreversible damage (i.e. death).
posted by scalespace at 6:02 PM on September 17

My guy died from a fat embolism four days after his femur and hip were crushed.

There are times when someone with an acute head injury is kept on life support until everyone is absolutely sure that it's a no-go. There are occasions when someone is put into an induced coma for several days, hoping that when it's reversed, there will be brain activity.
posted by reflecked at 6:29 PM on September 17

Smoke inhalation can kill you days after it initially happens.
posted by number9dream at 6:38 PM on September 17

I have worked in the PICU. Anything can cause death after trauma. I think the most common are infection (if you are on a vent, you've got a basic highway right into your lungs for infection, no matter how hard everyone tries to be sterile), uncontrolled inflammation and bleeding, embolisms/clots, etc. If you are in the ICU in the first place, it usually means you are still very touch and go. That is WHY you are in the ICU, so you can receive the constant monitoring and special services to try and prevent and intervene quickly with all the things that can and do go wrong after trauma. I'd say it can be very common to die a few days after initial trauma. That is exactly the situation that ICU care is trying to prevent, and it is sometimes extremely hard to do.
posted by Bueller at 6:41 PM on September 17

jjderooy: "If you're in intensive care in a hospital, you're on the verge of death, but there's still a chance you'll recover."

I disagree. You are at a much higher risk of injury/infection/death, but you're not necessarily "on the verge" of death. My dad was put in because he needed to be on high dose blood thinners for a few days after doctor error loosened some plaque in his artery, but he wasn't dying.
posted by IndigoRain at 7:07 PM on September 17

Hi IndigoRain,

Its hard to say, but I suspect your father was in Intensive Care because of the chance of a sudden blockage (and thus, high risk of death) as a result of the surgery, rather than to put some blood thinners through him.

If this were the case, your Dad needed to have a medical person right there ready to go at all times (which is in some ways, the definition of Intensive Care - at least a 1:1 active staff/patient ratio, if not higher - and why its so resource intense) and hence why he was in intensive care until the risk abated.

This is the contrast to other hospital beds, where doctors go on rounds to see patients every once in a while, nurses manage a group of patients, etc. These patients are largely stable and not on the verge of death ...
posted by jjderooy at 7:23 PM on September 17

Sadly, emergency rooms are full of stories where the person came in talking, and went out feet first. We can fix a lot of things, but if the body gets set on a path toward death, it's pretty hard to make it stop.
posted by gjc at 7:26 PM on September 17

My understanding is that the danger of a clot can be very high in the weeks after major traumatic injury. A friend of my brother's died this way -- a terrible fall, followed by several days when they thought he would recover, and then a pulmonary embolism that killed him.
posted by palliser at 8:16 PM on September 17

I heard that if you're punctured deeply (as in shot or stabbed) basically though your bellybutton, you will bleed out slowly and without really any options to save you. The mesenteric arteries are all coiled around there and ripping them up is a bad bad thing. I heard this pretty much from a friend of mine who's done years of medical school, rounds, etc. who saw this with a patient who had been shot.
posted by Doctor Suarez at 9:58 PM on September 17

Acute Radiation Sickness
posted by dseaton at 10:52 PM on September 17