(For a story) What kind of injuries could make someone bleed to death?
March 23, 2013 10:29 PM   Subscribe

I'm writing a story in which a character is shot with a gun and is too disoriented to call for help. Someone else arrives about 30 minutes later, at which point the shooting victim is close to death due to blood loss. 1) Is this a plausible scenario (Is 30 minutes too long or too short to bleed to death)? 2) If so, what kind of injuries might cause such a scenario (a shot to the head, shot to the chest, hitting an artery)? Detailed answers would be greatly appreciated.
posted by SockISalmon to Grab Bag (11 answers total) 4 users marked this as a favorite
I'm an ICU nurse who's cared for plenty of patients with gun shot wounds. This is entirely plausible. A shot to the neck that nicked the carotid artery could easily result in loss of conscious in minutes and death in less than half an hour. A shot to the thigh that hit the femoral artery could also result in the victim exsanguinating in under thirty minutes. If any major artery is severed, death will result from blood loss in well under an hour if bleeding is not stopped or slowed.
posted by pecanpies at 10:46 PM on March 23, 2013 [3 favorites]

In addition to the injuries that pecanpies mentioned, the right gut shot could also do it (if it hit a highly vascularized organ or an artery / major vein).
posted by charmcityblues at 11:14 PM on March 23, 2013

Oh, man, I just got this lecture in EMT school!

If your character is also too disoriented to apply pressure or a tourniquet (or if the bleeding comes from some place he can't reach) then thirty minutes is definitely enough time to bleed out.

The usual suspects are the femoral arteries in the inner thighs, the carotid arteries in the neck, the heart, the aorta, and the vena cava. These are mostly arteries because it's hard to control bleeding when the blood is spurting out at systolic pressure; the vena cava gets thrown in because it's enormous and impossible to control with external pressure.

Less dramatic things include highly vascularized organs such as the spleen, the liver (also has the hepatic portal circulation), and the marrow of the pelvis and femurs.

Also, when you say someone else arrives, does that mean a paramedic unit with a short ETA to a level 1 trauma center, or does that mean some schmuck with a Band-Aid? The former gives your patient a much better prognosis.
posted by d. z. wang at 11:20 PM on March 23, 2013 [1 favorite]

Is 30 minutes too long or too short to bleed to death

Neither. Depending on the injury, you can bleed out in as little as a minute or twelve hours or anything in between.

On the short end, almost anything that involves blood coming out of your aorta is going to kill you, especially if the injury is near the top, i.e., closest to the heart. An aortal tear, puncture, or rupture within the first few inches of the vessel will result in your heart pumping pretty much your entire blood volume in the time it takes to circulate all of the blood in the body, i.e., under a minute. If the damage is farther down, this could take two or three minutes. Basically, if this happens, you're dead, and you're dead right now. Period. This, along with gross cranial trauma, is one of the leading causes of death in car accidents.

On the long end, damage to veins feeding internal organs can go for a long time. A friend of mine nearly died a few years back when a vein to one of her internal organs ruptured (for no obvious reason; there's a fun thought). She called 911 about twelve hours after the onset of symptoms. The doctors told her that if she'd waited another 30-45 minutes, she'd have died. She got a transfusion equivalent to about 150% of her total blood volume before the figured out what the deal was and fixed it. Part of the reason these things can be so dangerous is that there really isn't any first aid you can do, assuming you even realize what's going on. Even if the wound is such that you can get to the vessel in question (remember that scene from Black Hawk Down?), trying to clamp it off anywhere but a surgical bay is almost impossible. But there are plenty of blunt-force injuries that can cause significant internal bleeding with little in the way of exterior symptoms.

Given the variety of vessels in the body, you can pick almost any time period between one minute and twelve hours and identify some vessel that, if compromised, will result in you bleeding out in the desired period of time unless something is done about it. Also, not all vessel injuries are created equal. Severing a vessel will clearly give you maximum blood loss. But if you just nick it, and the hole is less than the diameter of the vessel itself, you'll get a slower leak. My late grandfather had just the slightest flaw in a vein in his brain that was just slowly oozing for about a week before anyone figured out what was going on. He was fine, but it just goes to show that not all vascular injuries are created equal.

For 30 minutes, it sounds to me like you're talking about a shot to the arm that clips one of the bigger vessels there, maybe the brachial artery. Those are large enough to cause serious blood loss sooner rather than later, but small enough that you won't necessarily die in five minutes. You might explain things by having the victim hit their head on the way down, producing a mild concussion. Disorientation would be natural in such a case.
posted by valkyryn at 12:33 AM on March 24, 2013 [2 favorites]

Seconding Valkyryn's final paragraph. (I'm a paramedic who has cared for many GSW victims.) There is nothing unrealistic about someone bleeding to death in about 30 minutes from a gunshot wound. Or in 3 minutes. Or over several hours. The only problematic aspect of the story is why the person was so very disoriented within the first minutes. If this were from blood loss, I would expect death to ensue more rapidly than half an hour.

If the victim strikes his or her head very hard when falling, that could do it. A shot to a limb might hamper his or her getting to a phone. The shot might graze the skull, producing a concussion and a very bloody scalp wound (though maybe that's less likely to cause death).

FYI the things bullets do inside the body are so unpredictable it's spooky. Shot in one place and near instant death. A half-inch to one side and minor injuries. Plus, the paths that bullets take (small caliber especially) can be insane.
posted by wjm at 3:17 AM on March 24, 2013

Perhaps another injury to consider is the potential for broken bones to damage blood vessels or internal organs and cause death without an external puncture being visible. Comments on whether this is possible?
posted by biffa at 4:13 AM on March 24, 2013

Another factor I didn't notice mentioned is that bullets often pierce multiple areas, opening multiple outlets. A wound in an arm can continue into the torso, etc. This torso wound can be less noticeable (hence not immediately treated) due to the significant trauma to the arm with blood loss and the possibly less noticeable entry of a somewhat flattened bullet slicing into the torso. Bullets also often follow unexpected paths within the body.
posted by uncaken at 6:26 AM on March 24, 2013

The scalp is highly vascular. You could bleed out from a large scalp wound. I agree with striking the head to produce a concussion. A bullet grazing the skull is not likely to cause a concussion, a concussion is typically caused by a significant blunt trauma.

I also would just second the point that if the wound is to the aorta or heart, the victim will die too quickly. An extremity trauma would make more sense. Also, if the wound is to an internal organ/vessel that cannot be compressed, then the victim would be difficult to save if they were close to death after 30 minutes (would require massive transfusion right away and surgery, so would need to be at a hospital with a trauma center), whereas if it is an extremity wound, it is much easier to stop the hemorrhage via tourniquet (not sure if the victim needs to be saved after 30 minutes or if the plan is for them to die after having made it alive to 30 minutes).
posted by treehorn+bunny at 7:34 AM on March 24, 2013

You may find this FBI paper on handgun wounding and effectiveness of use.
posted by laconic skeuomorph at 9:30 AM on March 24, 2013 [1 favorite]

There is a chapter about what it is like to bleed to death (or a portion of a chapter) that may be of help or some interest in How We Die by Sherwin Nuland. At least, I'm 99% sure there is--I read it about 10 years ago. It can be had for one cent plus postage on Amazon or may be at your library.
posted by K.P. at 11:34 AM on March 24, 2013

Thanks, everyone. You've all given me a lot to think about. I think I'm going with the injury to an extremity plus concussion, but that may change when I finish reading the background material. I'm marking this as resolved, but if anyone else has something to add, I'd love to hear it.
posted by SockISalmon at 11:43 AM on March 24, 2013

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