Dying from knife wounds, but only after several days in hospital?
August 22, 2013 1:13 AM Subscribe
Recently there was a stabbing where the victim was attacked on Monday, brought to hospital immediately, but died from her wounds on Thursday. What I don't quite get as a layperson is how a stabbing victim can perish in a modern, First World hospital after being kept alive for several days? The newspaper accounts were understandably short on detail. Are there blood vessel injuries that simply cannot be surgically repaired or replaced? Or might there have been secondary injuries due to the initial blood loss, ie brain damage, that prompted life support to be discontinued after a while?
Ok. Lots of possibilities here. Blood loss secondary to stabbing is on the table. Infection from a ruptured bowel is possible.
In addition to the actual stabbing, if the weapon is removed outside of an operating room (and even in one!) it can cause further damage, in addition to greater blood loss. Think of the knife like a cork in that case, keeping the hole it made shut, and maintaining pressure on the site.
You also have the possibility that the knife introduced an infection deep into the wound. Then there's the possibility that something else introduced an infection (perhaps a passerby took off his shirt and held it to the wound).
Lung involvement could have caused a pneumonia or a blood clot which may have resulted in an embolism.
The patient could have gone into cardiac arrest for a dozen or more different reasons and been impossible to revive.
Additionally, this time of year is when all the fresh faced 3rd year medical students are arriving in hospitals to do their rotations. Coincidentally, a rise in documented hospital mistakes occurs this time of year.
Finally, and least likely, the patient may have expected to die and potentially done things (either knowingly or not knowingly) that sped this up. Not sleeping, reaching up to hug friends and family if he was allowed visitors, probably other things. Before you say I'm making this up, read about the Hmong men in the 70s and 80s who died from a culture bound sydrome known as SUNDS, which is well described in Shelley Adler's book Sleep Paralysis. Sometimes cancer diagnosis leads to a death much faster than the actual state of the cancer (on autopsy) "should" have caused. Expectations often shape events.
posted by bilabial at 4:33 AM on August 22, 2013 [4 favorites]
In addition to the actual stabbing, if the weapon is removed outside of an operating room (and even in one!) it can cause further damage, in addition to greater blood loss. Think of the knife like a cork in that case, keeping the hole it made shut, and maintaining pressure on the site.
You also have the possibility that the knife introduced an infection deep into the wound. Then there's the possibility that something else introduced an infection (perhaps a passerby took off his shirt and held it to the wound).
Lung involvement could have caused a pneumonia or a blood clot which may have resulted in an embolism.
The patient could have gone into cardiac arrest for a dozen or more different reasons and been impossible to revive.
Additionally, this time of year is when all the fresh faced 3rd year medical students are arriving in hospitals to do their rotations. Coincidentally, a rise in documented hospital mistakes occurs this time of year.
Finally, and least likely, the patient may have expected to die and potentially done things (either knowingly or not knowingly) that sped this up. Not sleeping, reaching up to hug friends and family if he was allowed visitors, probably other things. Before you say I'm making this up, read about the Hmong men in the 70s and 80s who died from a culture bound sydrome known as SUNDS, which is well described in Shelley Adler's book Sleep Paralysis. Sometimes cancer diagnosis leads to a death much faster than the actual state of the cancer (on autopsy) "should" have caused. Expectations often shape events.
posted by bilabial at 4:33 AM on August 22, 2013 [4 favorites]
And any pre-existing condition can cause additional complications.
posted by mightshould at 4:49 AM on August 22, 2013
posted by mightshould at 4:49 AM on August 22, 2013
What Moonlily said about sepsis. I worked on a drug that was hoped to be a treatment for sepsis once upon a time. It wasn't. We were far from the only ones to have tried. And failed.
I expect that the victim was barely hanging on throughout.
posted by Kid Charlemagne at 5:10 AM on August 22, 2013 [1 favorite]
I expect that the victim was barely hanging on throughout.
posted by Kid Charlemagne at 5:10 AM on August 22, 2013 [1 favorite]
Moonlily's response is right on.
Additionally, this time of year is when all the fresh faced 3rd year medical students are arriving in hospitals to do their rotations. Coincidentally, a rise in documented hospital mistakes occurs this time of year.
This isn't really the case. Believe you me, third year med students never have the chance to do anything autonomous to or for a patient that would raise that patient's risk of anything.
There has been at least one study showing a slight rise in summer hospital deaths in Britain after new interns come on (these are new doctors, not med students). To mitigate the effect of new interns, teaching hospitals in the US often schedule their most experienced senior doctors to supervise new interns during the summer.
posted by killdevil at 5:14 AM on August 22, 2013 [2 favorites]
Additionally, this time of year is when all the fresh faced 3rd year medical students are arriving in hospitals to do their rotations. Coincidentally, a rise in documented hospital mistakes occurs this time of year.
This isn't really the case. Believe you me, third year med students never have the chance to do anything autonomous to or for a patient that would raise that patient's risk of anything.
There has been at least one study showing a slight rise in summer hospital deaths in Britain after new interns come on (these are new doctors, not med students). To mitigate the effect of new interns, teaching hospitals in the US often schedule their most experienced senior doctors to supervise new interns during the summer.
posted by killdevil at 5:14 AM on August 22, 2013 [2 favorites]
Surgical ICU nurse here. I'd put my money on sepsis. Despite some advances, we are still impressively bad at treating sepsis and septic shock. Here's a fascinating article about why that may be.
posted by brevator at 5:45 AM on August 22, 2013 [9 favorites]
posted by brevator at 5:45 AM on August 22, 2013 [9 favorites]
Ed Gavagan told a fantastic story on The Moth that involved lots of intensive care due to knife wounds. Worth a listen.
posted by craven_morhead at 7:48 AM on August 22, 2013 [1 favorite]
posted by craven_morhead at 7:48 AM on August 22, 2013 [1 favorite]
After a certain point, a number of small factors can add up to cause a cascading failure. It does take time.
When our eldest son was a newborn, he developed an infection that caused the cascading failure of blood platelets. So he was at extreme risk of a haemorrhage. Luckily the doctor was able to treat him and he was saved.
Anyway, the process took 4 or 5 days, and the tipping point (the cascading failure, and then rapid death) would have been on the fourth day.
posted by KokuRyu at 9:06 AM on August 22, 2013
When our eldest son was a newborn, he developed an infection that caused the cascading failure of blood platelets. So he was at extreme risk of a haemorrhage. Luckily the doctor was able to treat him and he was saved.
Anyway, the process took 4 or 5 days, and the tipping point (the cascading failure, and then rapid death) would have been on the fourth day.
posted by KokuRyu at 9:06 AM on August 22, 2013
Mod note: Don't argue with other commenters.
posted by jessamyn (staff) at 9:09 AM on August 22, 2013
posted by jessamyn (staff) at 9:09 AM on August 22, 2013
As an emergency physician, I can keep a lot of people "alive" for several days, but perhaps we're talking about different definitions of "alive." A person "still alive" after massive stab wounds is typically intubated and sedated in drug-induced coma on a ventilator, sometimes paralyzed as well, receiving multiple infused drugs and blood transfusions, and may have an initial surgery and then a surgery several days later again. Their blood becomes acidotic, their electrolytes go all out of whack. Their kidneys shut down from the initial blood loss. They frequently get infected, as others have mentioned.
People rarely go from stabbing -> surgery -> completely okay, watch some TV in the hospital for a day -> suddenly dead. It's a long, drawn out process where some people may turn the corner and make a miraculous recovery, thanks to the amazing stuff that our intensive care units can do for patients, but many have a mortality greater than 50% and will die regardless. The person was probably critically ill (near death) from the moment they were stabbed, and their blood pressure was probably barely holding on for a few days. Most trauma victims are young men, and young people have a lot of reserve -- their bodies can compensate for a much larger amount of stress on them than older people -- but when they run out of reserve, they tank.
posted by gramcracker at 9:41 AM on August 22, 2013 [4 favorites]
People rarely go from stabbing -> surgery -> completely okay, watch some TV in the hospital for a day -> suddenly dead. It's a long, drawn out process where some people may turn the corner and make a miraculous recovery, thanks to the amazing stuff that our intensive care units can do for patients, but many have a mortality greater than 50% and will die regardless. The person was probably critically ill (near death) from the moment they were stabbed, and their blood pressure was probably barely holding on for a few days. Most trauma victims are young men, and young people have a lot of reserve -- their bodies can compensate for a much larger amount of stress on them than older people -- but when they run out of reserve, they tank.
posted by gramcracker at 9:41 AM on August 22, 2013 [4 favorites]
The person may have been kept on life support until a family member arrived for a goodbye, or until the family and health care providers all agreed to remove life support.
posted by theora55 at 9:47 AM on August 22, 2013 [1 favorite]
posted by theora55 at 9:47 AM on August 22, 2013 [1 favorite]
This thread is closed to new comments.
Thoracic wounds can cause issues with the lungs heart and major vessels.
Large amounts of blood loss can result in the patient developing clotting problems and organ failure due to the shock of the blood loss.
Abdominal wounds can involve the liver, spleen and kidneys as well as the major blood vessels. Also, stab wounds to the intestines can cause massive infection. The resulting sepsis can be overwhelming and often fatal even with the most aggresive treatment.
Even a stab wound to a muscular area can be fatal if a large artery or vein is hit.
The effects of massive blood loss aren't resolved with replacing the blood. The shock to someones' system can be devastating.
posted by moonlily at 1:30 AM on August 22, 2013 [6 favorites]