Bleeding to Death

[DragonOfTheAerie]

I'm new here and this is the first thread I've started. I have a research question that's a little too specific for the Internet to be much help, so I'm hoping you guys can help out.
Basically, I have a scene in my work in progress where I need a character to bleed to death in a particular amount of time. (It's hard to explain.) Actually, he can't actually bleed to death, they save him by stanching the blood flow by the powder of some root or something that induces clotting of blood-- I haven't given that part much thought, but I've heard of something like it and it's fantasy so I don't have to be too strict. Anyway. I need an injury that could cause someone to bleed out in an hour or two, but generally, bleeding to death from an external injury happens very quickly. In minutes, usually. I need to give them time to save him. Could a person be in imminent danger of bleeding to death from a wound that didn't hit a major artery, or would the bleeding be a minor concern? Is it possible that an artery was barely nicked, causing a slow but sure descent into death? What kind of effect would multiple wounds have? I'd imagine that if a person was bleeding from multiple places, they would be in danger of bleeding out, but having no background or experience in medicine, I can't say it for sure. I will note that I can't really have it be an internal injury, since my world's technology level is about equal to that of Ancient Rome and it has to be treatable. Magical healing is out of the question.
Also, can anyone tell me what effect the various possibilities might have on his mobility and ability to function? In each case, would he be able to sit up, walk, stand, climb onto a horse (he doesn't have to do much once he's on the horse except hold onto the rider)? I can't have him completely unable to walk.

By the way, I might have the immediate threat to his life be something other than blood loss, I'm just wondering if it is possible that I can use blood loss. Any other ideas are welcome. Poison is an option I'm considering. I've heard of drawing venom out of a wound using leeches, and I think I would use that, but again, I have no idea how much time he would have before the leeches are ineffective. Again, no antivenin or magical healing.

 

[Dren]

Hmmm...

First off, the powder thing is a real thing in real life. A chemical rather than a root, but it's a thing used to quickly clot blood in a life or death situation on the battlefield. They taught us about it in Basic Training; I'm an EMT in the Air Force so I can give you some idea. I'm no doctor though, so sprinkle what I say with salt, I guess...

If the wound is big enough... you don't necessarily have to hit a major artery to cause massive blood loss. A major artery will cause massive blood loss very quickly, but it's not the only way. A large enough wound that wasn't so deep that it caused massive organ damage on the stomach or chest could provide a surefire, steady amount of blood loss. However, I'd say that you might be able to swing major veins causing a slow blood loss if it's like... it won't stop bleeding but they're applying pressure, or something to that effect?

Context would help me give you a better idea though.

 

[Caged Maiden]

Um...exsanguination can happen from many kinds of injuries, whether they're blunt trauma that ruptures a spleen and causes internal bleeding, or having an artery in the thigh, shoulder, or neck severed.

Problem is, if you have an injury that'll cause you to bleed to death in a hour (say, like being gut-shot)...there's usually more trauma than clotting will fix. I mean, clotting doesn't repair organ function, or actually heal the effects of the blood loss.

So...I'm not sure what to say. If someone loses a lot of blood, say 20%, they have certain symptoms that you can look up on wikipedia here: Hypovolemia - Wikipedia, the free encyclopedia . It's pretty standard that you can anticipate how much blood volume someone's lost based on their symptoms. Problem is, when the blood gets low, you get all kinds of effects that simply stopping blood loss won't fix. It won't fix a salt imbalance, or dehydration, or kidney failure. It's a much bigger problem than merely stopping the bleeding, which is why blood transfusions save so many lives. An introduction of new red blood cells returns the body's function of delivering oxygen to organs. Without enough red blood cells...it doesn't matter if you stop the bleeding. You need to get more and introduce it.

I had to address this exact situation a few times in my books, where magical healing only closes a wound. Magic doesn't replace blood lost. So...my human character was fighting alongside some werewolves (that have magical healing as part of their transformation), and when they were all seriously wounded, the werewolves bounced back fast, but the human (who was magically healed with a spell) didn't. Because his blood didn't regenerate like the werewolves' did.

Hope I helped in some way. This is tricky, and without knowing more about the context or whether magic is involved, I can't really think of a better answer. Find a suitable injury that wouldn't cause excessive damage. Like being gut-shot, I'm not sure it's the blood loss that kills you on that one. It might just be the liver damage and damage to intestines, or whatever. I mean...even with magical styptic powder or silver nitrate to cauterize the wounds...the damage would probably be too extensive to survive in the long run without surgery. But I'm no expert.

Hollywood loves shoulder injuries to show how someone was just "winged", but I'd think a shoulder puncture injury might be the perfect fit for a case in which there's no organ damage and healing is mostly muscular, and bleeding can be profuse enough to set a one-hour limit on life. But would it be convincing to readers, who are used to seeing people brush off a shoulder injury and keep on fighting for two hours?

 

[DragonOfTheAerie]

So, I guess providing some context would be a good idea. I'm flexible with what exactly his injury is, the point is really to necessitate a character to go on an urgent trip to the healer/apothecary shop for something that will save him. She needs to be there for plot reasons. Saving someone's life would be a good reason for her to be there.

There isn't any magic (at least in this point in the story), so, I can't use magical healing.

So, using bleeding to death as an imminent threat to someone's life sounds like a lot of trouble.

I've heard that a human can lose 30% of their blood without dying, but I don't know if this takes blood transfusions into account. It probably does.

Putting continuous pressure on a wound might slow the bleeding, though not stop it...Right?

 

[DragonOfTheAerie]

I may end up cutting this scene anyway, since after revisiting my plan, it seems to me a bit extraneous. The goals of the sequence could be accomplished more simply.

 

[Caged Maiden]

Click on that link I left you. It'll tell you what happens with each stag of hypovolemic shock. That way, you can judge. In my story i'm rewriting right now, I have a character who loses a lot of blood and they have to work to rehydrate and rest her, because she nearly dies from the slow loss of blood after three days without water. When a person is dehydrated, blood loss is even worse, because diluting a person with a bunch of water after blood loss can actually be more harmful than just letting them recuperate more gradually. So...I'm not sure what to tell you. Hopefully the information we provided can help you figure things out. I mean...you could also go for a broken bone, where the woman needs to get to an apothecary for some knitbone (I think that's skullcap) to make plastered bandages and set the one? I'm not an herbalist in real life, but many years ago, I was fascinated by ancient medicine and traditional remedies. I still plant medicinal plants because of my old obsession. My front step has German Chamomile growing, and I planted purple coneflower because echinacea is just one of those things I still revere...and it's pretty, too.

 

[Caged Maiden]

You could also have had the guy eat something toxic and she's got to go fetch some orris root or red clover to remove the toxins from him before he gets really sick?

 

[DragonOfTheAerie]

He gets hurt in a fight, or that's the plan, so the eating something toxic won't work. I thought about poison as in poisoned weapons or something, but it seems like after an hour he'd be too far gone to do anything; the poison would have gotten into his bloodstream. I've heard of getting rid of poison by cutting into the flesh in the area just surrounding the wound, or by leeches--No magic, but huge leeches I can do. But they would have to do something FAST, or I think so. After an hour, he'd be dead or dying, and not much could be done.

 

[DragonOfTheAerie]

Coming up with a wound a person can easily recover from in a low-tech, magic free environment is difficult.

 

[Caged Maiden]

anything life-threatening will be hard to explain away because it usually requires immediate medical attention, not just the stopping of bleeding. You could just use a generic cut. A puncture is worse to heal than a cut, because punctures introduce bacteria deeper into the body and often infection is what kills. With a cut, the wound is in the surface, and any number of things could make it difficult to clot. Maybe it's on his knee or some other joint that isn't easy to keep immobilized and keep pressure on it? Problem is, though, that at that point, you're looking at the kind of wound that would take a long time to recover from, and perhaps permanent damage that will impact the person for life.

Very tricky. My case was a little easier, because it was the dehydration that made the character weak. Her actual blood loss wasn't that dire, but her overall blood volume was depleted because she hadn't eaten or drank in three days. So, once she was recovering and had access to food and water, she could recover because the injuries were cuts that could be stitched and they had access to medical supplies.

 

[skip.knox]

Murder mystery or detective forums would likely have answers for you.

 

[DragonOfTheAerie]

In an earlier draft, I had something similar happen to him, but the apothecary excursion wasn't neccesary. He got several long cuts across his shoulder and back from an attack by an animal (the claws). However, it wasn't life threatening and the other characters just cleaned the wounds and stitched him up. I later had him be healed through magical means (by a potion,) which was breaking my own rules, but I just couldn't have him immobilized any longer.
I could probably get around having the character have to go to the apothecary shop.
I don't know how long he's gone without food or water prior to the fight, but it could be a long time, days even.
I don't mind scarring or even crippling him, but he has to live.

 

[Holoman]

I'm far from an expert on this, but this is from personal experience so may help.

I don't think you need to be too bothered about what the injury is or where it is, more important would be the size. You can cut someone pretty much anywhere enough to kill them, or make them bleed slowly.

The type of wound is important though. A few years ago I sliced off the top of my finger, just skin, no bone, but it created a very large, shallow, open wound. It wasn't dangerous, but I sat there for hours with tissue and pressing on it and it would not stop bleeding. Because the surface area of the wound was so large it just could not clot.

In the end I had to go into hospital, they stuck my finger in adrenaline and it stopped the bleeding.

So if you have a large shallow open wound like that then it's very plausible you're losing enough blood to die after a few hours.

Also, you could have someone there that is putting pressure on a more serious wound and keeping him alive. Obviously its not a long term solution, so they need to find this root within a few hours to stop the bleeding completely.

 

[SeverinR]

A large artery or vein will bleed out quickly.
Smaller veins and arteries will bleed out slower.
The slow death bleeders usually are not the ones seen on the surface, internal injuries.
But if no one is around to help a surface wound could continue to bleed until it became life threatening.
Surface wounds are the typical apply pressure to stop the bleeding.
It is possible the loss of blood could keep the person weak for a long period of time. We don't usually see this in modern times since blood transfusions. Also lack of blood can damage organs or extremities and the victim might never recover.