[MUD-Dev] Wounds and trauma

[clawrenc at cup.hp.com]

>Pain is most definitely subjective...it's completely true that some
>people, especially the Irish, are stoic and will not complain about
>pain  Hispanics, on the other hand, generally are verbal and
>emotional and you'll know right away when they're having pain,
>physical or mental.  Those two ethnic groups stand out right
>away...others are a mix of their own personality and how they've
>learned to cope in life.  As a recovery room nurse, my goal is to
>treat pain of all types, whether it is verbalized or not, so I work
>at being adept at picking up pain signals; an increased blood
>pressure, heart rate, signs of restlessness, wrinkling of the brow,
>and other more overt ones like moaning or verbal complaint.  People
>truly tolerate different levels of pain - even as children - there
>are those who are and have always been "wooses" and others who are
>"troopers."

I can concur and support this.  As I have mentioned afore I've had a
couple of ER experiences.  In one case I was riding a bicycle down a
steep hill (est 60% grade (illegal BTW)), something got stuck in my
front spokes, and I attempted and failed to do a number of full
somersaults.  Mostly this resulted in the removal of large chunks of
the right side of my face and some very interesting bruising to the
right eye (the sclera went bright, vivid, astonishingly glaring and
uniformly blood red).  I got a couple dozen stiches in my face and was
more or less untouched and unbothered by the experience.

In a more topical case I caught a car while riding a motorcycle.  It
was a low speed impact (~30 mph), and I was concious the whole way
thru.  Damage: compound fracture femur with extrusion of femur from
left thigh, multiple compound fractures of left fibula (lost a 2"
section to the dog food people), compression damage and ultimate
debriding death of most of the flesh on the back of my left heel,
associated loss of 15% of the achillies tendon, several groin muscles
strained (one torn), multiple groin skin tears (pull skin hard enough
and it *will* tear), lower leg fasciotomy on both sides, about 3
square feet of skin grafts (my legs look like chessboards), multiple
bone grafts (one for the missing 2" section), etc.

Suffice to say that I managed the entirety of a 2 month hospital stay
during which they were doing wet->dry bandage debriding (essentially
they wrap you with bandages soacked in saline, and then let them dry
on you for 24 hours, at which point they quite literally rip them off
you along with whatever flesh has now attached to or grown into the
bandage) largely without pain killers (regretably I succumbed twice
and took demerol -- of all things at time not when it was
super-painful, but when I was promised it *would* be super-painful).

Lasting impressions:

  The purpose of skin is to keep the goopey stuff in.

  I have always had a high tolerance for pain.  I now have a much
higher tolerance for pain.  Additionally I also now have an very
accurate and detailed ability to predict and visualise a pain along
with its exact sensory effects.  The result is that while I now have a
higher pain tolerance, I'm also a heck of a lot more squeamish -- I
*know* exactly how much and exactly in what manner something could
hurt.  I preferred ignorance in many ways.

>Losing consciousness is not relative to pain, as movie directors
>would have us believe.  Losing consciousness is a result of two
>things I can think of off hand; decreased oxygen to the brain and
>direct injury (or medication i.e. anesthesia) to the brain's area
>that controls level of consciousness.  

Bingo.  A key element is also the individual's ability to confront
whatever is happening.  Many anesthesia-less surgery stories support
this.

>This last one,of course,
>refers to amputation or other trauma to the body where an artery is
>severed and the person bleeds big time.

Many are astoished at just how much blood a single body does contain,
and how much blood loss a body can survive if suitable addressed.  As
I recall off the top of the cranium its up in the quart+ range.

>If you have an unoccluded femoral artery bleeding (ripped
>off leg) you can bleed into shock and death within minutes.  

In my case I had crushed arteries and veins all thru the bottom end of
my calf.  The result was no blood flow to the foot -- headed for
amputation until a fasciotomy restored a bloodflow detectable only via
dopler.

>Blunt trauma...hmmmm....  Getting smacked with, say a shovel in the
>flank can cause things like hematuria (blood in the urine) that
>disappears in a few days, all the way up to something fatal like a
>lacerated liver or spleen.

A solid fist landed on either kidney can instantly incapacitate a
victem almost as fast as a kick to the goolies would a man (women are
not much better off BTW for goolie kicks).  Sufficient impact to the
kidneys (which fascinatingly are largely unprotected for such a key
organ) is fatal as you comment.

>Third degree burns are very very painful -
>raw nerve endings exposed to the air.  Not fun.

I've had second degree burns (got a pot of boiling water dropped on
me).  I can vouch for it being uncomfortable.

--
J C Lawrence                           Internet: claw at null.net
(Contractor)                           Internet: coder at ibm.net
---------------(*)               Internet: clawrenc at cup.hp.com
...Honorary Member Clan McFUD -- Teamer's Avenging Monolith...