I don't think people in coma last very long (like beyond 15 years) because when you stop moving, your whole body starts to atrophy, so it becomes pretty bad even after a few months. However, I'm not a doctor, so you'll have to figure out the specifics from someone more qualified.
edited 29th Jan '11 10:27:20 PM by breadloaf
Karen Anne Quinlan
: went into a coma in 1975. Removed from life support (mechanical ventilator) in 1976. Died in 1986, from complications of pneumonia. (10 years.)
Terry Schiavo
: collapsed following full cardiac arrest in February 1990. She was receiving both nutrition and hydration via tube from that time on because she was unable to swallow. The tubes were removed several times, but reinserted following court or government intervention,then removed for the final time on March 18th, 2005. Terry Schiavo died on March 31, 2005. (15 years)
Nancy Cruzan
7 years on a feeding tube in a Persistent Vegetative state. She died 12 days after it was removed.
Eluana Englaro
(Italian case.) Persistent Vegetative state from January of 1992. Feeding tube removed February 2, 2009. Death 9thof February 2009. (17 years)
In the latter three cases, there's no reason to believe that the person would have died had the feeding tubes been left in place.
The Tony Bland
case may also have information of use to you,since it occurred in England, rather than the US.
edited 30th Jan '11 12:42:21 AM by Madrugada
I've got one... say you've got a rather large bit of shrapnel embedded in your side below your ribs, perhaps two inches across and about an inch deep. Is it better to leave it in until it can be seen to or pull it out, put pressure on it, and hope you don't bleed too much?
Too geeky to live, too nerdy to die.A lot is gonna depend on factors you didn't mention. Where exactly? Below the ribs and about an inch deep could mean it's it in a muscle (if the victim is heavily muscled), in fat (if they're fat) or it could mean it's penetrated the large intestine (if it's on the right side) the small intestine (if it's on the left side), the liver or stomach (if it's in front, under the arch of the ribs). Here's a diagram
◊ to work from.
Then there's whether it would be endangering any of the major blood vessels — in the side that's not terribly likely — see this
◊? but there are some fairly dense clusters that could be a problem.
Other things to take into account — how far from medical attention is the person? five minutes? twenty minutes? an hour? three hours? six hours? days? Is it going to be a relatively smooth ride in a car to get there, is someone going to have to carry them, is it going to be a rough jolting ride in a wagon, or is it going to take something else to get them there?
edited 31st Jan '11 3:56:43 PM by Madrugada
Fwoof. Oh, you're fantastic! Honestly, this helps a lot. Thanks so much!
The character in question is male and fairly well-built. Going from these diagrams (why didn't I think of that??), the area I had in mind looks like he'd be in for it just below the liver. After he's injured, it's about ten minutes before he is able to get to a car (as it stands, he has to be carried the last couple hundred feet or so) and then three hours before a doctor can have a look at him. Even then, there's limited access to medical supplies, as he can't go to a regular hospital.
edited 31st Jan '11 5:24:41 PM by PFrost
Too geeky to live, too nerdy to die.Ok, so you're looking at possible trauma to the liver — lots of blood flow there. Lots and lots. So bleeding is a major threat. Here are a couple of pages on trauma to the liver:
Specifically addressing puncture trauma to the liver
.
Here's one on penetrating wounds to the abdomen in general:
http://www.ptolemy.ca/members/archives/2009/Penetrating Injuries/index.html
The section on the liver specifically is here:
http://www.ptolemy.ca/members/archives/2009/Penetrating Injuries/index.html#T4.1
(you'll have to copy and paste those — they have spaces in them that the forum software doesn't like.)
What it boils down to - he's got a very high chance of not making it, whether the piece of shrapnel is removed or not.
Make it a little bit lower and farther around to the side, and you're more likely to be dealing with either muscle damage, but no organ damage (the rectus abdominus
◊, to be exact.) That will hurt like hell and make it really hard for him to stand upright, but it's would be survivable. Get through that muscle and you've got a hole in the ascending colon — that's bad. Peritonitis and infection bad.
edited 1st Feb '11 12:12:11 AM by Madrugada
Someone in a coma (or a quadriplegic person, or basically anyone with very limited mobility) faces the following problems:
aspiration pneumonia - this is what happens when someone who can't cough vigorously gets fluid in their lungs. Can be lessened by tube-feeding, though they could still inhale their own spit or whatever. Typically this means that every so often, they get pneumonia. Each bout of pneumonia has the potential to kill them.
contractures - this is more uncomfortable than actually dangerous, basically your muscles atrophying causes your joints to get locked into certain positions. Can be helped by regular physical therapy, but you'll still get some contractures. If someone is neglected (eg left in a bed all day) this'll progress quite quickly. Makes them more difficult to care for (how do you dress someone whose arm can't straighten? I've done it, it's pretty tricky), can cause physical pain when someone tries to move them (because their limbs no longer move that way) and can interfere with functional skills they might otherwise have had.
over or under weight - a lot of severely disabled people seem to be one or the other. If they don't have any feeding problems and aren't prone to pneumonia (in other words, if they have good control over facial muscles) then inactivity can easily make them overweight, which makes them harder to care for and can cause health problems. A much more serious concern, however, in those with feeding problems, is being underweight. I've seen people who, despite plenty of effort to care for them, you can literally see their ribs when you're changing them. This means that any kind of stress on their system, such as illness, kills them off more easily than most people (they can be killed by the common cold). In addition, they have just about no ability to maintain body heat, so you have to be careful about hypothermia. Many of them wear extra layers of clothes just to keep them warm.
pressure sores, also called bedsores - if you're constantly putting pressure on a body part (pretty much anywhere except for the soles of your feet) you'll get sores developing. They start as a red spot on the area, and eventually become an open sore that can cause infection. People in wheelchairs can get these on their butts, people who are bedridden can get these basically anywhere along their body or even the back of their head. The solution is quite simply to change their position a lot. In hospitals, nurses will come every hour to turn a person over, to prevent bedsores. You can also put them in a bed designed to move around. Physical therapy is also helpful mainly because it involves putting them into different positions. Contractures can increase the risk of bedsores because it's harder to get them into certain positions.
falls - if you don't move, you get osteoporosis. Furthermore, if you can't move, you can't break your own fall. Even just falling out of their wheelchair can cause broken ribs, legs and/or arms. And, of course, if you're underweight and fighting infections a lot, it's harder to heal a broken bone. And if they have some mobility, being immobilized during healing can cause them to loose that mobility due to muscle atrophy, since often they had just barely enough muscle to move that way.
If I'm asking for advice on a story idea, don't tell me it can't be done.Right, 'nother question. An eighteen-year-old girl just had her leg severed mid-thigh by a high-velocity railgun round. She is capable of temporarily shutting down her nerve endings around the wounded area in order to avoid being immediately incapacitated by pain (method irrelevant), but medical assistance is not readily available at the moment.
So... best-case scenario for this sort of injury? Worst-case scenario? And how long does she have to live should the worst-case scenario occur? I mean, I'm imagining the answer to the last question is 'not long', but just how not-long is it?
edited 27th Mar '11 9:38:25 AM by Iaculus
What's precedent ever done for us?With my very little medical knowledge, I would have thought that the best cast scenario is that the round cleanly severs the leg and cauterizes the wound on its way out. Worst case scenario is that the wound is torn rather than cleanly cut, and there is little-to-no cauterization, in which case she'll probably die from blood loss within 10 or 20 minutes. (without medical attention)
And I have a question: in my backstory, two characters are involved in a terrorist bombing. One is outright killed, but the other "merely" has both legs damaged to the point of requiring amputation. Assuming medical help arrives pretty much immediately, and they carry 20 Minutes into the Future medicine, is that at all plausible?
edited 27th Mar '11 10:07:02 AM by Yej
Oh, so it'd be in tens of minutes, then? Thought it'd be less for a breached artery.
About how long would it take for her to be incapacitated by the blood loss, even if the nerve-deadening is keeping the pain from affecting her?
edited 27th Mar '11 10:57:25 AM by Iaculus
What's precedent ever done for us?If the femoral is severed, she's got far less than 10 to 20 minutes — more like 1 to 2 minutes in a worst-case scenario. With no medical attention available, there is no "best case". (I'm assuming that by "no medical attention", you also mean "no first aid, however primitive".) Even a crude tourniquet could give her more time, if it's sufficiently tight.
edited 28th Mar '11 9:57:03 AM by Madrugada
A round that's high-velocity by railgun standards would probably punch clean through and leave a neat hole behind. The severity of the wound depends on what the hole is through (ie, whether it drills through bone, or just muscle, or whether it hits an artery). If it's through the meat, then they'd probably be fine; through bone, it depends on the size of the round (if it takes out enough of the bone to make the limb no longer able to bear weight...), and would require some pretty extensive care eventually in even the best case. Hitting a major artery has already been covered pretty well; you're talking 2-3 minutes, not 10-15.
Really from Jupiter, but not an alien.Yeah, eventual care isn't really the issue here - medicine in the setting is absolutely excellent if you have access to it. The question is more regarding immediate survival odds when said medical care is a considerable distance away.
Incidentally, what factors other than the calibre of a projectile weapon will affect the size and severity of a wound?
What's precedent ever done for us?The material the projectile is made of, for one. A bullet that's made of a soft but pliable metal like lead will tend to deform, but stay in one piece; a bullet made from a harder but brittler metal may fragment.
Shape also enters into it — a "hollow point" (just what it sounds like — the point of the projectile has a depression (a hollow) cast into it) will also flatten and mushroom on impact
◊, making a larger, more ragged hole than a solid-point.
Jacketing a hollow-point can increase how much penetration power it has before the mushrooming robs it of sufficient velocity. Putting a full jacket on a bullet can have different effects depending on other factors, here's a pretty clear set of photos of what different fully-jacketed ammos do when fired into jugs of water.
Velocity also enters into it, but that gets way complicated.
edited 28th Mar '11 9:56:41 AM by Madrugada
A few things to think about when translated projectile impact into damage done:
Size of the round is obvious. Bigger round, more damage.
Material/shape of the round is related. If it's soft and/or shaped a certain way, the round will expand upon impact and leave a much larger exit wound than entry wound. Alternatively, causing the bullet to tumble (spiral end-over-end through the target instead of punching straight through) will have a very similar effect. Generally speaking, anti-personnel ammo will be designed to do this; armor piercing (designed to defeat personal body armor) or anti-armor (designed to destroy vehicles) weapons are designed to avoid doing that, in order to successfully pierce the armor and actually damage the target inside. (Of course, if a person is hit by an anti-vehicle round, they're probably going to be hurting no matter what.)
Velocity is complicated, as Madrugada mentioned, but the short version is that you want to be as fast as possible — up to a point. Too slow and you're not doing as much damage as you could because the round doesn't have enough energy. Too fast and you're not doing as much damage as you could because the round is passing straight through the target and continuing on. Like with material/shape, generally armor-piercing and anti-armor rounds are going to be higher velocity than anti-personnel. There have been Real Life instances where soldiers using armor-piercing rounds have found themselves at a disadvantage when they end up fighting unarmored opponents.
edited 28th Mar '11 10:30:20 AM by NativeJovian
Really from Jupiter, but not an alien.^ Yeah, that's why I said velocity is way complicated.
If you really want to be sure that you get it right, you need a forum populated by serious, experienced shooters, and you need to be ready to wade through a lot of technical talk and answer the myriad of questions they'll have about the gun, the ammo, the armor (if there is any...).
It would probably be simpler and more effective to introduce yourself, explain that you;re looking for accurate information, tell them what the result you want is and how much you're willing to handwave to get it, and let them tell you what you need to do to get there from here.
edited 28th Mar '11 11:22:32 AM by Madrugada

Given that most of us are writing about humans, I figure thatmore than a few folks will have questions about the human body, how to treat it when things go wrong, and the systems and conventions surrounding such treatment.
I'll kick us off.
Patient is a male in his mid-twenties with no immediate relatives (only child, grandparents died of natural causes, parents died in a car crash) and no particularly close friends. Country is England. Patient was found in a coma, taken to hospital, and hasn't woken up since.
When, if ever, would they turn off his life-support?
What's precedent ever done for us?