# Shot in the foot?



## Deleted member 49710 (Jul 19, 2012)

All right, say you are a doctor and you've been abducted by this loser kid, driven out into the middle of nowhere, and then when you try to struggle, the loser accidentally shoots you in the foot. Blows off a couple toes. You have an emergency medical kit. What do you do?

Right now, I have my doctor (and his lovely assistant) putting a tourniquet on (the ankle? seems like the closest convenient spot), verifying there's nothing he can use to cauterize the wound, spraying it with disinfectant and wrapping it up tight, then taking some heavy painkillers and hoping for the best.

But I'm not a doctor or an EMT or anything knowledgeable. Thoughts? Basically I want him hurt so that it's non-fatal if help comes soon, but fatal if it takes a couple days (infections? predatory animals?), and I want him unable to walk.


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## Potty (Jul 19, 2012)

Tourniquets are a last resort and with good reason. If you have one on for an extended period, toxins in the limb begin to build up. When the tourniquet is removed those toxins flood back into the body and usually has a detrimental effect on the person (Shelling out for a coffin for example). The best he could do in this stage is basic first aid... and that is just to clean the wound as best he can and wrap a tight bandage round it and keep it clean.

A tourniquet untill he is able to find rescue will probably result in amputation of the limb rather than risk letting the toxins back into the body. 

Maybe that's your seller? Not exactly sure how long one would need to be on before it becomes dangerous. But if help comes pretty soon then a tourniquet is good, because if it doesn't then his health can start to suffer from it (Snags it on a branch loosening it killing him off). You need to find out if there is an artery in the foot though as that is the only reason to use such an extreme technique.


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## Olly Buckle (Jul 19, 2012)

A tourniquet is a good way to lose his foot, basically you are stopping the blood supply to the whole foot. The more modern method is direct pressure on to the wound to stop bleeding. You know how it leaves a white patch if you press on the skin, that is the blood vessels compressing, you are doing the same thing on a larger scale, so a pad to absorb blood and press as hard as you can, if they have to let go to move or something bind the pad in place as tightly as possible. A touniquet only gets used for really major bleeds, like a femoral artery, even then they are not easy as arterial blood travels deep next to the bone and the veinal blood nearer the surface, that can mean get it wrong and you fail to stop the artery bleeding but stop any blood getting back into the body, making the bleeding worse.
The fatal in a couple of days is more problematical, things like gangrene can take a lot longer than that, Admiral Benbow died a month after losing a leg to chain shot for example, especially as he is a doctor and aware of the risk of infection, make it a wound from something filthy, the spade from the cow shed for example, and the chances go through the roof suddenly. 
I expect Ditch and The Feurer will be along, probably better informed than me.


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## Winston (Jul 19, 2012)

Get the patient prone. Elevate the foot.  Clean with water, cleanest cloth available and alcohol or mild dilute soap if available.  Wrap tightly.  It shouldn't bleed too much, as the arteries in the tips of the extremities are small.  Blood seepage into the bandage is good.  Clean bandage every few hours.

If excessive bleeding occurs, apply pressure to the femoral artery (upper, inner thigh).  Release pressure and repeat as necessary.  If it's still bleeding, cauterization may be an option (if they drove, it'd be a hard sell to your reader that they couldn't cauterize the wound).  

Your only chance to make this wound life threatening would be like Olly B said:  Make it septic.  With nothing available to clean it.


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## The Backward OX (Jul 19, 2012)

Only recently I finished reading a novel where the MC was shot in the foot. The bullet entered through the top of his foot and came out underneath. He hobbled around for two or three chapters before obtaining expert medical attention, with, as I remember it, only a dirty bandage around the wound, and it all seemed quite plausible. The novel may have been one of James Lee Burke's, who writes this type of stuff, and I imagine he researches thoroughly.


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## Sam (Jul 19, 2012)

All bullets and all guns aren't the same. You need to tell us the calibre and what type of bullets were used. For instance, if it's a .45 with hand-load, hollow point rounds, kiss your foot goodbye. If it's a .22 with FMJ (full metal jacket) rounds, there's a chance the wound will be a through-and-through without much damage to the foot, leaving the toes intact. Either way, your character needs treatment before infection sets in.


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## Bloggsworth (Jul 19, 2012)

Just ensure that he is hopping mad...


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## Deleted member 49710 (Jul 19, 2012)

This is so helpful - thanks very much to all of you. Potty, I will ditch the tourniquet, just clean and disinfect the wound and wrap it. I'll also skip the cauterization discussion. He's got disinfectant and  gauze, and if this isn't necessarily a dirty wound, maybe he wouldn't want to burn the heck out of himself. Thanks, Olly and Winston.

It occurs to me the injury doesn't have to be life-threatening, the doctor just has to be able to convince someone else that it will be, in an effort to persuade her to take him home. He can be lying about it.

Sam W, I am gun-ignorant as well, unfortunately. I'll do a bit of my own research so as not to impose, but since you appear to know about this, I'll throw it out there: I don't want to blow off the doctor's entire foot, but he does need to be taken hostage using this gun, so he should believe it's big enough to kill him if he's shot in the head or chest at close range. Is a .22 big enough to be convincing?


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## Sam (Jul 19, 2012)

A .22 can kill you, yes, but it also has a nasty way of caroming inside the skull and lodging there. There are people who have survived getting shot in the head with anything up to a 9mm pistol. After that, the stopping power of most handguns will blow your head apart. To go back to the .22, it can lodge in there and cause irreparable brain damage. The person becomes a vegetable for the rest of their life. 

A shot to the heart, from close range, with any pistol will kill you. That's why the military refer to the heart as the 'ten ring', because you score ten points on the range if you hit it. A head-shot only earns you eight.


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## Deleted member 49710 (Jul 19, 2012)

Great, thanks again. You're all saving me from being too laughably ignorant. O


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## TheFuhrer02 (Jul 20, 2012)

Cool. So you had him shot in the foot and you want him unable to walk, but alive... 

Olly had this spot on, I think. A septic infection would be nice.

So... Where is the setting? He was abducted, right? Maybe he was kept in a large warehouse, lot's of sawdust or dirt on the floor maybe? That'd lead to an acute infection that may turn to gangrene. Gangrene would be fatal if left untreated for say, three to four days? You could go a bit more extreme and have the dirt contain the etiologic agent for tetanus. Treatable in the first two days or so, maybe a bit more. Two weeks without proper treatment, though, would lead to complications.


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## Deleted member 49710 (Jul 20, 2012)

Hi Fuhrer, our doctor is at the side of a road in the middle of a forest, miles from anywhere, somewhere in Northeastern North America. So there's a lot of dirt available. Gangrene sounds pretty plausible, then, yes?

We could also shoot him somewhere else, like the ankle, if we want to increase the bleeding. (I love writing sentences like that, makes me feel like a sadistic god.)

The situation is that the truck's broken down, and the kid with the gun and his girlfriend can walk a few days to get where they're going, but the doctor's stuck. He's trying to convince the girlfriend that she can't leave him there to die so she'll come home with him. Now, if the injury is actually serious, it's more poignant and the doctor isn't quite such a terrible jerk, but he's already lying when he says he can't call for help, so he could just as easily be lying about this, too.


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## Evil Jennius (Jul 21, 2012)

Hi, 

This webpage:-

http://www.users.totalise.co.uk/~leiafee/ramblings/realistic_injuries.htm#cut 

'Writing Realistic Injuries' has some info on blood loss about half way down.  I thought maybe if he wanted to make his injuries seem worse he could fake symptoms?  Or if you decide to have him shot in the ankle there would be more blood loss.

There are also shock symtoms a bit further up.

Hope that helps.

I'm not affiliated to the site in any way.

Evil Jennius


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## TheFuhrer02 (Jul 21, 2012)

lasm said:


> Hi Fuhrer, our doctor is at the side of a road in the middle of a forest, miles from anywhere, somewhere in Northeastern North America. So there's a lot of dirt available. Gangrene sounds pretty plausible, then, yes?



Indeedy. Sounds plausible, if not likely, from the sound of the setting.



> We could also shoot him somewhere else, like the ankle, if we want to increase the bleeding. (I love writing sentences like that, makes me feel like a sadistic god.)



:thumbl:


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## Deleted member 49710 (Jul 21, 2012)

Thanks, EvilJennius and Fuhrer!


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## Jon M (Aug 8, 2012)

Nobody mentioned the toes. In the OP the guy's toes get blown off. In that case, you would make an effort to find the toes and put them on ice, hopefully so that they can be reattached later. I could see these kids putting the toes in something like a Burger King cup, on the left-over ice. I don't know, seems kind of funny to me.


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## Deleted member 49710 (Aug 8, 2012)

Thanks for the suggestion! The setting is also a future bereft of fast food franchises and other crappy roadside things, I suppose I should have mentioned. So I can't do the Burger King cup, exactly, but I can certainly have a humiliating search for lost toes.


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## Krzyh (Aug 19, 2012)

I have to wonder what all comes in with the emergency kit that the doctor (and his lovely assistant) have to work with. I can tell that he has gauzes, bandages, some sort of disinfectant such as hydrogen peroxide or isopropyl-alcohol. Does he have access to something like a needle and thread? If I were treating a injury which the person lost a toe I would use something to stitch the open wound back together to reduce the risk of infection. Fishing hook and line can be a good substitute for medical tools in this case seeing how the hook and line can be sanitized with the disinfectant. The doctor could also if possible grind the pain medication and mix it with something to knock the injured person out so that it be easy to work on them. He would also to rig the foot so that in would not move to prevent additional injury, scrap wood and tape can be used in lue of a cast.


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## Deleted member 49710 (Aug 19, 2012)

Hi Krzyh - I was leaving the question of what's in the kit open with the idea that it could contain whatever people responding seemed to expect. But my basic idea was that they're in a vehicle equipped to travel 250-300 miles through wilderness without expecting to run into any towns, hospitals, etc., so it would probably have a pretty decent medical kit in case of accident.

The doctor is the injured person, so while the girl can help him out, she doesn't know what she's doing and he's going to need to stay somewhat lucid. So you think needle and thread would be typical? he might stitch himself up a little? I guess I was imagining that it would be sort of a rough wound, harder to stitch than something like a cut. But I know nothing.

Currently, thanks to the smart people on this thread, my doctor character is elevating his foot, swearing a lot, putting pressure on the wound, getting it clean, wrapping it, taking some hydrocodone, telling everybody his lifestory, and mooning sadly at the girl while she decides what to do about him.

Oh, and trying to convince her that if she leaves without him, he'll die in horrible pain from the infection before he can be rescued. Which is probably not true, but he's a doctor so she'll believe him.


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## Cardynal (Aug 25, 2012)

My first thought on reading this is, what is the loser shooter doing?  He or she is presumably still in control of the gun.  Did he or she get scared and run off?  Is the victim being allowed to perform ANY sort of work on himself?


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## Deleted member 49710 (Aug 25, 2012)

Hi Cardynal,
The guy with the gun is standing around aghast and fetching supplies from the truck. He feels a little bad about the whole thing, to tell the truth. Yes, the victim is being allowed to treat himself as necessary/possible.


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