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quick medical question for fic

I'm working on a Sherlock story, and need to have a conversation between a paramedic and a friend of the patient (also an off-duty doctor) about the patient's condition. The patient in question has been shot in the chest and his heart actually stopped but who the paramedics were able to resuscitate and now believe is reasonably stable and has a good chance of recovery. The trouble is I have very little actual medical knowledge.

I don't suppose someone better educated in these things could work out what kind of vital statistics and symptoms a person in this situation might reasonably have, which would communicate that a patient with this kind of wound was critical but increasingly stable? It would need to be the kind of data a paramedic could gather while in transit so no involved tests but certainly EKG rhythm, blood pressure, pulse-rate, general physical demeanor and the like would all be possibilities. I just need a few factors that would make an emergency medical team optimistic and some that would perhaps make them still concerned.

ETA: A little more detail for any medical-type people looking at this:

If you know my current fandom and read this carefully, you can perhaps work out a decent guess of what scene this medical situation comes from. I've been trying very hard to avoid actual spoilers, and I'm still not giving away anything too explicit. That said, this situation I'm describing is from a canonical scene from Sherlock series three, and there's some details that may place together a plausible course of events.

The pertinent details are:

1. [B] is shot and assesses his situation (possibly unreliably) to be: he was shot from the front in the chest. No exit wound. There's comparatively little blood which he takes to mean the bullet is probably acting as a stopper. He falls backward to try to keep the bullet in place and minimize blood loss. [B] calms himself down to prevent shock.

2. [A] comes into a room and sees [B] collapsed on the floor. [A] checks for breath, which he seems to hear, but on asking [B] if he can hear [A], [B] is unresponsive. [A] phones for an ambulance.

3. In the next flash, [A] and [B] are in an ambulance. [B] has an oxygen mask on and a paramedic is heard to say "We're losing him," but no indication on what the exact problem is.

4. In the next flash, [B] is in an operating theater and a heart monitor shows him flatlining. Several of the doctors have turned away from the operating table, apparently thinking it's beyond hope, but eventually [B]'s heart starts beating vaguely, then stronger. The scene closes with with [B] whispering a single (very spoilerish) word around a tube struck down his throat.

Based on this, my initial chain of events - [B] is shot but is stable enough for paramedics to be reassuring to [A] in the ambulance ride seems overly simplistic. Also, the fact that he was given both an oxygen mask and was apparently intubated at some point makes me think there are lung issues, but [B] himself thinks toward the end of moment (1) that the main danger is loss of blood due to a bullet tearing through his chest. [B]'s a scientist, not a medical doctor, and he's also just been shot so he may not actually be a reliable source, but the fact that it seems to be a stopped heart makes me suppose (in my very much amateur evaluation) that it's heart problems rather than breathing that comes closest to killing him.

So what I need help working out is,

A - is there a likely series of injuries that would result in these kinds of symptoms, and
B - what would be the physical effects of these injuries at various points, in the ambulance and in the operating room and after waking up?

Any help any one can offer on either of those points would be very much appreciated.


( 10 comments — Leave a comment )
Jan. 18th, 2014 01:06 am (UTC)
Two folks on my f'list would be able to help, but neither are very active on LJ anymore. If you want to try to contact them, kookaburra1701 is a paramedic, and surgicalsteel is a surgeon.
Jan. 18th, 2014 01:20 am (UTC)
Do you know how to get in contact with them except through LJ, by any chance? I used to be on a discussion list with Surg, and I remember Kookaburra's name as one of the co-authors (I think?) of Llinos's story where Merry and Pippin are kidnapped in Moria, so I'm vaguely familiar with them and would love their help in any case, but I'm afraid I'm not sure how to get in touch.

If you do want to drop them a note asking for help whenever they can provide it, either here or by email at mlaytonATfordhamDOTedu, that would be lovely. But if you don't know how to get in touch, that's okay too.
Jan. 18th, 2014 01:55 am (UTC)
I emailed them both, and gave them the URL for your post here. I don't know if kookaburra1701's email is still good, but hopefully one of them will respond.
Jan. 18th, 2014 02:05 am (UTC)
Thanks! I appreciate it.
Jan. 18th, 2014 04:09 am (UTC)
I see Shirebound is putting you in touch with the person I'd recommend! SS is usually very good about that sort of help.

One thing you may want to keep in mind: that off-duty doctor would need more than his friendship with the patient for the paramedic to speak in any detail about the patient. He'd have to have a real need or right to know, or the paramedic would be violating confidentiality. (At least if they are American. Privacy laws in another country might be different.)
Jan. 18th, 2014 04:24 am (UTC)
I actually have a work-around to that issue that I think, while not quite legal, would make it plausible the paramedics would talk to him. It's a good point to keep in mind, though, isn't it? I've certainly seen enough fanfic that just assumes because someone's at the scene and seems to be a friend, medical personnel would tell him whatever he asked.
Jan. 18th, 2014 02:34 pm (UTC)
Being married to a nurse has made me quite sensitive to HIPPA violations, so it's something I try to keep in mind.
Jan. 18th, 2014 04:27 am (UTC)
When have you known me to write fanfic set in America? ;-) This is set in the UK, but based on the bit of experience I've had with UK medical clinics I think my plan will work.
Jan. 18th, 2014 02:36 pm (UTC)
LOL! There is that! But I didn't want to make assumptions (even though I pretty much suspected the fandom. ;)
Jan. 18th, 2014 02:05 am (UTC)
Pandemonium may know how to get in touch with surgical steel. Unfortunately, I'm not in contact with either of them any more, so I can only give you the basic contact.

- Erulisse (one L)
( 10 comments — Leave a comment )



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