How would you save this person? [Generic Fantasy]

[Deadly]

Picture this hypothetical situation:

You're faced with a person who has been struck by a spear. The spear entered below the shoulder blade and exited below the right breast, just barely missing both spine and heart, but puncturing the lung in two places. The spear is still stuck there. The person is malnourished, exhausted and unconscious, but so far still alive.

The technological level is roughly comparable to the 12th century, but we're talking about a fantasy setting so there's some room for creative exceptions, and for magic; though not D&D magic with its solve-everything-in-a-snap healing spells. More like, magical herbs and medicine which are more effective than you'll probably find in the real world.

The patient is a lycanthrope, but I don't want to say they're so awesome that you can just pull out the spear and they'll heal and be up and running lickety-split. Basically assume a normal human as far as possible, and don't use the race as a way to solve the whole problem.

The usual choice would be to give the person a quick and merciful death, but for whatever reason you've been tasked with trying to save them using whatever means you have available. You're a skilled healer with decades of wartime experience and a skilled assistant to aid you, as well as a bunch of non-skilled people available should you need more hands.

So, how would you save this person? What kind of surgical/medical procedures would you employ? The more specific the better. It's important that the person actually does survive, though not necessarily for much more than a year or two afterwards. Permanent trauma of various sorts are always perfectly ok, as long as the patient will be able to walk and talk after a suitable recovery period.

[balistafreak]

Obviously, no insta-heals...

If both lungs are punctured, you have a very short window of time before blood fills the pleural cavity and collapses the lungs. Immediately pulling the spear out just exacerbates the issue as now the cavity is completely compromised to the outside as well, so you have to be prepared to work fast and quickly after removing it.

... truthfully, this is an extremely difficult case. The best solution I can think of would be to first clip the excess haft of the spear, before fully removing it. After this, one would need to control the blood loss from the ruptured air sacs and capillaries within the lungs, to prevent said lungs from flooding from the inside. This is where most of the blood flow is - the damaged skin/muscle/fat walls of the thorax itself actually won't bleed that much.

After controlling the lungs... seal the outside holes, to restore integrity of the pleural cavity. Doesn't have to be healed, just airtight. After that? Well, you've stopped the bleeding, and plugged the holes. Now you wait.

Sanitation to avoid infection is a must.

Trauma repair is simpler in base theory than people make it out to be. The hard part is execution.

[Jubal_Barca]

A punctured lung with a puncture of that size in the 21st century is often a sign of imminent death, let alone the 12th.

I think the obvious thing to do would be to use magic or possibly even stitches to seal off the bronchus to the damaged lung - this will allow the patient to breathe through the other lung securely. If that isn't done the blood could flow into the other lung and the patient could choke. Essentially the punctured lung is gone for good, so the survivor will have to live with one (which will greatly decrease their physical stamina, though after a year or so they should be able to walk normal distances. Adventuring days are definitely over though.) Once the bronchus is sealed off, the spear would have to be removed. The head should be broken off so you don't have to pull it back through, then the shaft can be slowly eased out. After that, stopping the major internal bleeding and infections would be key, that's where the herbs and magic probably come into it. If the bleeding can be stopped (which basically requires that not only was the heart not hit, but the veins that went to the lung probably need to be intact too to prevent impossibly large blood loss), and by some miracle they don't die of the trauma, then eventually they should recover.

I'd say a few days of "intensive care" needed, more or less constant attention to avoid further blood loss and allow recovery from the initial trauma (they'd be barely concious during this time). Then a bedridden month or so, then they might be able to start hobbling about.

Hope that helps. :P

[Deadly]

Thanks. I know it's a tricky case, and in the real world the person would have died already probably. I'm taking some artistic licenses, obviously :)

Just to be clear, only one lung is punctured.

Edit: There's no hope of repairing the lung? Stitching it up, or something, maybe?

[OverdrivePrime]

What kind of magic is there? Could you saw the spear-haft off, and then slowly transform the wood of the spear into a more spongy organic matter? I'd try doing a ritual that uses part of the spear to replace the damaged body tissue. Transform it into a spongy lichen that eventually incorporates itself into the lung tissue. Some sort of sympathetic magic like that seems appropriate.
And then, of course, there's the fun chance of the spell spreading to the rest of the body and slowly turning the recipient into a plant/human symbiote.

[Tvtyrant]

One of my best friends lungs collapsed from having tiny holes in them and filling the rest of the chest cavity with air and pressurizing it till his lungs couldn't expand. Lungs are a fragile part of the body, I wouldn't expect your example to live. Only thing I can think of is something that keeps them frozen or otherwise unable to breathe and then perform the surgery to knit everything; if it was D&D Flesh to Stone would work.

[Deadly]

What kind of magic is there? Could you saw the spear-haft off, and then slowly transform the wood of the spear into a more spongy organic matter? I'd try doing a ritual that uses part of the spear to replace the damaged body tissue. Transform it into a spongy lichen that eventually incorporates itself into the lung tissue. Some sort of sympathetic magic like that seems appropriate.
And then, of course, there's the fun chance of the spell spreading to the rest of the body and slowly turning the recipient into a plant/human symbiote.

Heh, cool idea. I don't think it'd work for this particular story, but it reminded me of a brief idea I had a while back and forgot to write down, involving blood magic. Maybe create a kind of sympathetic connection between the patient and a healthy person, using the healthy person's vitality and blood to help heal the patient. Kinda like a donor.

One of my best friends lungs collapsed from having tiny holes in them and filling the rest of the chest cavity with air and pressurizing it till his lungs couldn't expand. Lungs are a fragile part of the body, I wouldn't expect your example to live. Only thing I can think of is something that keeps them frozen or otherwise unable to breathe and then perform the surgery to knit everything; if it was D&D Flesh to Stone would work.

Hmm. I guess maybe freezing could help. If nothing else, ice may help slow the bleeding until something can be done.

[Aux-Ash]

Using the means of the 12th century, that lung cannot be saved. You'd need to seat all punctures in the lung and the pleura (lungsack) with something waterproof after reinflating the lung. The lung will collapse and there's not much to do about it.

Luckily the lungs are separate and you don't need both. So losing one of them is not a huge deal. Simply stitch the holes together and accept that the patient has lost one lung and hope for the best. The spear will have to be removed by sawing of the spear and then pulling the rest of it out the shortest way out (for the edge).

It's not good odds for the patient, especially considering the risk of a infection in the pleura or chest cavity. But there is a chance of survival.

[Deadly]

Thanks. I can live with the lung being lost. It'd be an interesting character flaw (they're piling up on this one, it seems).

Just evaluating the options, though, so keep it coming.

[Tyrmatt]

My natural choice would be to use magic to simulate full moonlight and wrench the spear out as the transformation begins the flurry of mitosis and cell division that occurs to produce the lycanthropic form will deal with some of the damage. The animal form (I'm guessing wolf) will be much more able to cope with the shock and blood loss compared toThen dispel the source of moonlight and have the process repeat in the opposite direction as many times as necessary until the damage heals. But you've removed that as a possibility.

A quick invention on the spot from a medical treatment used in the modern day is filling the lung with a foam-like poultice, plugging up the holes and stopping the bleeding. This can be very crudely achieved with baking soda and lemon juice both of which I think are available circa 12th century. The shock of such a brutal treatment would almost undoubtedly kill a healthy person, let alone someone with blood loss and shock trauma though.

[Deadly]

My natural choice would be to use magic to simulate full moonlight and wrench the spear out as the transformation begins the flurry of mitosis and cell division that occurs to produce the lycanthropic form will deal with some of the damage. The animal form (I'm guessing wolf) will be much more able to cope with the shock and blood loss compared toThen dispel the source of moonlight and have the process repeat in the opposite direction as many times as necessary until the damage heals. But you've removed that as a possibility.

There are a number of reasons for my choice, one being that these lycans aren't quite like the classic werewolves. In particular they don't change shape. For our purposes it's perfectly fine to think of them as just like humans, so I left it out.

A quick invention on the spot from a medical treatment used in the modern day is filling the lung with a foam-like poultice, plugging up the holes and stopping the bleeding. This can be very crudely achieved with baking soda and lemon juice both of which I think are available circa 12th century. The shock of such a brutal treatment would almost undoubtedly kill a healthy person, let alone someone with blood loss and shock trauma though.

Fascinating idea. Although undoubtedly risky.

[J.Gellert]

While it's true that you can survive with one lung, all the air/blood/collapsing of the damaged one pulls the rest of the thorax out of place, which means you can't really use your other lung as well.

If the lung just has a hole in it, you can potentially save it if you can inflate it. If the main bronchus is damaged, you need to perform bronchoplasty.

If a spearhead is large and messy enough, there is nothing to sew; the surgery you are looking for is Pneumonectomy. That lung is probably destroyed, and even nowadays cutting it out would be the only treatment.

Either way you need to prevent the accumulation of air and blood in the pleural cavity. You need equipment for this... You can substitute cheap materials to create a valve, but I don't know what you'd use in the 12th century.

You can't administer 100% oxygen either...

And, you don't have a way for cardiopulmonary support (for example), without which you can't really do anything...

And I'd point out the lack of antibiotics if there was any chance of surviving long enough for that to matter...

[Tvtyrant]

Graft some gills on them and allow them to live a life of waterfilled beauty!

[Aux-Ash]

A quick invention on the spot from a medical treatment used in the modern day is filling the lung with a foam-like poultice, plugging up the holes and stopping the bleeding. This can be very crudely achieved with baking soda and lemon juice both of which I think are available circa 12th century. The shock of such a brutal treatment would almost undoubtedly kill a healthy person, let alone someone with blood loss and shock trauma though.

Injecting a mix of baking soda and lemon juice* into a perforated and hemorrhaging lung with 12th century tools and no sterilisation available? Oh gods, no!
If that stuff or airbubbles enter the bloodstream the result would be absolutely disastrous. And we're not even touching the risk of a major sepsis here (which is pretty much huge even without that procedure).

Theoretically, the blood should be able to clot on it's own. But it's probably to risky to count on it. You'd probably have to cauterize it and seal of the pulmonary veins for good measure.
I'd echo Firkraags suggestion of a pneumoectomy, but I'm unsure if anyone could survive that with 12th century tools. But a combination of a cauterization, sealing of the pulmonary vein and the bronchi and sealing up the collapsed lung could perhaps work... theoretically.

Of course... with no blood transfusion, no 100 % oxygen and the hygiene of the time... it's not looking good.

EDIT: *Not to mention... citrate (citric acid, which is definantely in lemon juice) binds calcium which is a prerequiste for blood clotting. Adding lemon juice to that wound literally makes clotting impossible. You might as well give the patient heparin.

[Deadly]

Well, antibiotics could probably be solved by introducing "magical" herbs. It wouldn't stretch my imagination very far to do that.

As for the rest, I get the feeling I really do have to invoke magic, at least once the spear has been removed and the external holes have been patched up?

[Asheram]

Thinking that the person is both malnourished and fatigued...
One lung punctured and perforated through the chest... if you're really really lucky he might survive the surgery but if he doesn't die there he'd die post-op.

[Deadly]

Hmm... just a wild idea, what would happen if the spear was simply just left in? I mean, cut off as much of what sticks out, but leave it in, let the body heal around it. I assume infection and rejection by the body, but... could it work? Just for one year, that's all.

[Jubal_Barca]

With a massive lump of wood in his chest cavity, he won't be able to move his ribcage properly so he'd be barely able to breathe. I don't think leaving something the size of a spear in is an option.

[Deadly]

Figured as much :)

As an alternative to all this, is there any way, however miraculous, that the spear could have missed the lung? I find this quite unlikely too, and it probably would make the story a little less interesting, but just want to consider various ideas.

[Aux-Ash]

Figured as much :)

As an alternative to all this, is there any way, however miraculous, that the spear could have missed the lung? I find this quite unlikely too, and it probably would make the story a little less interesting, but just want to consider various ideas.

Well... the torso is essentially packed with important stuff so hitting one of the lungs is perhaps one of the better options. But it could miss everything important (or just narrowly hit one such thing).
Getting impaled is still a very big deal and by no means is survival guaranteed. But the chances are much better... and the character can probably get back to adventuring after a short time to recover, unlike the loss of lung case.

Basically... It's insane luck. But it is plausible.

[Asheram]

Figured as much :)

As an alternative to all this, is there any way, however miraculous, that the spear could have missed the lung? I find this quite unlikely too, and it probably would make the story a little less interesting, but just want to consider various ideas.

If the spear went in under the shoulderblade and perforated the chest? Nope. Not much of a chance, the lungs are too big to miss. There's also a good chance he nicked a part of the liver as well.

[Deadly]

Hmm, conflicting responses to that one

Right now I'm leaning towards one of two options, which are not necessarily mutually exclusive.

1. First pull out spear and cauterise the external wounds. I figure to increase chances of survival, the spear will not be pulled out completely from the start, but first only far enough to allow cauterisation and possible stitcing of the entry wound. Then, once the entry is sealed, the spear is fulled the rest of the way out.

2. In the first scenario the exit wound is then cauterised and sealed. In the second scenario the exit wound is used to remove the damaged lung before being cauterised and sealed as well. I imagine it'd be done kinda like how the ancient Egyptians removed the brain of their dead through the nose with a long hook. Something along those lines, at least.

3. Finally, some sort of sympathetic blood magic ritual to heal up the internal damage. Will still leave a lot of permanent damage that the person will have to live with, probably chronic pain and short breath, but at least they'll survive.

[Asheram]

I can say that with 12'th century medicine, there's No mundane way of saving that lycanthrope. He'll need healing, magical healing and that Very fast.

[Aux-Ash]

I imagine it'd be done kinda like how the ancient Egyptians removed the brain of their dead through the nose with a long hook. Something along those lines, at least.

Given how many bloodvessels, muscles and other tissues connects to the lungs. No. Tearing it out is way to dangerous.
It would have to be cut out and all bloodvessels sealed manually. Which contemptory medicine probably cannot do.

[Incanur]

Folks did sometimes survive penetrating lung wounds in earlier times.

[UserClone]

Fantasy world, you say? Definitely go for the Rambo approach, plus magic. Either yank or, preferably, teleport the spear out of the lycanthrope's body, then immediately cauterize the wound with either a flaming brand or, preferably, a jet of blue flame from your finger. Then let his lycanthropic metabolism heal the rest. You're welcome.

[Asheram]

Folks did sometimes survive penetrating lung wounds in earlier times.

Indeed, but this is a spear that've completely penetrated the chest. Such a wound is difficult to treat even by todays standards if it didn't kill the person immediatly.
Also, remember that there's a lot of bloodvessels in a lung. He ought to be bleeding out.

[Deadly]

Thanks for the link, Incanur. That was interesting. I figure even if it is a lot worse with a spear, maybe it's not completely hopeless, especially when you factor in stuff like race, magic and plot.

Well, seems like I'm back to just pulling the spear out, cauterise and seal up external wounds and hope for the best.

So, what specific magical solutions would you use? Again, excluding the snap-your-fingers-and-it's-gone kind of magic. Specifically interested in "blood magic".

[Incanur]

Indeed, but this is a spear that've completely penetrated the chest. Such a wound is difficult to treat even by todays standards if it didn't kill the person immediatly.

From the linked article, two folks who received sword wounds fully through lung recovered. Sixteenth-century martial writer George Silver gives a similar account of a man pierced repeatedly by rapier thrusts who survived. A spear wound would perhaps be worse, but it's not necessarily fatal.

[DrizztFan24]

Once you have exhaled arent your lungs only as big as your fist? If the spear entered the back medially(? going towards the arm from the spine right?) an inch below the shoulder blade and exited in a straight line. I imagine it would end up about an inch below the usual male nipple. That area COULD be free of lung tissue if the character had JUST exhaled...but you would probably hit the liver and some other goodies.