Murder and Mayhem (8 page)

The dressing applied should be "occlusive"; that is, it should seal the opening in an airtight fashion. A porous gauze wouldn't do. There are several types of plastic-coated bandages that stick to the skin and make an airtight seal. Also, a sheet of plastic wrap, a plastic

food or trash bag, or a piece of cellophane would work. If only gauze is available, it should have some salve such as petroleum jelly, butter, or mud applied to it; that would make it airtight or nearly so.

If the lung itself wasn't also punctured, some re-expansion of the lung would occur while the victim awaited transport to a facility for definitive treatment. Once at the hospital a surgeon would repair the wound and place a thoracostomy tube (or chest tube). This large-bore plastic tube is slipped through the chest wall and into the chest cavity between the lung and the chest wall. Suction is applied to the tube in order to reinflate the lung. After a few days the tube is removed. The victim should recover and do well if this is his only injury.

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ENVIRONMENTAL INJURIES AND THEIR TREATMENT

What Happens When Someone Dies from Exposure?

Q: What does it mean when someone dies of exposure— not freezing to death, just exposure?

A: "Exposure" is a broad term that covers deaths from freezing, heatstroke, starvation, and dehydration. In short, if the victim is in the middle of nowhere and doesn't die from injury or illness, then exposure is what did it. He didn't have food, water, or shelter. So to answer your specific question, if cold or heat isn't a factor, then lack of food and water is the likely culprit.

What Happens When Someone Dies from Dehydration?

Q; What's it like to die of dehydration? Delirium? Extreme thirst or the opposite? Does the mind fool the victim into seeing mirages? How long would this process take in an elderly woman lost in the mountains during the summer?

A: Dehydration is when the body loses water. This loss occurs due to sweating and through the lungs during normal breathing

(called "insensible loss," since we are unaware of water lost in this fashion). The drier the air is and the more rapid the breathing, the more water will be lost through the lungs. Literally quarts of water can be lost this way. Any activity such as walking, running, carrying a backpack, or climbing increases the rate of breathing and, thus, insensible water loss. Hot and dry climates lead to more rapid water loss, though the dry air in winter mountains can cause considerable dehydration even though the temperature is low.

The time required for dehydration to appear depends on these and other factors. The process can take only hours if the weather is very hot and dry, or it can take a few days if it is cloudy and cooler.

In severe dehydration the blood pressure falls as the loss of water from the body reduces the blood volume. Also, electrolytes such as sodium, potassium, and magnesium are lost through sweating, which can lead to muscle weakness and cramps.

Thirst, an early symptom, doesn't appear until considerable loss of water has occurred. This means that by the time thirst develops, the person is already well into dehydration. Thirst is followed by fatigue, shortness of breath, weakness, muscle cramps, nausea and sometimes vomiting, delusions, delirium, and finally collapse, coma, and death.

With a high ambient temperature, body temperature can rise dramatically, and once it gets above 103 or so, the mind isn't as sharp as it should be. The victim will not be able to think well and may literally wander in circles or hallucinate. Mirages can be seen as a result.

Of course, mirages are due to the physics of light. Heat rising from a desert or a road bends light rays due to changes in density of the air (hot air is less dense than cooler air). The result is that you see blue sky below the horizon, and it looks like a body of water. Often a person who is dehydrated and confused will rush blindly toward it but can never reach it because it doesn't exist and because the optical illusion keeps moving away, so to speak.

The young and the old are particularly susceptible to dehydration and heatstroke since they tend to have less muscle and tissue

mass in which to store water. They dehydrate faster and show the signs and symptoms of dehydration earlier and more severely.

In your scenario both the summer heat and the altitude would conspire to hasten your lady's dehydration. The heat would increase sweating, and the low water vapor pressure (meaning the air is dry) that is found at higher altitudes would accelerate insensible loss of water through the lungs. Another factor would be her degree of hydration at the time her adventure began. If she was already a little dry, she would get into trouble more quickly. Also, as explained above, the more active she is, the faster she would dehydrate. If she sits in a cool spot and waits for someone to find her, she might survive for several days. If she attempts to walk over hilly terrain, she might not last twenty-four hours. Obviously, if she has any underlying heart or lung disease or perhaps diabetes, her survival time would decrease.

What Is the Treatment for Dehydration?

Q: What's the first aid treatment for dehydration? In my story a forest ranger comes across a severely dehydrated and weakened hiker. He carries the young man to safety. But what would he actually do? Dribble water between his lips and get him to a hospital? Then what? An IV with a glucose drip?

A: That's right. Get water in any way you can safely do it, such as sips or dribbles at first, depending on the condition and level of consciousness of the victim. Other treatment depends on whether heat prostration or heatstroke is present.

If the environment is cool or cold, as in the mountains or snowy areas, wrap the victim in blankets, towels, or sweaters since dehydration in these circumstances often leads to a drop in body temperature. Typically, the victim of this type of dehydration feels cool

to the touch and appears pale. If the dehydration is severe, the blood pressure will be low and the pulse weak and thready, and confusion and disorientation are likely. Giving fluids (preferably warm liquids) and warming the victim are the major frontline treatments.

In your story, heat prostration and heatstroke are more likely since the ambient temperature is high. These two entities are similar, with the latter being more severe. Both are caused by dehydration and rising core body temperature. Common victims include runners, football players, construction workers, military personnel, and anyone who exerts himself in hot climates, such as your hiker. Sweating in these situations is typically profuse, so dehydration can occur rapidly.

We use the term "heat injury" as a broad category for anyone who develops significant dehydration and an elevation of body temperature. Early in heat injury (heat prostration) the victim may sweat, but as the process continues and the core body temperature rises, sweating ceases, compounding the problem by the loss of the body's natural radiator system (resulting in heatstroke). The reason this occurs is that the body's innate self-preservation actions divert what blood volume there is toward vital organs such as the heart and brain, and away from the skin. But it is blood flow through the skin that acts as the radiator to dissipate the rising body heat. The body actually works against itself, and the core temperature rises rapidly. Body temperatures of 105 to 108 are not uncommon. Thus, victims of heatstroke may appear flushed and often feel warm and dry to the touch. Heatstroke has a high mortality if not treated quickly and aggressively.

Whether the victim is suffering from heat prostration or heatstroke, the treatment is directed toward lowering the body temperature and replacing the lost fluids. These measures should begin immediately and should not be delayed in order to transport the victim to a hospital. Cool the victim by sponging with water or any cool liquid, and fan with a towel, shirt, or anything

handy. This lowering of the core body temperature is as important as relieving the dehydration by giving fluids. In fact, when a victim of heatstroke appears in the hospital emergency room, we often place him in a tub of ice water to rapidly lower the core body temperature. The brain does not tolerate the high temperatures seen in heatstroke, and irreversible brain damage occurs quickly.

A victim who is in a coma or delirious or confused and combative is another problem. Pouring water into the mouth of a comatose person or one who will not cooperate may lead to aspiration and injury to the lungs. It's a judgment call as to which is the greater risk: untreated dehydration or aspiration.

Your forest ranger would likely have a canteen or some other water container. He would give the victim sips, splash some on his face and chest, and fan him with a shirt or similar object. He would move him into the shade of nearby trees and then transport him to civilization by whatever means he had available. He might call in a helicopter rescue team or make a litter and haul the victim down the mountain. Regardless, he would continue to rehydrate and cool the hiker as long as his water supply lasted.

In the hospital the victim would receive IV fluids, usually D5W, which is 5 percent dextrose in water, or D5'/2 NS (normal saline,) which is 5 percent dextrose in salt water that has half the salt (NaCl) content of blood.

Other electrolytes such as potassium and magnesium can be added to the IV as needed, depending on the results of blood tests for these minerals. Tests of kidney function are also important since dehydration and heat injury can damage them.

How Long Can Someone Survive in a Freezer?

Q: Say I want to shove a character in a commercial freezer.

How long would it take for the poor soul to die?

A: The time required depends on so many factors that no definitive answer is possible. Here are some factors that would impact survival:

Size and weight of the victim:
This is a situation where a high percent of body fat would be welcome. Fat serves as insulation and a source of energy for heat production by the body.

Age:
The very young and the very old would tolerate the cold poorly and be at greater risk.

Diseases the victim may have:
The presence of heart or vascular disease, diabetes, or anemia would likely hasten the victim's demise.

Food and beverage intake:
When and what was the last meal? A high-carbohydrate meal might help somewhat. If the victim was well hydrated, he would be better off than if he was dehydrated. Alcohol consumption would definitely hasten loss of body heat and quicken the demise

Medications or drugs:
Alcohol, as mentioned, and some other medications can hasten heat loss from the body. Diuretics lead to dehydration, and certain blood pressure medications dilate the body's blood vessels and thus increase heat loss.

Clothing:
A ski parka would be better than a cotton Hawaiian shirt.

Temperature within the freezer:
Pray it's defective. If it is simply a cold locker for vegetable storage, the ambient temperature would be above freezing. If it was a meat or frozen food freezer, the temperature would be well below freezing and maybe below 0 degrees. A circulating fan in the freezer would definitely shorten the survival time. Think windchill.

Protective materials present:
Any cloth, canvas, or covering inside the freezer that could be used as a coat or to build an "ice cave" would be helpful. Either would help retain body heat.

Perhaps you can use some of these to make the victim's survival longer or shorter as dictated by your story requirements. In general, two hours probably wouldn't be enough, and forty-eight would be plenty. I suggest leaving the victim in overnight if he is an average person and not dressed for the Antarctic. That'd probably do it.

Many people survive for days lost in blizzards or in the mountains during the winter. Others don't make it through the first twelve hours. Your victim could do either, depending on what you want.

Does Alcohol Intake Prevent Death from Freezing?

Q: Does this make sense medically? A man falls through the ice of a frozen lake at night. He is unable to get himself out but has a bottle of brandy in his pocket, which he sips through the night and survives until he is rescued the next morning. Would the alcohol help him survive? Would it act like antifreeze?