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Monthly Archives: April 2019

Criminal Mischief: Episode #18: Gunshot To The Chest

XRay Chest Bullet

 

Criminal Mischief: Episode #18: Gunshot To The Chest

LISTEN: https://soundcloud.com/authorsontheair/gswtochest

PAST SHOWS: http://www.dplylemd.com/criminal-mischief.html

SHOW NOTES: http://www.dplylemd.com/criminal-mischief-notes/18-gunshot-to-the-chest.html

Gunshot wounds (GSWs) come in many flavors and those to the chest can be particularly dicey. Yet, a chest GSW can be a minor flesh wound, a major traumatic event with significant damage, or deadly. If you have a character who suffers such an injury, this podcast is for you.

Here are a few interesting questions about chest GSWs:

Could a Person Survive a Gunshot to the Chest in the 1880s?

Q: My scenario is set in 1880. A man in his early 20s is shot in the back by a rifle. He loses a lot of blood and is found a couple of hours later unconscious. Could he survive and if so how long would it take him it recuperate? Also, would it be possible to bring him to consciousness long enough for another man to get him into a buggy. Is any part of this scenario possible?

A: Everything about your scenario works. A gunshot wound (GSW) to the chest can kill in minutes, hours, days, or not at all. The victim would be in pain and may cough and sputter and may even cough up some blood. He could probably walk or crawl and maybe even fight and run if necessary. Painful, but possible. He would likely be consciousness so could even help get himself into the wagon.

If all goes well, he should be better and gingerly up and around in a week or two. He would be fully recovered in 6 to 8 weeks.

After surviving the initial GSW, the greatest risk to his life would a secondary wound infection. Since no antibiotics were available at that time, the death rate was very high—40 to 80 percent—for wound infections. But, if he did not develop an infection, he would heal up completely.

How Is A Gunshot To The Chest Treated?

Q: I have a few questions regarding a gunshot wound that my poor character will be sustaining later on in my story. Supposing it’s a fairly small caliber bullet (typical handgun fare, not buckshot or anything) and it hits near the heart without puncturing anything important, how long might his recovery time be? He’s a strong, kinda-healthy guy in his thirties, although he drinks a fair amount and used to smoke. He’ll be rushed to a high-quality hospital immediately and receive the best care throughout recovery…what’s his outlook? When will he be allowed to go home, if all goes well? How long before he’s healed to normal?  When will it be safe for him to walk around, drive, have sex, etc.?

A: In your story, what happens to your shooting victim depends upon what injuries he received. A gunshot wound (GSW to docs and cops) can be a minor flesh wound or can be immediately deadly or anywhere in between. It all depends on the caliber and speed of the bullet and the exact structures it hits. A shot to the heart may kill instantly or not. The victim could die in a few minutes or survive for days or could recover completely with proper medical care and surgery. It’s highly variable but ask any surgeon or ER doctor and they will tell you that it’s hard to kill someone with a gun. Even with a shot or two to the chest.

A small caliber and slow speed bullet—such as those fired by .22 and .25 caliber weapons—are less likely to kill than are heavier loads and higher velocity bullets such as .38, .357, or .45 caliber bullets, particularly if they are propelled by a magnum load—such as a .357 magnum or a .44 magnum. Also, the type of bullet makes a difference. Jacketed or coated bullets penetrate more while hollow point or soft lead bullets penetrate less but do more wide-spread damage as the bullet deforms on impact.

All that is nice but the bottom line is that whatever happens, happens. That is, a small, slow bullet may kill and a large, fast one may not. Any bullet may simply embed in the chest wall or strike a rib and never enter the chest. Or it could enter the heart and kill quickly. Or it could puncture a lung. The victim here would cough some blood, be very short of breath, and could die from bleeding into the lungs—basically drowning in their own blood. Or the lung could collapse and again cause pain and shortness of breath. But we have two lungs and unless the GSWs are to both lungs and both lungs collapse the person would be able to breathe, speak, even run away, call for help, or fight off the attacker. Whatever happens, happens.

This is good for fiction writers. It means you can craft your scene any way you want and it will work. He could suffer a simple flesh wound and have pain, shortness or breathe, and be very angry. He could have a lung injury and have the above symptoms plus be very short of breathe and cough blood.  If the bleeding was severe or if both lungs were injured he could become very weak, dizzy, and slip into shock. Here his blood pressure would be very low and with the injury to his lungs the oxygen content of his blood would dip to very low levels and he would lose consciousness as you want. This could happen in a very few minutes or an hour later, depending upon the rapidity of blood loss and the degree of injury to the lungs.

Once rescued, the paramedics would probably place an endotracheal (ET) tube into his lungs to help with breathing, start an IV to giver IV fluids, and transport him to the hospital immediately. He would then be seen by a trauma surgeon or chest surgeon and immediately undergo surgery to remove the bullets (if possible) and to repair the damaged lung or whatever else was injured. He could recover quickly without complications and go home in a week, rest there for a couple of weeks, return to part-time work for a few weeks and be full speed by 3 to 4 months. Or he could have one of any number of complications and die. Or be permanently disabled, etc. It all depends upon the nature of Injuries, the treatment, and luck.

What Does a Close-range Gun Shot to the Chest Look Like?

Q: I have a question regarding gunshot wounds. In my latest mystery, a man and a woman, my heroine, struggle for a gun. It goes off, hitting the man in the chest. I want the man to live, but be temporarily incapacitated and need hospital care, so if the chest isn’t the best location, other suggestions are welcome. What would the gunshot wound likely look like before and after the man’s shirt was removed? Would there be a lot of bleeding where my heroine would take his shirt off and stuff it over the wound?

A: A gunshot wound (GSW) to the chest would work well. For it to be quickly fatal, the bullet would have to damage the heart or the aorta or another major blood vessel, such as the main pulmonary (lung) arteries. Under these circumstances, bleeding into the chest, the lungs,  and around the heart would likely be extensive and death could be almost instantaneous or in a very few minutes. He could survive even these injuries, but this would require quick and aggressive treatment, including emergent surgery, and a pile of luck.

If the bullet entered the lung, the victim could die from severe bleeding into the lung and basically drowning in his own blood. Or not. He could survive such an injury and would then require surgery to remove the bullet, control the bleeding within the lung, and repair the lung itself. This would require a couple of hours of surgery, a week in the hospital, and a couple of months to recover fully.

The bullet could simply embed in the chest wall and never enter the chest cavity. It could bounce off the sternum (breast bone) or a rib and deflect out of the chest, into the soft tissues of the chest wall, or downward into the abdomen. Once a bullet strikes bone, it can be deflected in almost any direction. Sometimes full-body X-rays are required to find the bullet. If the bullet simply embedded beneath his skin or against a rib or the sternum, he would require a minor surgical procedure to remove the bullet and debride (clean-up) the wound. He would be hospitalized for only 2 to 3 days and would go home on antibiotics and basic wound care.

Close-range, but not direct muzzle contact, wounds typically have a small central entry wound, a black halo called an abrasion collar, and often an area of charring around the wound. The charring comes from the hot gases that exit the barrel with the bullet. In addition, there is often tattooing, which is a speckled pattern around the entry wound. This is from the soot and unburned powder that follows the bullet out of the muzzle and embeds (tattoos) into the skin. The spread of this pattern depends upon how close the muzzle is to the entry point, If it over about 3 feet, then no tattooing or charring will occur.

In your scenario, the victim’s shirt would likely collect the soot and heat so that it would be charred and “tattooed,” rather than the victim’s skin. So, the shirt would show an entry hole, charring, and blood. Once the victim’s shirt was removed, the entry wound likely be a simple hole without any charring or tattooing, since the shirt would have collected this material and absorbed most of the heat. The wound could bleed a lot, a little, or almost none. It depends upon how many of the blood vessels that course through the skin and muscles are damaged.

Yes, her initial efforts should be the application of pressure over the wound to control bleeding until the paramedics arrive.

For more fun questions check out my Q&A books:

F&F200X302

FORENSICS and FICTION: http://www.dplylemd.com/book-details/forensics–fiction.html

MF&F 200X320

MORE FORENSICS and FICTION: http://www.dplylemd.com/book-details/more-forensics-and-fiction.html

M&M 200X300

MURDER AND MAYHEM: http://www.dplylemd.com/book-details/murder-and-mayhem.html

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Criminal Mischief: The Art and Science of Crime Fiction: Episode #17: DNA and Twins

DNA Replication

 

LISTEN: https://soundcloud.com/authorsontheair/criminal-mischief-episode-17-dna-and-identical-twins

PAST SHOWS: http://www.dplylemd.com/criminal-mischief.html

SHOW NOTES:

For years it was felt that the DNA of identical twins was indeed identical. Since they come from a single fertilized egg, this would seem intuitive. But, nature likes to throw curve balls—and the occasional slider. After that first division of the fertilized, and after the two daughter cells go their way toward producing identical humans, things change. And therein lies the genetic differences between two “identical” twins.

LINKS:

One Twin Committed the Crime—but Which One?: https://www.nytimes.com/2019/03/01/science/twins-dna-crime-paternity.html

The Claim: Identical Twins Have Identical DNA: https://www.nytimes.com/2008/03/11/health/11real.html

The Genetic Relationship Between Identical Twins: https://www.verywellfamily.com/identical-twins-and-dna-2447117

Identical Twins’ Genes Are Not Identical: https://www.scientificamerican.com/article/identical-twins-genes-are-not-identical/

Rare Australian Twins Are “Semi-Identical,: Sharing 89 Percent of Their DNA: https://www.inverse.com/article/53633-semi-identical-twins-share-78-percent-of-dna

 

Criminal Mischief: Episode #16: Arsenic: An Historical and Modern Poison

Arsenic

Criminal Mischief: Episode #16: Arsenic: An Historical and Modern Poison

LISTEN: https://soundcloud.com/authorsontheair/criminal-mischief-episode-15-arsenic-an-historical-and-modern-poison

SHOW NOTES: http://www.dplylemd.com/criminal-mischief-notes/16-arsenic-an-historical.html

PAST SHOWS: http://www.dplylemd.com/criminal-mischief.html

Howdunnit200X267

From HOWDUNNIT:FORENSICS

Toxicology is a relatively new science that stands on the shoulders of its predecessors: anatomy, physiology, chemistry, and medicine. Our knowledge in these sciences had to reach a certain level of sophistication before toxicology could become a reality. It slowly evolved over more than two hundred years of testing, starting with tests for arsenic. 

Arsenic had been a common poison for centuries, but there was no way to prove that arsenic was the culprit in a suspicious death. Scientist had to isolate and then identify arsenic trioxide—the most common toxic form of arsenic— in the human body before arsenic poisoning became a provable cause of death. The steps that led to a reliable test for arsenic are indicative of how many toxicological procedures developed. 

1775: Swedish chemist Carl Wilhelm Scheele (1742–1786) showed that chlorine water would convert arsenic into arsenic acid. He then added metallic zinc and heated the mixture to release arsine gas. When this gas contacted a cold vessel, arsenic would collect on the vessel’s surface. 

1787: Johann Metzger (1739–1805) showed that if arsenic were heated with charcoal, a shiny, black “arsenic mirror” would form on the charcoal’s surface. 

1806: Valentine Rose discovered that arsenic could be uncovered in the human body. If the stomach contents of victims of arsenic poisoning are treated with potassium carbonate, calcium oxide, and nitric acid, arsenic trioxide results. This could then be tested and confirmed by Metzger’s test. 

1813: French chemist Mathieu Joseph Bonaventure Orfila (1787–1853) developed a method for isolating arsenic from dog tissues. He also published the first toxicological text, Traité des poisons (Treatise on Poison), which helped establish toxicology as a true science. 

1821: Sevillas used similar techniques to find arsenic in the stomach and urine of individuals who had been poisoned. This is marked as the beginning of the field of forensic toxicology. 

1836: Dr. Alfred Swaine Taylor (1806–1880) developed the first test for arsenic in human tissue. He taught chemistry at Grey’s Medical School in England and is credited with establishing the field of forensic toxicology as a medical specialty. 

1836: James Marsh (1794–1846) developed an easier and more sensitive version of Metzger’s original test, in which the “arsenic mirror” was collected on a plate of glass or porcelain. The Marsh test became the standard, and its principles were the basis of the more modern method known as the Reinsch test, which we will look at later in this chapter. 

As you can see, each step in developing a useful testing procedure for arsenic stands on what discoveries came before. That’s the way science works. Step by step, investigators use what others have discovered to discover even more. 

Acute vs. Chronic Poisoning 

At times the toxicologist is asked to determine whether a poisoning is acute or chronic. A good example is arsenic, which can kill if given in a single large dose or if given in repeated smaller doses over weeks or months. In either case, the blood level could be high. But the determination of whether the poisoning was acute or chronic may be extremely important. If acute, the suspect list may be long. If chronic, the suspect list would include only those who had long-term contact with the victim, such as a family member, a caretaker, or a family cook. 

So, how does the toxicologist make this determination? 

In acute arsenic poisoning, the ME would expect to find high levels of arsenic in the stomach and the blood, as well as evidence of corrosion and bleeding in the stomach and intestines, as these are commonly seen in acute arsenic ingestion. If he found little or no arsenic in the stomach and no evidence of acute injury in the gastrointestinal (GI) tract, but high arsenic levels in the blood and tissues, he might suspect that the poisoning was chronic in nature. Here, an analysis of the victim’s hair can be invaluable. 

Hair analysis for arsenic (and several other toxins) can reveal exposure to arsenic and also give a timeline of the exposure. The reason this is possible is that arsenic is deposited in the cells of the hair follicles in proportion to the blood level of the arsenic at the time the cell was produced. 

In hair growth, the cells of the hair’s follicle undergo change, lose their nuclei, and are incorporated into the growing hair shaft. New follicular cells are produced to replace them and this cycle continues throughout life. Follicular cells produced while the blood levels of arsenic are high contain the poison, and as they are incorporated into the hair shaft the arsenic is, too. On the other hand, any follicular cells that appeared while the arsenic levels were low contain little or no arsenic. 

In general, hair grows about a half inch per month. This means that the toxicologist can cut the hair into short segments, measure the arsenic level in each, and reveal a timeline for arsenic exposure in the victim. 

Let’s suppose that a wife, who prepares all the family meals, slowly poisoned her husband with arsenic. She began by adding small amounts of the poison to his food in February and continued until his death in July. In May he was hospitalized with gastrointestinal complaints such as nausea, vomiting, and weight loss (all symptoms of arsenic poisoning). No diagnosis was made, but since he was doing better after ten days in the hospital, he was sent home. Such a circumstance is not unusual since these types of gastrointestinal symptoms are common and arsenic poisoning is rare. Physicians rarely think of it and test for it. After returning home, the unfortunate husband once again fell ill and finally died. 

As part of the autopsy procedure, the toxicologist might test the victim’s hair for toxins, and if he did, he would find the arsenic. He could then section and test the hair to determine the arsenic level essentially month by month. If the victim’s hair was three inches long, the half inch closest to the scalp would represent July, the next half inch June, the next May, and so on until the last half inch would reflect his exposure to arsenic in February, the month his poisoning began. Arsenic levels are expressed in parts per million (ppm).

An analysis might reveal a pattern like that seen in Figure 11-1. 

IMAGE in HOWDUNNIT: FORENSICS

 The toxicologist would look at this timeline of exposure and likely determine that the exposure occurred in the victim’s home. The police would then have a few questions for the wife and would likely obtain a search warrant to look for arsenic within the home. 

LINKS: 

Arsenic Poisoning (2007): CA Poison Control: https://calpoison.org/news/arsenic-poisoning-2007

Arsenic Poisoning Cases Wikipedia: https://en.wikipedia.org/wiki/Arsenic_poisoning_cases

Arsenic” a Murderous History: https://www.dartmouth.edu/~toxmetal/arsenic/history.html

Facts About Arsenic: LiveScience: https://www.livescience.com/29522-arsenic.html

Poison: Who Killed Napolean?: https://www.amnh.org/explore/news-blogs/on-exhibit-posts/poison-what-killed-napoleon

Victorian Poisoners: https://www.historic-uk.com/HistoryUK/HistoryofEngland/Victorian-Poisoners/

12 Female Poisoners Who Killed With Arsenic: http://mentalfloss.com/article/72351/12-female-poisoners-who-killed-arsenic

 

 
 
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