# LESSON Realistic Blood Loss

Discussion in 'REFINING WRITING' started by Sen, May 29, 2016.

1. What have you seen more of? Characters who get stabbed and bleed a swimming pool worth of blood, or characters who get stabbed and only ooze out a teaspoon before collapsing dramatically? Writing blood loss can be a difficult thing if you don't know what you're talking about, so this is a friendly murder-free guide on how to make your characters bleed!

Note: This guide is best used if you have a newer computer and not an ancient Windows XP because I'll be using a lot of symbols that may or may not appear on your screen.

Also, I'll be using liters, not gallons. Sorry, people who use the imperial system. Here's a converter.

The Basics

= one liter of blood
= half a liter of blood

Statistically, the average person has around 5 liters of blood in their bodies.
But in some cases, people can have as much as 8 liters of blood in their bodies.

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This is going to be our human being, with 5 liters of blood. Take note that smaller people don't have as much blood as bigger people, so the affects of blood loss will come to them faster. Bigger people have more blood, so it will take longer for the symptoms to take affect. People who are more healthy tend to less affected as well, but anyone who has a fast heart rate will lose more blood. Common sense.

You got stabbed! That was a 'sharp' turn of events!

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Losing half a liter of blood is actually 10% of your total blood volume. Typically, there is no change in vital signs and fluid resuscitation and there is still a pulse and a steady heart rate. Characters will still be able to breathe normally. Not in any immediate danger and will survive.

Still-lett-o here? You got stabbed again! Lost another half a liter of blood!

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Losing 1 liter of blood is 20% of your total blood volume. Characters will still be perfectly alert and have a pulse. Their heart rate will start to increase to about 100+ beats per minute. Their blood pressure and respiratory rate will rise if they are elevated, so it's best to keep them lying down. The skin might start to look pale or cold to touch and the character's behaviour might start to change. Worrying, but they won't die.

Just keep stabbin', just keep stabbin'...

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You have just lost about 30% of your total blood volume. Characters will start to become more anxious and confused as mental status worsens. This is when their pulse stats to weaken and blood pressure is decreased. Character's respiratory rate rises to 30 or more breaths per minute. Fluid resuscitation and blood transfusions are usually needed here, so depending on what treatment the character receives... they'll be fine.

What was the 'point' of this experiment, again?

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Lost 40% of your total blood volume. Characters become lethargic and even more confused. May not be responsive to other characters or events. Their pulse becomes even weaker and heartrate soars to 120 beats per minute. Breathing becomes shallow and fast. Aggressive resuscitation is needed to prevent death.

It was knife to meet you.

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This is 50% of your total blood volume. At this point, they're unconscious and will not respond to anything. Their pulse will disappear and heartrate becomes 140 beats per minute, which is basically a person in the middle of an intense workout, blood pressure is at its lowest and breathing is very shallow and very fast. Unless they're some sort of god, they're going to die.

Any more blood and the characters is not going to survive. Presuming this isn't a world of magic and characters don't need to blood to survive or something. Anyone who loses more than half their body's blood can have friends start preparing their funeral, as they will die of blood loss or shock.

So where can I bleed?
Brilliant question, let me indulge you.

From the mouth​
• Hematemesis – vomiting up fresh blood​
• Hemoptysis – coughing up blood from the lungs​
From the butt
• Hematochezia – rectal blood
From the urinary tract
• Hematuria – blood in the urine from urinary bleeding
• Intracranial hemorrhage – bleeding in the skull.
• Cerebral hemorrhage – a type of intracranial hemorrhage, bleeding within the brain tissue itself.
• Intracerebral hemorrhage – bleeding in the brain caused by the rupture of a blood vessel within the head.
From the lungs
• Pulmonary hemorrhage - usually linked to a more massive condition, or when 30% of the lungs is bleeding.
• Postpartum hemorrhage - loss of more than 500ml of blood within the first 24 hours of childbirth.
• Breakthrough bleeding - mid-cycle bleeding usually caused by combining oral contraceptives.
• Ovarian bleeding
From the stomach / intestines
• Upper gastrointestinal bleed - bleeding arising from the esophagus, stomach, or duodenum. can result in vomiting or bloody poop.
• Lower gastrointestinal bleed
• Occult gastrointestinal bleed - gastrointestinal bleeding that is not visible to the patient or physician and is the result of postivie fecal occult blood tests or iron deficiency anemia.
What can cause bleeding?
(excluding medical conditions)
• Abrasion - or a graze, is superficial damage to the skin. usually doesn't go any deeper and mild grazes do not scar. but more severe ones can affect the tissue.
• Excoriation - the outer layer of skin being removed, usually caused by a medical condition.
• Hematoma - caused by damage to a blood vessel that in turn causes blood to collect under the skin.
• Laceration - irregular wound caused by blunt impact to soft tissue overlying hard tissue or tearing such as in childbirth. can also be another word for an incision
• Incision - a cut into a body tissue or organ, such as by a scalpel, made during surgery.
• Puncture Wound - caused by an object that penetrated the skin and underlying layers, such as a nail, needle or knife
• Contusion - or a bruise, this is a blunt trauma damaging tissue under the surface of the skin
• Crushing Injuries - caused by a great or extreme amount of force applied over a period of time. the extent of a crushing injury may not immediately present itself.
• Ballistic Trauma - caused by a projectile weapon such as a firearm. this may include two external wounds (entry and exit) and a contiguous wound between the two
Happy bleeding!

#1
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2. Here's something fun (from a former EMT)-- blood from different areas/injuries will be in varying colours and bleed patterns. If you're unsure about something and you want it to be realistic, spend a few moments on Google. It really is worth your time.

Nice guide, btw! c:

#2
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3. Came for the info, stayed for the knife puns, left with information on how many times to stab someone before they die. Thanks.

#3
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4. I came for the blood and delighted to see the floor is red. I think it also needs to be noted that where a stab happens and how deep also determines how much blood will be lost.

Varying colors and bleed patterns? now that is something I do need to google <3 .

#4
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5. I find this incredibly comical in a very morbid sense. So much so that I've begun hemorrhaging from my eyes. That and I started thinking about Plague Inc. (a game) and the symptoms your diseases can cause, so now I can say I've a better way of viewing just what terrible things are happening to the citizens of Earth as my plague sweeps the land.

#5
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6. Such a lovely read on my saturday evening ^^ I loved it

But of course I have a question. What about internal bleedings?

#6
7. Quoted:

#7
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8. If someone donated blood the day of the stabbing, does that cause them to lose blood more slowly, or does that mean they immediately start at the lessened blood level, is their cogency reduced the moment the knife hits them?

#8
9. When you donate blood they usually only go for 470-500mL, your body works super quickly to replace the blood ASAP. Plasma is replaced in 24 hours and red cells need about 4-6 weeks to be replaced.

I suppose they'd be weaker than a healthy person?? Not so much though, I don't think there would be much difference since we have so much blood.

#9
10. So, if someone got shot in the left shoulder with a typical gunshot wound, what would determine how much you bleed? And how much would you typically bleed?

#10
11. Gday, Um with Puncture wounds not all bleed (Speaking from personal experience when I got stabbed with a fire poker (Definitely did not trip over at a party)). However with this being said there is a small chance, I'm not going to guess because id be off by a large percentage, that the wound and damage caused would not bleed.

#11
12. There are many many variables, including the calibre of the bullet, the type (Like a hollow point), the weapon used to fire said bullets and whether or not the bullet went straight through. Typically with the shoulder and if it's a through and through it isn't any major blood loss, people usually faint from the pain of being shot or the shock even. Another factor is if it has clipped an artery since they have more blood pumping through them.

All in all, most bullet wounds don't bleed bucket loads, to use the scale above id say maybe half a litre to a litre on a standard wound. Arterial wounds vary.

#12
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"It's the shoulder, which leads to the arm. The arm has a major artery running through it. It's why, in the case of a severe injury to the arm, you need to apply a tourniquet. That shit is gonna bleed out. It's a gunshot wound. Major trauma. Blood happens.

Also. Pass through would actually cause more blood loss, thanks to more area from which to bleed. The only benefit a pass through has is that there's nothing to extract. But even that is a bad thing. A) because of friction the bullet is sterile. B) pass through is only possible from a full metal jacket round, which anyone who knows what they're doing would never ever load a pistol with, as you don't want the round causing collateral damage. C) If it is a hollow point, as appropriate, the resulting mushroomed round is going to cause more damage to the tissue, causing even more bleeding. Gunshot wounds bleed like hell."

#13
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14. Oh my god, you are a lifesaver. Please, thank your buddy for me! I needed it for a story! xD

Thank you very much for your insight! :D

#14
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15. Apparently there was a qualifier:

"It all comes down to precisely where you were shot. If it hits an artery, yeah, that's gonna bleed heavily. But if it misses that, it'll hurt like hell and mess up your movement, obviously, but it'll bleed less. As "less" as a gunshot wound can.

That said, not getting shot at all is definitely your best bet."

So...for the sake of writing plot, etc, I guess it all depends on what you specifically want. XD

#15
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