Stormwind Medical Handbook: Chest & Abdominal Injuries

The Chest & Abdominal Injuries chapter of the Stormwind Medical Handbook covers the terminology and treatment of wounds to the chest and abdomen. All medical staff should be able to identify and treat these wounds and determine triage based on the severity. 
It is recommended that all medical personnel read and comprehend the Medical Theory & Anatomy, 
Soft Tissue Wounds, and Bone Fractures chapters of this handbook before attempting any treatment outlined in this chapter.
== Terminology ==
Common chest and abdominal injury terminology are defined and explained below.
=== Lung Contusion ===
A lung contusion is a bruise or injury to the patient’s lung tissue typically sustained from blunt force impacts. Such lung injuries can result in swelling and even internalized bleeding. Symptoms of this injury include pain in one’s chest or shortness of breath after the injury. A lung contusion is typically accompanied by broken ribs, though not always. Minor lung contusions will heal on their own in time, but severe lung contusions result in unstanchable internal bleeding and suffocation. There is not much that can be done in the case of a severe lung contusion other than to seek out a magical healer or grant the victim a swift death.
=== Lung Laceration ===
A lung laceration is a tear or cut to the patient’s lung tissue sustained through penetrating or blunt force trauma. Lung lacerations are serious injuries that show symptoms immediately; the victim will cough up blood, be short of breath, and experience severe chest pain. Blood will pool in the chest cavity where the lungs are torn. If the location of penetrating trauma is obvious, such as a stab wound, a tube should be inserted to allow blood to drain from the chest cavity. Severe lung lacerations are almost always fatal; a swift death would be preferred to drowning in one’s own blood in the case that magical healing cannot swiftly be administered.
=== Rib Fracture ===
Rib fracture is a serious type of chest bone fracture typically sustained from blunt force impacts. Due to their proximity to the lungs, rib fractures can be compound injuries where the lungs will most likely be bruised or lacerated by bone fragments or edges. Symptoms include chest pain, shortness of breath and coughing up blood. While in some cases ribs can be surgically reaffixed with steel plates and bolts to encourage proper healing, often times a patient will have no respite to the wound other than to wait for it to heal on its own, magical healing, or a swift death in the case that the wound is too severe to allow breathing.
=== Flail Chest ===
A flail chest is when several ribs have broken off from the sternum, causing abnormal “opposite” lung behavior and extreme pain when breathing. The most common way to determine if a patient has a flail chest is to observe their chest as they breathe. Due to the vacuum and expansion of the lungs, a patient with a flail chest will have their chest expand when they try to breathe out and withdraw when they try to breath in, usually on only one side of their chest. A flail chest is extremely dangerous as the jagged broken bones will eventually pierce or scrape the lungs, causing severe internal bleeding and suffocation. Surgical intervention and magical healing are required to ensure the bones are reattached in proper orientation.
=== Collapsed Lung ===
In some cases of penetrating or blunt chest trauma, blood, air, or other fluid buildup in the chest cavity will result in constriction and collapse of the lung. Symptoms include shortness of breath, chest pain, or chest tightness on the side of the collapsed lung. The most straightforward treatment is to carefully insert a catheter tube between the ribs and into the chest cavity to allow air, blood, and fluid to escape and permit the lung to expand. The patient should be instructed to take a deep breath to “push out” as much fluid and air as possible before the tube is sealed to prevent further external air from disrupting the chest cavity. The tube should eventually be removed and the wound should be closed with healing magic.
=== Heart Contusion or Laceration ===
Heart injury, whether contusion or laceration, ranks amongst the most dire medical conditions. The heart may be bruised after a blunt impact to the chest, causing fluid to build up and impair the heart from beating properly. Penetrating trauma or more severe blunt impacts may cut or tear heart tissue, stopping the heart from beating completely. Without a heartbeat, a patient’s humours are unable to traverse the body. Penetrating trauma or tears to heart tissue are almost always fatal unless magical healing is administered immediately. There is little that can be done with traditional medicine. 
=== Organ Injury ===
The organs can be bruised, torn or cut from blunt force or penetrating trauma. Symptoms vary depending on which organ is injured:
In the theory of humours, blood originates from the liver. An injury to the liver can cause severe internal bleeding that will cause a fatal imbalance of the humours within the course of a day if left untreated.
Yellow bile as a humour originates from the spleen. An injury to the spleen can cause significant internal bleeding if one of the arteries connected to it is ruptured. Spleen injuries are typically sustained as a result of fracture of the lower-left ribs, though may be sustained as blunt force or penetrating trauma.
An injury to the pancreas will lead to a severe imbalance of the humours if not treated, leading to long-term symptoms including fainting, necrosis of the extremities, and even death. Pancreas injuries are typically sustained from blunt force impacts to the lower chest and are not detected until much later. Magical healing is typically the best option, though humour-based diet regulation may alleviate the symptoms.
An injury to one or both of the kidneys is typically diagnosed with the symptom of bloody urination. Yellow bile may leak into the abdomen following a kidney laceration, which may corrupt the other organs. 
=== Bowel Injury ===
As part of the bowels that include the intestines and stomach, the gallbladder is the source of black bile in the theory of humours. An injury to any of the bowels can be sustained by blunt force or penetrating trauma to the stomach. Lacerations of the bowels typically prove fatal unless reconstructive surgery and healing magic are swiftly applied.
== Treatment ==
Common Treatment Methods for chest and abdominal injuries are defined and explained below.
=== Positioning & Stanching ===
In cases of chest injury where one of the lungs are affected, it is best for the patient to be positioned lying on the side of their injury so that their unaffected lung may breathe freely until treatment can be administered. If both lungs are affected, the patient should sit up. A patient with a chest injury should not lie on their back while waiting for treatment, as blood may pool throughout the chest cavity. If an organ is injured with an open wound, cloth should be stuffed into the wound in attempt to stanch bleeding. The wound should be cleaned and dressed until magical healing may be applied. 
=== Catheter ===
A catheter is a tube hewn from rubber that can be inserted into a patient’s chest cavity to drain blood, air, or other fluid buildup. A catheter is typically tipped with a sharpened steel needle to aid insertion. This surgical intervention is used to treat a collapsed lung, lung infection, fluid buildup in the chest cavity, or other breathing difficulties. In chest injury treatment, it is typically inserted alongside the ribs. Once satisfactory fluid drainage is complete, the catheter should be removed and the insertion point carefully sutured closed.
=== Exploratory Surgery ===
Sometimes a patient’s chest wounds are not easily diagnosable and must be investigated with exploratory surgery. Such surgery should be as directed and informed as possible in order to reduce the number of incisions and probes into the patient’s tissue. If the patient is awake and conscious, they should be able to identify where they experienced blunt impacts that would cause trauma to the ribs or lungs. If the patient is not able to identify such, then the one performing the surgery should look for sites of swelling or discoloration of the flesh.
In the case of an open wound to the torso or stomach, exploratory surgery may be performed to determine if organs are ruptured and if they may be stitched closed. Remember that further laceration caused by exploratory surgery will result in more blood loss and imbalance of the patient’s humours. Exploratory surgery should only be performed if bleeding cannot be stanched by traditional means. As with any laceration of incision wound, any exploratory surgery incisions should be cleaned, closed, and dressed in order to avoid infection.
=== Rib Fixation ===
Rib fixation is the act of securing segments of broken ribs in their natural orientation with steel plates and screws so that the bones might heal in proper alignment. After exploratory surgery to reveal the ribs at the fracture, the broken ribs should be reset to their natural orientation. A steel plate should be placed parallel to the rib itself and screwed into the bone on either side of the fracture. The incisions made to reveal the ribs should be cleaned, closed, and dressed to avoid infection. Once the bone sets, the steel plates and screws may be extracted with a secondary surgery if the patient desires.
Category:Medical Handbook