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First, let’s talk about the shape, or hub, of needles. It’s important to know that with these, it’s just the shape, and not actually the needle.

Butterfly

This is a butterfly hub. This is just one version, sometimes the wings have extra stuff on it and sometimes they don’t. These provide more stability when we tape the needle down, so it’s good for more fragile veins like with younger and older people.

Straight

I personally prefer a straight needle hub, since it’s much easier to insert and see flash (blood inside the hub that knows we hit the vein). They aren’t as stable as a butterfly, but they’re a lot easier to use.

And now, the actual needle itself

Once again, there are so many different types. The most common ones we see are catheter needles and stainless steel needles.

Catheter

These are usually used for administering medications, not drawing blood. As you can see in the picture, there’s a little plastic straw thingy. That straw sits over the needle and is inserted into the vein, and then the needle retracts while the straw stays in. So you don’t have a needle sitting in your arm.

Stainless Steel Needle

This baby is used for blood draws and plasma stuff. This is where there is no catheter and it’s just the needle, so when it’s inserted you’re sitting with the actual needle in your arm.

And now, needle sizes

We call these gauges, and it’s sort of weird. The smaller the number, the bigger the needle and vice versa. They’re also color coded!!! Feel free to look up a little chart, but one of the smallest needle size is a 27 and and one of the biggest is a 14, which I’d say is maybe slightly bigger than a capri sun straw. The ones used in EMS most often are a 20 gauge and an 18 gauge needle.

Honorable mentions

Intramuscular needle. Think epi pens and flu shots. These are thin and short, straight and stainless steel.

Intraosseous needle. These get drilled into bones. They’re usually short and thick, straight and stainless steel

Needle decompression needles. These are the needles that you poke into people’s ribs to release unwanted air. These are long and thick. I hate when movies show them using a straw.

I'm first gonna go over what would be happening in the body, just so we're all on the same page, then answer your bullet points.

OH NO YOU GOT SHOT!!!! Guess what? The lungs aren't as hollow as you think. There are structures within the lungs that are also being affected (side note the actual lung itself is like a sponge, it's always super cool to hold them). Inside the lungs you also have the main bronchi stems, the bronchioles, and the alveoli. All incredibly important in the breathing process (specifically the alveoli as that is the vessel where oxygen is transferred onto our blood cells). Keep that in mind.

Additionally, when we're talking about a collapsed lung, we are usually referring to some sort of pneumothorax. This one would specifically be called, since blood from the bullet wound is involved, a hemopneumothorax, which broken down means "blood, air, lung". I've talked about it before, but to refresh the lung has an outer lining surrounding it. With a bullet wound, both air and blood would be filling in between the lung and that outer lining, causing the lining to fill and pressure the lung into "shrinking".

Alright, I think that's pretty good there so on to the bullet points.

If quickly and effectively triaged in the field, how long would someone have before needing proper care?

Just to clarify for other people, triage for me and triage for people who work in hospitals looks a bit different. My version of triage is quickly going from person to person, checking their ABCs (airway, breathing, circulation) and getting them stable enough and to the hospital as fast as possible. Their triaging has more in depth care. For this guy? I'd say 30 minutes at most before he needs care. He quite literally cannot breath, and shot to the lungs are very fatal. 30 minutes AT MOST. Maybe more like 20 minutes.

Would surgery always be needed?

Yes. Like any gunshot wound, you need stitches. The same goes for the lungs, especially with the lung being collapsed and there being "shrinkage" and all the structures inside of the lungs. These lungs need to be drained of air and blood. In the field as we are going to the hospital, I would do something called a needle decompression with this patient to get that draining process started. Needle decompression, in short, is where we stick a HUGE needle in between their ribs to drain out blood and fluid. That crap they do on TV with straws? NEVER do that.

What are some potential complications during surgery/treatment?

Now from here on, this is the stuff that I don't know a whole lot about, since I am an advanced EMT and not a surgeon or nurse, so be careful here.

Some complications in the field are that we miss the needle decompression, or the patient dies. In the surgery, one big one is also that the patient dies. An educated guess I have is that they will put this patient on some sort of ventilator to aid in breathing while they operate. Their main focus is gonna be closing any leaks and draining the blood and air out of that pleural space so that the lung can then inflate itself. Infection is also a HUGE one. There's probably more specific things, but like I said that is not my field of medicine.

What would be an estimated recovery time?

That one I cannot tell you, it all depends on the patient, as well as how fast they were able to get treatment. I'd say maybe a year to heal as much as they can? They'll always have problems with their lungs after this, though.

Long term/permenant issues and side effects?

I'm gonna combine this one since it's sort of the same. Like I said before, I am not a nurse and only deal with emergencies, not so much long term stuff. One thing that I can think of is that they might need some sort of long term oxygen? They might not breath all that well, and their lungs will definitely be weaker. Weaker lungs, especially in the area of that bullet wound, make them at risk for a tension pneumothorax, which is the collapse of a lung due to weak lung tissue. That's about all i can give with out questioning myself on that, lol.

But oh my there are SO many things that could lead up to someone passing out. Like, so many I probably can't even name or think of them all. I'll talk in depth about some of the more common ones, then just make a list of any other ones I can think of lol.

Passing out can happen on levels as well. Some people pass out cold, and others go in and out of consiousness.

HYPOTENSION

This one is the one I deal with the most were I currently work. Hypotension means low blood pressure, and low blood pressure is what happens anyways when you're dying. ANYWAYS, the perfect blood pressure someone can have is 120/80 mmHg, but healthy ranges vary for everyone. I don't wanna see a blood pressure any lower than 90/60, though. It means that you don't have enough blood flow throughout your body. With this people will usually feel faint, lightheaded, dizzy, like they're seeing stars, nausea, some vomit, and they're very hot and sweaty and weak.

HYPOVOLEMIA

This can LEAD to hypotension, which leads to passing out. Basically, this means that you're losing fluids. Fluids can mean blood, sweat, tears, urine, diarrhea, plasma, and such. This will feel similar to the hypotension depending on the situation and cause.

SHOCK

Blah blah hypovolemia is a type of shock whatever. Any type of shock will lead to hypotension, which leads to people passing out. How it feels depends on the shock. Like septic shock is due to infection, so that's gonna feel different than bleeding out.

SYNCOPE

Syncope literally means fainting, but I didn't wanna put down psychogenic shock for this because the origins of it are iffy. So, syncope is my placeholder for the type of fainting you see in the movies. Shock factor, being scared or surprised and stuff like that. This kind of fainting is usually because of shocks to the system, and your body freaks out and you faint. Expect hot flashes and dizziness and "seeing stars".

TRAUMA

This is gonna be any sort of head trauma. Depending on how hard the hit is or where, the passing out part could be prolonged, or could happen instantly. Dizziness, memory problems, unable to focus or be coherent, "seeing stars".

OTHER CAUSES

Heat exhaustion Heat Stroke Seizures Iron deficiency Orthostatic hypotension Citrate Reactions And a billion medical conditions can cause it

Something important to note is that everyone reacts to things differently. I can see blood and be perfectly fine, and someone else can see it and pass out or throw up. I can handle a blood draw and a needle, someone else who's body isn't used to it can freak out and have a major reaction.