#blast trauma

Hey nonny! Awesome question!

Blasts cause 4 types of injuries:

Primary Blast Injury: this is the pressure wave that radiates out from the exclusives. Eardrum rupture, eye injury, and lung injury can happen here due to the massive pressure differential. Long term, some hearing damage would absolutely be believable.

Secondary Blast Injury: this is direct injury from shrapnel and heat. Puncture wounds, limbs blown off, etc.

Tertiary Blast Injury: this is when your character gets thrown by the blast. What they get thrown into is up to you -- walls, tables, etc. This is primarily a blunt injury mechanic, so this would most be fractures and head injury.

Quaternary Blast Injury: this is when the structure your character is in falls on your character. This could also be the fire the blast sets off.

Your character could suffer injury from only one or two parts of these subsets, or up to all four. I would believe scars, prosthetics, TBI with brain damage, or more.

Whatever you decide, I wish you all the best!

Hey there @studiozealot. Thanks for your ask! 

I’m going to suggest you change your story event in some way, and I’m going to tell you why. 

Even if it’s technically possible for two people to be that close to an explosion and not suffer any wounds -- it may be, but it would have to be a truly miniscule amount of bang, comparable to a “cherry bomb” firecracker -- I wouldn’t believe it as a reader. 

One thought on this: if your character is going to escape danger like that, it has to be because of something they did. We throw around words like “active protagonist” and “agency,” and this is part of what that means. They can’t be saved because the baddie didn’t include enough boom to sink a measly little gondola! Instead have them save themselves -- have one of them fling the explosive out into the canal (I’m thinking Venice!), or have them dive overboard away from the bomb. 

But if the bomb goes off and they’re in the gondola, with the bomb? Even if it’s realistic, it’s going to feel like cheating to the reader. 

Remember: coincidences that screw your hero are great. Coincidences that help your hero are gonna feel like you’re robbing the audience of a chance to see the hero be heroic. 

Best of luck with your NaNo! 

xoxo, Aunt Scripty

Oh jeeze. This could be absolutely anything.

There are four kinds of blast trauma. 

Primary blast trauma comes from the pressure wave. This includes damage to the eardrums (tympanic rupture) and lungs (blast lung). 

Secondary blast trauma is from the shrapnel from the blast. This can include a whole lot of things depending on how the explosive was designed -- if it’s a terrorism thing, often they’ll use ball bearings as projectiles specifically to increase secondary trauma. 

Tertiary blast trauma is damage the character takes from being thrown by the blast. That could include fracuters of the wrist, arm, skull, leg, etc. 

Quaternary blast trauma is what happens when the character gets hurt by the surrounding structure. So for example -- does part of the ceiling cave in and crush him? Does he trip and impale his hand on an exposed piece of rebar? etc etc 

Concussion is very probable. So is hearing loss with tinnitus. So are shrapnel injuries and broken bones and general confusion and post-traumatic stress. 

Even shrapnel can go so many different ways from a writing standpoint. They might have some building material embedded in their skin that can be pulled out with tweezers, or a significant piece of material can impale itself in a vital organ. 

My suggestion is to focus on the specific thing you want to have happen to him. Start  with how long you want him out of commission and work backwards to the injuries you need to give him to make that happen. 

Sorry I can’t be more specific. 

xoxo, Aunt Scripty

[disclaimer] 

For more info on constructing injury plots, see [Maim Your Characters: How Injuries Work in Fiction] or [the free email course]

Happy New Year and welcome back to Mangled Mondays, where every Monday we talk about another facet of maiming, mangling, mauling, and mistreating your main characters — and all of their friends. 

Today we’ll be talking about Ruptured Eardrums. For the rest of the Mangled Mondays series, [click here].

Ruptured Eardrum

Lethality Index

1

What Is It?

A ruptured eardrum is exactly what it says on the tin: an eardrum that’s burst.

The eardrum, or tympanic membrane, is a thin layer of tissue between the ear canal itself and the middle ear, where we begin to process sound.  It protects the sensitive inner ear from damage.

When it’s ruptured, the eardrum can no longer effectively transmit clear sound to the inner ear. The character may hear a significant ringing sound, and may lose some or all hearing in the ear for some time.

  Clinical Signs:

Blood or clear fluid draining from the ears.

With otoscope: visible tear or rupture of the tympanic membrane.

  Symptoms:

Severe pain before and during rupture; may be painless afterward.

Hearing loss (partial or complete).

Buzzing or ringing sound in the ear; may hear whistling when sneezing or blowing the nose after the tear.

How Does It Happen?

There are two main causes of tympanic rupture.

The first is direct trauma. This is typically inadvertent, when the character digs too deep with a Q-tip, though because we are authors and thus inherently evil, it’s also possible for this to be a deliberate attack or form of torture by a villain using anything from a Q-tip or toothpick to the tip of a thin knife or scalpel.

The second cause is pressure. Severe ear infections can build up enough pressure to rupture the membrane – this is exceedingly painful – but other forms of excess pressure can cause it too. Rapid ascent from a dive is a plausible cause; . and, especially when added to the increased pressure resulting from ear or sinus infection or congestion, so is rapid altitude change on a flight or in an elevator. Pressure injuries are known as barotrauma.

Barotrauma can also be a side effect of an explosion, where pressure builds up quickly enough to rupture the eardrum. This is known as a primary blast injury, because the injury is from the pressure wave (as opposed to the shrapnel, the character being thrown, or subsequent trauma from causes related to the explosion).

  Immediate Treatment

  Immediate care for a ruptured tympanic membrane is supportive; that is, the symptoms are cared for, but not the injury itself. If there’s dirt or debris in the ear, characters might flush it out with saline solution (salt water).

Definitive Treatment

Surgery / Hospitalization

Tympanic ruptures are typically left to heal on their own. Extreme ruptures can be repaired with a piece of paper surgically attached to the eardrum, which provides a scaffold for the eardrum to heal on. This procedure is outpatient and the character will be awake for it, but the ear will be well anesthetized.

  In the Austere Environment

There is nothing to be done. The ear will heal on its own.

The Rocky Road to Recovery

Capabilities Retained

Cognition and limb motion are unaffected. Vision is unaffected.

  Disabilities: Temporary

Characters may experience trouble with balance during healing. Hearing loss is significant but often not complete, and is temporary. Speech may be slightly uncoordinated and louder because of the character’s difficulty hearing their own speech.

  Disabilities: Permanent

Depending on the circumstances, the character may experience some permanent hearing loss.

  Features of Recovery: Hospital Stay

N/A.

  Features of Recovery: PT/OT

N/A.

The New Normal

The eardrum will heal in about 2 weeks, and the character’s hearing will be restored, either completely or partially.

  Future Risks

Your character will be at elevated risk for future tympanic rupture.

Total Recovery Time (Typical)

2 weeks

Sensory

Sights

Blood, or clear fluid similar to mucus, coming from the character’s ear(s).

  Smells

None.

  Sounds

Affected character may hear a loud bang, and may continue to hear whining, buzzing, or ringing in their ears.

The character may hear a whistling sound while blowing their nose or sneezing.

Medslang

The tympanic membrane is often referred to as the TM.

A TM rupture might also be known as a perforation or a TM perf.

Key Points

Tympanic rupture produces ringing in, and draining of blood or fluid from, from, the ears.

Characters will have partial or complete hearing loss.

Hearing should be regained as the eardrum heals, about 2 weeks, but some loss may persist indefinitely.

xoxo, Aunt Scripty

[disclaimer]

This post is an excerpt from Blood on the Page Volume One: A Writer’s Compendium of Injuries. The book details thirty-one injuries with which to maim, mangle, and maul your characters, as well as nine indispensable articles of Wound Wisdom covering everything from burn stages to suture selection.

Print and digital editions are available on [Amazon], and digital editions are available [everywhere else].

Heyhey! Welcome to the blog!! Always glad to have newreaders on board XD

So your character got blowed up. Eepness!! For those who arewondering about the secondary/tertiary/etc language, it references back to thispost, where I went over the four different phases of blast injury. I’ll give aquick recap:

Primary blast injury is secondary to the pressure wave, and includestympanic ruptures, lung damage, and damage to the hollow organs (like thebowels).

Secondary blast injury is your typical shrapnel injuries,which is the #1 point of pipe bombs.

Tertiary injuries are what happens when you get thrown bythe blast, like throwing them against walls.

Quaternary blast injuries are what happens when the bombcauses other environmental damage; this is the building falling on yourcharacters, or them catching on fire.

SO, we were talking about secondary blast injuries, whichare the actual ball bearings, nuts (like nuts and bolts) that get thrown by theblast. How bad these will be will depend on a few things, including how muchboom the bomber used, their proximity, and what (if anything) is between thebomb and the victim.

You mentioned the back and the arms, but don’t forget thelegs, ankles, and feet. The Boston Marathon Bombing produced severalamputations at various heights in the leg, because the bomb was on the ground.What height is the pipe bomb at? Consider severe damage at that height level asfragments get sprayed sideways.

As to your persistent dizziness, a garden-variety concussioncan cause prolonged dizziness, confusion, short term memory issues, or whathave you. Bomb goes off, character falls, head goes bounce. Easy peasy. Also,even without a concussion, if the explosive used is high enough in force,damage to the eardrums could cause dizziness and balance problems for some timeto come.

Best of luck with your story!!

xoxo, Aunt Scripty

disclaimer    

This is an interesting case of blast trauma. What you’re suggesting is that a piece of shrapnel severs his arm, not the actual explosion itself (secondary blast trauma instead of quaternary or tertiary).

Oooooh, I like this one! BLAST TRAUMA, BABY! boom.

Blast injuries happen in 4 stages. They are:

1) Primary blast injury. This is from the pressure waves sent out by the explosion, as it pushes against the surrounding air. This is what ruptures eardrums and, at higher pressures, causes lung damage (pulmonary contusion) and damage to hollow organs, like the bowel. The lung issues alone can put someone in the ICU.

2) Secondary blast injury. This is the effect of shrapnel getting thrown at, oh, 30,000 feet per second (depending on the explosive used). This is the “most direct” form of damage, and the one that produces the most visible wounds.

3) Tertiary blast injury. This is when the force of the explosion physically throws you. You may just land on the ground, but you might get thrown into a car, or into a concrete pillar, or or or. This is a blunt force trauma, whereas secondary blast injuries are penetrating trauma.

4) Quaternary blast injury. This is when the thing that was behind you, falls down on your head, and also the “miscellaneous” injuries associated with blasts--things like thermal burns, eye injuries, etc. Amputation from the blast itself actually falls into this category, too; those amputations require immediate tourniquets if the victim is to survive.