The Shielded Mind

In anticipation of the upcoming Children’s Week, The Shielded Mind Health and Wellness Clinic cordially invites you to its annual toy drive!  Finger foods and non-alcoholic beverages will be provided at the cost of one donation per person:  Toys, necessities, and monetary contributions are all welcomed, everything collected will be given to the orphanage.  

WHEN: Saturday, May 3rd 2025 6pm WrA/Pacific Time (8pm MG/Central Time) WHERE: The Shielded Mind Health & Wellness Clinic Silvermoon City, Walk of Elders (Velanni’s Arcane Goods) WYRMREST ACCORD

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Sample spread of what foods and drinks will be available!

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I’ve gotten a lot of variations of this ask.

Does the bullet stay in? Does it get taken out? What are the consequences? What are the after effects?

“Lead poisoning” is a common ER and EMS term for someone getting shot. “What happened?” “Lead poisoning.” is a conversation between a medic and a nurse that would make 100% sense, even though the character is bleeding out on the stretcher.

But does leaving a bullet in lead to lead poisoning? As in, actual elevated levels of lead in the blood?

It depends!

First, the myth that the bullet must come out! is a Hollywood trope, based off of Civil War medicine. So let’s look at where that comes from.

The idea that the bullet has to come out typically comes from a mindset that the bullet is, by itself, inherently dangerous. And back in the Civil War, that was true, not because of the bullet but because of the wadding that stuffed the bullet into the musket.

See, it was infection, not lead poisoning, that made those gunshot wounds more dangerous, because the wadding was typically covered in bacteria – and injected directly into a wound. Removing the bullet would also allow the physic to remove the piece of cotton, and remove the source of the infection. (In the modern day we would call this source control.)

But these days, our typical GSW patient doesn’t have a wadded-up piece of cotton in the wound, and if they do, it’s something pulled in behind the bullet. It’s superficial, and easily picked out with tweezers forceps. So the infective risk of leaving bullets in place is actually pretty low.

In fact, in the modern era, doctors actually tend to leave a lot of bullets in place.

The typical process looks like this:

The character gets shot (owies!) and goes to the hospital.

The doctors (read: trauma team) will examine the wound and get x-rays (NOT an MRI!)

The wound itself will be explored. If the docs happen to find the bullet along the way, they’ll remove it, but removal isn’t the goal, it’s finding other things that might have been in the wound and evaluating the underlying tissue.

If the bullet is in a location that’s risky to perform surgery to get to, such as the chest or the abdomen, the bullet will likely actually get left in place. The theory is that the risk of surgery outweighs the risk of leaving the bullet in place.

Similarly, if the bullet is in an extremity where surgery would be easy, but the bullet is close to a nerve or significant piece of vasculature, the bullet is likely going to be left in.

Really, removing the bullet is a matter of convenience, not of necessity.

But what about lead poisoning?

Ahhh, yes, lead poisoning. Where we started. Where we’ll finish.

Lead poisoning is surprisingly rare with gunshot wounds, even if the bullet is left in place.

The reason is this: the tissue will actually grow a capsule around the bullet and prevent the lead from leeching out into the bloodstream.

The only significant risk is if the bullet is lodged in the bone, and even then, it can take years for symptoms of lead poisoning to develop.

And if that DOES happen? Here’s the symptom list:

●Abdominal pain (“lead colic”) ●Constipation. ●Joint pains. ●Muscle aches. ●Headache. ●Anorexia. (Decreased appetite) ●Decreased libido. ●Difficulty concentrating and deficits in short-term memory. ●Irritability. ●Excessive fatigue. ●Sleep disturbance. ●Confusion, seizures, and encephalopathy (brain swelling) can be seen with extremely high levels of lead. ●Anemia. ●A “lead line,” a bluish pigmentation seen at the gum-tooth line, is the result of a reaction of lead with dental plaque.

And that’s all she wrote!

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August, a year and a half ago

The first two children kept it a secret. Each had separately been exploring the playground and the forest edge outside the orphanage and had discovered secret treasures hiding the the burls of trees or perched in the leaves of a bush. The third child couldn’t resist the adventure of it and told her friends to keep an eye out. Children laughed and played and climbed on things as they always had.

And little glass animals began popping up in bedside trunks and personal trinket boxes and the places children kept their secret treasures.

By late July, most of the older kids knew to look, but finding one was still a rare treat. A red dragonhawk dangling from a ribbon on a tree branch. A fox curled in a ball for a nap resting in a little niche at the base of an oak. A purple dragon sparkling a handspan from the shore of a tiny, shallow lake they sometimes splashed in during the hot summer months. The glass animals were an open secret among the more adventurous children, though none of them were ever found in any place the children weren’t allowed to go. They never had a note or a signature, and no one saw who left them.

———-

At the toy drive hosted by the Shielded Mind clinic, more of the little animals were donated. Every one of them is tempered glass - harder to break than average glass - but they probably should be given to children ten and up.

Naivaria checked around her studio to see if anything she’d intended to donate was still lying about. She didn’t see anything on the first pass, but when she picked up the gigantic red sack filled with home-made stuffies, she noticed a little white bunny with a green scarf on the floor below it  and settled the sack on the floor beside it. Picking it up, she smiled. “No need to stay, little guy! You’ll be going to a good home soon, I promise.” Tucking the stuffie in with the others, she tied off the sack and made ready to leave for the toy drive. She felt like Greatfather Winter today!

So, pretty frequently writers screw up when they write about injuries. People are clonked over the head, pass out for hours, and wake up with just a headache… Eragon breaks his wrist and it’s just fine within days… Wounds heal with nary a scar, ever…

I’m aiming to fix that.

Here are over 100 links covering just about every facet of traumatic injuries (physical, psychological, long-term), focusing mainly on burns, concussions, fractures, and lacerations. Now you can beat up your characters properly!

General resources

WebMD

Mayo Clinic first aid

Mayo Clinic diseases

First Aid

PubMed: The source for biomedical literature

Diagrams: Veins (towards heart), arteries (away from heart) bones, nervous system, brain

  Burns

General overview: Includes degrees

Burn severity: Including how to estimate body area affected

Burn treatment: 1st, 2nd, and 3rd degrees

Smoke inhalation

Smoke inhalation treatment

Chemical burns

Hot tar burns

Sunburns

  Incisions and Lacerations

Essentials of skin laceration repair (including stitching techniques)

When to stitch (Journal article—Doctors apparently usually go by experience on this)

More about when to stitch (Simple guide for moms)

Basic wound treatment

Incision vs. laceration: Most of the time (including in medical literature) they’re used synonymously, but eh.

Types of lacerations: Page has links to some particularly graphic images—beware!

How to stop bleeding: 1, 2, 3

Puncture wounds: Including a bit about what sort of wounds are most likely to become infected

More about puncture wounds

Wound assessment: A huge amount of information, including what the color of the flesh indicates, different kinds of things that ooze from a wound, and so much more.

Home treatment of gunshot wound, also basics More about gunshot wounds, including medical procedures

Tourniquet use: Controversy around it, latest research

Location pain chart: Originally intended for tattoo pain, but pretty accurate for cuts

General note: Deeper=more serious. Elevate wounded limb so that gravity draws blood towards heart. Scalp wounds also bleed a lot but tend to be superficial. If it’s dirty, risk infection. If it hits the digestive system and you don’t die immediately, infection’ll probably kill you. Don’t forget the possibility of tetanus! If a wound is positioned such that movement would cause the wound to gape open (i.e. horizontally across the knee) it’s harder to keep it closed and may take longer for it to heal.

  Broken bones

Types of fractures

Setting a broken bone when no doctor is available

Healing time of common fractures

Broken wrists

Broken ankles/feet

Fractured vertebrae: Neck (1, 2), back

Types of casts

Splints

Fracture complications

Broken noses

Broken digits: Fingers and toes

General notes: If it’s a compound fracture (bone poking through) good luck fixing it on your own. If the bone is in multiple pieces, surgery is necessary to fix it—probably can’t reduce (“set”) it from the outside. Older people heal more slowly. It’s possible for bones to “heal” crooked and cause long-term problems and joint pain. Consider damage to nearby nerves, muscle, and blood vessels.

  Concussions

General overview

Types of concussions 1, 2

Concussion complications

Mild Brain Injuries: The next step up from most severe type of concussion, Grade 3

Post-concussion syndrome

Second impact syndrome: When a second blow delivered before recovering from the initial concussion has catastrophic effects. Apparently rare.

Recovering from a concussion

Symptoms: Scroll about halfway down the page for the most severe symptoms

Whiplash

General notes: If you pass out, even for a few seconds, it’s serious. If you have multiple concussions over a lifetime, they will be progressively more serious. Symptoms can linger for a long time.

Character reaction:

Shock (general)

Physical shock: 1, 2

Fight-or-flight response: 1, 2

Long-term emotional trauma: 1 (Includes symptoms), 2

First aid for emotional trauma

  Treatment (drugs)

WebMD painkiller guide

  Treatment (herbs)

1, 2, 3, 4

  Miscellany

Snake bites: No, you don’t suck the venom out or apply tourniquettes

Frostbite

Frostbite treatment

Severe frostbite treatment

When frostbite sets in: A handy chart for how long your characters have outside at various temperatures and wind speeds before they get frostbitten

First aid myths: 1, 2, 3, 4, 5 Includes the ones about buttering burns and putting snow on frostbite.

Poisons: Why inducing vomiting is a bad idea

Poisonous plants

Dislocations: Symptoms 1, 2; treatment. General notes: Repeated dislocations of same joint may lead to permanent tissue damage and may cause or be symptomatic of weakened ligaments. Docs recommend against trying to reduce (put back) dislocated joint on your own, though information about how to do it is easily found online.

Muscular strains

Joint sprain

Resuscitation after near-drowning: 1, 2

Current CPR practices: We don’t do mouth-to-mouth anymore.

The DSM IV, for all your mental illness needs.

  Electrical shock

Human response to electrical shock: Includes handy-dandy voltage chart

Length of contact needed at different voltages to cause injury

Evaluation protocol for electric shock injury

Neurological complications

Electrical and lightning injury

Cardiac complications

Delayed effects and a good general summary

Acquired savant syndrome: Brain injuries (including a lightning strike) triggering development of amazing artistic and other abilities