Sunday, August 19, 2007

Writing and describing injuries and miscellaneous vampire lore

Depending on the fictional situation, there will be fights, battles, etc… and wounds to your hero, heroines and secondary characters in addition to any alien romance. Here’s a basic listing of the possible injuries and results.



Scalp wounds bleed copiously, making it a major source of hemorrhage and shock. They may also be incidental to damage to the skull.


Skull fractures in different places have rather different effects, but for these purposes, symptoms include one or more of the following; a mixture of blood and cerebrospinal fluid leaking from the ears, nose, or throat, blood in the whites of the eyes, loss of the sense of smell, loss of vision in one eye, a dilated, fixed pupil, a worsening in the patients level of consciousness.

These last symptoms are indicative of pressure on the brain, caused either by swelling of the brain or bleeding into the skull. Swelling of the brain can cause serious damage or possibly death on its own, but has the advantage that its self-limiting (and in a modern setting, usually controllable with drugs). On the other hand, hemorrhage will almost always lead to continued degradation and death if left untreated.

The patient may have a headache localized at the injury. He may be lucid for a period after the injury, but this will rarely be a period of normalcy. He will usually feel drowsy, and may thereafter slip into a coma. The patient will lose one set of reflexes after another. He may gradually lose the use of one of his arms or legs, or become completely paralyzed on one side of the body. This will happen gradually as pressure increases starting with a slurring of speech and clumsiness. His breathing may become uneven, and some part or all of his body may begin shaking uncontrollably (seizure activity.)

The time course for these degradations can be hours or days and the condition can worsen dramatically in minutes.


A broken jaw is associated with numbness, bleeding from tooth sockets, fractured or missing teeth, inability to close the jaw properly (teeth don't come together right), pain on moving the jaw, and sometimes with bleeding from the ear. Fractures of the jaw also allow the tongue and other soft tissues to intrude into the airway, leading to suffocation.


All sort of bones can be broken in the face: the face plate, sinuses, cheekbones, the orbits of the eye, and of course, the nose. There are a wide variety of possible symptoms, but severe facial injury usually results in progressive swelling, resulting in difficulty breathing, inhalation of blood, frequently eventually (~1 hour) completely closing off the airways, resulting in suffocation. There may also be numbness or paralysis in some part of the face. Facial injuries can also lead to extreme hemorrhage and shock.

Neck Injuries

As you may imagine, there are a lot of important things passing through the neck, including the spinal cord, larynx and trachea, phrenic nerve, brachial plexus, carotid artery, jugular vein, cranial nerves, oesophagus and pharynx, thyroid gland, and stellate ganglion. Of course, many of these may be damaged simultaneously. Possible symptoms for damage to each of these are listed below. Not all will necessarily be present.

Spinal cord: paralysis, partial paralysis (no surprise !)

Larynx and trachea (you breathe through your trachea): spitting blood, a sucking neck wound (see chest wounds), hoarseness, difficulty breathing, high-pitched, noisy respiration (stridor).

Brachial Plexus: numbness and/or partial paralysis in an arm.

Carotid artery: decreased level of consciousness, heavy bleeding (which may compress the trachea, causing difficulty breathing), and hypovolemic shock.

Jugular vein: heavy bleeding, hypovolemic shock.

Cranial nerves: inability to shrug a shoulder or rotate chin to opposite shoulder, paralysis of the tongue, hoarseness, and difficulty in swallowing.

Oesophagus and pharynx (connects to your stomach): difficulty swallowing, bloody saliva, sucking neck wound.

Stellate ganglion: dilated pupil.

Thyroid gland, phrenic nerve: no special short-term effects.

Also, damage to the muscles in the neck will mean that the patient is unable to hold his head upright.

CHEST (Thoracic) Injuries

Trauma that is inflicted on the chest can result in damage to the chest wall, lungs, trachea, major bronchi, esophagus, thoracic duct, heart, diaphragm, mediastinal vessels, and spinal cord. Any combination of these injuries may occur.


A person inhales by moving a muscle called the diaphragm, creating a vacuum in the chest, which pulls air in through the mouth down into the lungs. However, if there is a hole in the chest wall, air can enter through that hole instead, preventing air from entering the lungs. The patient will feel short of breath, air will visibly be being sucked in through the hole in the chest wall. The resulting low oxygen will usually result in unconsciousness in fifteen minutes to an hour, but is unlikely to be fatal on a short time scale.


Sometimes, a hole in the chest wall acts as a one-way valve, letting air in, but not out again. Sometimes, the lung is punctured without the chest wall being punctured (from a broken rib, for instance). Alternatively, if a wound that punctured both the chest wall and the lung is treated with a tight compress, air will still escape from the lung but not from the chest cavity.

In these cases, the increasing air pressure in the chest cavity will cause hyperinflation of the chest, preventing the patient from breathing. The patient will have rapid, shallow breathing. He will fall unconscious from low oxygen in fifteen minutes or so, and will probably suffocate if left untreated.


Is a similar problem, but in this case it results from blood filling up the chest cavity. The patient will probably be suffering from shock, as well as suffocation. This will usually result from multiple rib fractures damaging internal tissues. Frequently seen together with tension pneumothorax (in which case it's a hemopneumothorax).


The main symptom of rib fractures is that it hurts to breathe, which will make exertion difficult. The amount it hurts depends on how many ribs are broken (a broken sternum is especially painful). Beyond this, unless the patient has flail chest, hemothorax, the ribs have damaged the lung, or the ribs are displaced to such an extent that their motion damages surrounding tissue, the ribs will probably be held in place by the surrounding muscle, and are largely ignorable.


Yet another way to suffocate: the ribs or the sternum are broken in such a way that breathing moves air from one part of the lungs to another, rather than in and out. This will usually result in unconsciousness from low oxygen in fifteen minutes to an hour, but not death.


Until it's splinted, pain in moving at all, inability to use the arm effectively, pain in attempting to use the arm. Can't really be fatal.


Lacerations of the lungs may cause pneumothorax, as above, as well as bleeding into the lungs. Contusions (blunt damage) will cause swelling of interstitial tissues and bleeding into the small airways. In either case, the patient will have difficulty breathing and will probably be coughing blood or exhaling blood. If this is severe enough, low oxygen may lead to unconsciousness and death.


Damage to the heart may result in massive blood loss, heart failure, and death in short order. However, less severe injuries can result in bleeding into the pericardial sack (tamponade). When this fills up with blood, it will put pressure on the heart, making it more difficult to beat, lowering blood pressure. The patient will initially feel very tired, leading to increasing stages of shock shortly.


With modern medical care, 85% of patients with multiple aortic ruptures will die at the scene, 20% of the survivors die within six hours, and 72% of the remainder will die within a week. This is, then, another good way of bleeding out in minutes. Massive hemothorax and loss of blood pressure are the most common symptoms for penetrating injury. However, for blunt injury initial manifestations are pain behind the sternum or between the shoulder blades, difficulty in swallowing, hoarseness, and difficulty breathing, leading to a left hemothorax and increasing levels of shock.


A penetrating chest wound at or below the level of the nipple is likely to enter the chest, pierce the diaphragm, and enter the abdominal cavity. Since the diaphragm is the muscle you use to breathe, injury to the diaphragm results in respiratory distress, often associated with hemothorax, pneumothorax, and shock.

Abdominal and Pelvic Injuries

The principal immediate danger resulting from abdominal and pelvic trauma is profound hemodynamic instability resulting from injury to the spleen, pancreas, liver, kidney, or tributaries of the aorta. Most abdominal injuries result in poorly localised and nonspecific pain, nausea and reflex vomiting. In general, blunt injuries to the abdomen are more dangerous than penetrating injuries.


Abdominal pain and peritonitis. Peritonitis is an inflammation of the tissue that lines the abdominal cavity. Starting a day or so after the injury, it will lead to severe abdominal pain and distention, fever, vomiting, thirst, and, if left untreated, death in a week or two. It is easily treatable. Injury to the duodenum leads to more severe symptoms (severe abdominal tenderness in the upper right quadrant, sever vomiting), rise of fever within hours, and may have hemodynamic instability with time.

Note that evisceration isn't automatically fatal, in the absence of major hemorrhage, especially if the intestines aren't otherwise damaged, but that with poor medical care, sepsis will probably be a killer.


Abdominal pain in the upper left (spleen) or upper right (liver) quadrant, severe hemorrhage rapidly leading to increasing shock and death. The mortality rate without intervention is near 100% for splenic injuries, and almost as high for blunt injuries of the liver.

Sepsis (inflammation or infection) is a major postoperative complication for liver injuries. Splenic rupture can also occur up to two weeks after the initial injury, as an initial clot dissolves, or the splenic capsule ruptures under pressure of an initially small hemorrhage.


Abdominal pain, back or flank pain, inability to void or blood in the urine. Some kidney injuries will result in massive hemorrhage, but others will not. In the long term, damage to the kidney may lead to renal failure (this can also be caused by shock and sepsis.) The course of renal failure can last weeks to months. This is fatal more than 50% of the time.


Damage to the stomach muscles will make it difficult or impossible to stand; just think of all the things it's hard to do after you've done too many sit-ups.


Injury to major blood vessels in the abdomen may cut off the blood supply for the legs, making it impossible to stand in very short order. Depending upon where they're damaged, they make drain into the upper legs, causing extreme swelling.


Besides making it impossible to stand, it is likely to cut one of the major blood vessels leading into the legs. Pelvis fractures are commonly associated with massive hemorrhage.


The nature of damage to extremities (arms and legs) is fairly intuitive. Generally, minor damage will make the extremity painful or difficult to use; major damage will make it impossible to use. Major blood vessels may be damaged, leading to heavy hemorrhage. Joints can be dislocated, bones broken, muscles and tendons cut. Note that damage to the scapula (shoulder blades) or clavicles will make the arm nigh-on unusable.


Fever, shock, decreasing mental status, can easily lead to death if untreated. A common problem, especially with poor medical care, in the days and weeks after injury.


To recap - what makes you fall unconscious is either direct injury to the brain, or inability to feed it enough blood or oxygen. If you lose all blood supply to the brain, you fall unconscious in seconds. Massive hemorrhage can lead blood pressure to drop fast enough that unconsciousness follows in seconds to minutes. If you lose oxygen supply, you fall unconscious in ~4-30 minutes, depending upon how restricted your air supply is. Poisoning - as from sepsis - can also cause unconsciousness.

Putting it all Together

Probably the easiest way to use this guide to traumatic injury is to use the damage system for your game, and if you want a graphic description look up an injury of the appropriate severity to the appropriate body part.

Note that there are major blood vessels just about anywhere, so if you want blood loss, you can feel free to add it in.

The trick to making it seem especially nasty is not to read the whole laundry list of symptoms at once. Give them a few at a time, so that they have a chance to sink in. Remember to add in the effects of sepsis, and of torn muscles and broken bones.

If they have to continue operating while septic, make sure to make them feel it - weakness, fever, chills, reflex vomiting, trembling hands, occasional unconsciousness.

"And they all died horribly. The End.

Time frame for Death after vampire bite

An initial peak of mortality occurs within minutes of hemorrhage due to immediate exsanguination.

The average 70 kg (154 lbs) male has approximately 5000 ml (5.3 quarts) of circulating blood.

Severe external hemorrhage is associated with the following symptoms: rapid pulse; dizziness or faintness; collapse; a drop in blood pressure; a rise in pulse rate; and pale, cold, clammy, or sweaty skin.

Certainly, the severing of a common carotid artery will immediately terminate a large portion of the blood supply to the brain. Nevertheless, the victim of such a wound may remain conscious for from fifteen to as many as thirty seconds.

The largest portion of your blood volume at rest, about 64%, is in systemic veins and venules. Systemic arteries and arterioles hold about 13% of the blood volume, systemic capillaries hold about 7%, pulmonary blood vessels hold about 9% and the heart holds about 7%.

Because systemic veins and venules contain a large percentage of the blood volume, they function as blood reservoirs from which blood can be diverted quickly if the need arises. In cases of hemorrhage, when blood volume and pressure decrease, veno-constriction helps counteract the drop in blood pressure. Among the principal blood reservoirs are the veins of the abdominal organs (especially the liver and spleen) and the veins of the skin.

Signs & symptoms of shock.

Systolic blood pressure is lower than 90mmHg
Resting heart rate is rapid due to sympathetic stimulation and increased blood levels of epinephrine and norepinphrine.
Pulse is weak and rapid due to reduced cardiac output and fast heart rate
Skin is cool, pale, and clammy due to sympathetic constriction of skin blood vessels and sympathetic stimulation of sweating
Mental state is altered due to reduced oxygen supply to the brain.
Urine formation is reduced due to increased levels of aldosterone and anti-diuretic hormone (ADH)
The person is thirsty due to loss of extra-cellular fluid
The pH of the blood is low (acidosis) due to buildup of lactic acid
The person may have nausea due to impaired blood flow to the digestive organs after sympathetic vasoconstriction.


The patient will be pale, have rapid, shallow breathing and a high heart rate, will sweat, and will feel quite weak. He will be thirsty, his extremities will be cool, and his senses will start to cloud. Even the most stout of heroes will start to feel a rising panic, from purely physiologic hormonal reactions.


Platelet aggregation in the lungs will lead to respiratory failure. Failure of cellular processes will lead to sequential systems failure, frequently starting with the heart and kidney. Basically, you stop breathing, your heart stops, everything else fails, and you die. This can take anywhere from hours to days after the initial injury.

There’s a possible SF story from the following articles. Remember when Frankenstein was a horror story? Now we have organ transplants, reattachment of limbs and electro-shock to restart stopped hearts.

Dogs reanimated after death by removing all of their blood, replacing blood with ice-cold saline solution. A few hours later, saline solution removed, fresh blood supplied and dogs revived.

Scientists Develop Substance to Stop Heavy Bleeding

Fangs: Retractable or not???

Retractable fangs would work physiologically while having a set that drops down behind the first creates a poor feeding design. Unless the fang that dropped down had a notched design so that rear tooth clicked into place with the front tooth forming a single unit.

As for where the teeth would retract into Vampires could have a hollow pocket in the upper mandible where the fangs could sit when not in use. No need to tuck them into the gunk found in the sinus cavity - eeew.

Another option would be rather then a second set of teeth you could have them replace the incisors or canines depending upon which teeth you have them bite with. The majority of the tooth could sit in the pocket and come down when needed. A series of tiny ligaments that hold the tooth in place would work as the mechanism of action. When relaxed the tooth would drop. When tensed they would pull them up and out of sight (just an fyi muscles pull not push - picky I know but its one of those anatomy thing people pick up).

Since vampires are their own species (either a sub of humanity or completely separate depending on your lore their physiology would have evolved/designed/been tailored for their survival. So think human bone structure with a twist.

Here is a link to a close up of the sinus cavities.

The maxillary sinus is the one behind the nose. Notice the pad of tissue below it and then the bone underneath. Under the bone is the hard palate, which flows into the soft palate. The small white shape on the lower right is a tooth. In front of the tooth is the gum line and lips.

The neat thing is as long as your design works you could have their fangs do what you want just create a space for them within the upper mandible and your good to go. A long time vamp wouldn't even notice the changes but a newbie would especially if the pocket holding the fangs protruded from the hard pallet. They'd be running their tongue over the spots all the time.

Then again you could always go with magic and screw the physiological aspects.

At the following link, where they show the surgical process of inserting an IV line down the jugular vein for chemo and other medical procedures, they say the right internal jugular vein is usually chosen for this procedure because since the right lung is lower than the left and this route does not endanger the thoracic duct.

Here’s a link to the Gray’s Anatomy Image showing the locations of the neck veins and arteries.

Most vampire movies shows the bite on the left side of the neck where the left common carotid artery is located. I believe the assumption there is that the vampire saliva secretes a substance that prevents blood clotting and increases bleeding because this is what happens with the saliva from a vampire bat.
Here’s a news article about how the substance in the vampire bat’s saliva may bring new treatment for strokes

Preferred Method of Killing a Vampire.

#1. Albania = Stake through heart

#2. Bulgaria = Chain to grave with wild roses

#3. Macedonia = Pour boiling oil on, drive nail through navel

#4. Prussia = Put poppy seeds in grave. (With all due respect, putting seeds in the grave, it doesn’t have to be poppy seeds, just something unfeasibly numerous and un-countable, wasn't to kill a vamp, simply to keep him occupied counting 'til the end of days. You ever wonder why they had the counting Count on Sesame Street? Old folklore.)

#5. Rumania = Remove heart, cut in two; garlic in mouth, nail in head

#6. Saxony = Lemon in mouth

Thank you for reading my blog topic.

Barbara K.


  1. Excellent information! The data on blood loss effects is, of course, of special interest for vampire authors. Even with supernatural vampires, I believe their physical traits should make sense, e.g, how the fangs work. After all, they're physical beings, not ghosts. And of course this kind of thing is essential if someone is creating a natural vampire (like Suzy McKee Charnas, Jacqueline Lichtenberg, Elaine Bergstrom, Octavia Butler et al -- and me). I wish people who write movie and TV scripts could have that "5.3 quarts" blood volume hammered into their heads, and Anne Rice could have used that treatment, too. It drives me crazy to see vampires "drain a victim of blood" in one feeding, esp. if it's portrayed as taking only a couple of minutes. Unless the explanation actually is a hand-waving fall-back on "magic," no physical creature of human size could ingest that much liquid at once.

  2. I would think that most of the blood would be wasted and dumped on the ground.

    Thanks Margeret for posting your comment. This way I know at least one person is reading my blog entries. LOL.

  3. If the blood is "wasted," fine, but the sloppy-thinking books and movies always say something like, "Horrifying, spooky mystery! The body was completely drained of blood, but there was no blood found at the scene." Yet these kinds of writers / scriptwriters never follow up on the implication that a corporeal, man-size creature must have somehow ingested all that liquid at once.

  4. I'm not necessarily working on anything with vampires, but I like your physiological view on the body and its limitations.

    This is also the most comprehensive list of body injuries and their effects that I found, thank you so much for posting this!

  5. Came here looking for the symptoms my character should exhibit after being bitten by a vampire, and found all kinds of useful information! Awesome!