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Explore the art of health deduction with medically illustrated cases by Dr Ciléin Kearns

Survival medicine with Miss Croft

Survival medicine with Miss Croft

A cartoon analysis of Lara Crofts survival skills in the 2013 Tomb Raider reboot, from a medical perspective.

caretoon by Ciléin Kearns (artibiotics)
Caretoon by Cilein Kearns

Burns

In the game’s opening sequence Lara is tied upside down, several meters up, and left for dead. She decides to set herself on fire to escape her bindings; props for actually falling head-first into the adventure.. Without arms/legs free to break the fall (perhaps literally), she’s at high risk for head and neck injuries, never mind the little complication of being on fire, which is no trivial problem. Flames are unfortunately a little too ‘PC’, they do not discriminate; clothes, flesh and hair all burn well (or badly) enough to necessitate a surgical speciality field for their management.

Classic Tomb Raider fans will be excited, then disappointed, to hear that the new Lara Croft character may end up getting plastic surgery after this adventure (burns is a plastics sub-speciality).

Flames can be deadly while ablaze, and also after through fluid loss and infection (due to loss of the skin barrier). Even when healed, tissue loss and scarring can also be disabling/disfiguring (eg via eyelid loss and scar contractions). While visually dramatic and portrayed as ‘quick thinking’ in-game, burns are not an injury to be treated lightly, or should I say a-lightly? Whatever your taste, at least nobody can deny that Lara was smokin’ at the start of this adventure, and on this note: smoke is actually the leading cause of death due to fires; via carbon monoxide poisoning, and airway burns/irritation – so stay away from that too.

Stab wounds: take it out or leave it in?

Lara falls and is impaled by a spiked ribbed iron bar, sustaining a through and through stab wound if you want to be forensic about it. How should we approach these?

  1. “Oh [insert choice profanity]!”
  2. Is the patient stable? Are they losing blood, consciousness?
  3. How deep, and through what anatomy? Organs, blood vessels, etc
  4. Potential for further trauma. eg arrows, blades, on extraction/movement
  5. Infection risk: What contaminants might be in the wound tract (eg soil, rust)?

Lara’s wound likely perforates the bacteria filled colon, will be contaminated by the dirty spike, and may have nicked a kidney or ovary on that side. Is this is natural selection in action? I cringe thinking of how messy her mansion must be, judging from her dis-organ-isation right from the start of this adventure.. In real life (once stable), we would leave the impaling object in place to ‘plug’ the holes it has made, and bandage it there to reduce further trauma from movement. Next she needs urgent transfer to a medical facility for imaging of the anatomy involved, allowing surgeons to plan for removal, and complications.

Caretoon by Cilein Kearns

The injury serves the story well with a memorable, visceral moment players react to, but in real life if stabbed by something: DO NOT PULL IT OUT.

Let’s pretend she did all that so I can make a final point: you are not safe once it’s out. Colon leakage and the dirty wound tract could rapidly lead to overwhelming sepsis. Assuming no surgical repairs were needed: the cavity still needs irrigated; the wound sterilised, sutured, and dressed; and antibiotics +/- vaccine prophylaxis given. Respiratory arrest from tetanus would be an anti-climactic death after surviving so much badass-ery on the island..

Caretoon by Cilein Kearns

Bear traps

Like a land-mine or pâté of dog crap, you probably didn’t intend to step on it, but now that you have – what’s the plan? I had to Google a bit for this one, the only trap I’m used to opening is my mouth. Unfortunately releasing the mechanism varies by device; many require a tool you probably won’t have handy (especially if that’s the part of you caught in the trap). The crushing force can be more than enough to break bone, mash muscle, and cut off blood supply to the limb beneath. Manually prying the clamp apart risks re-closure while pulling out the limb, and struggling can worsen the damage done, especially if they have teeth. So Lara should be pretty stuck, and hurt when she steps into one of these..

Caretoon by Cilein Kearns

An old rusty trap’s spring mechanism could have lost some closing power, but I’d still treat sticking my hand in one with the apprehension of a crocodile’s dentist pulling it’s wisdom teeth. I’d not be surprised if the in-game trap broke Lara’s fibula at least (the thinner of the two lower leg bones), potentially destabilising the ankle (as one of the 3 bones comprising that joint), or/and did enough soft tissue damage to have her limp the rest of the game. However, as the eloquent scholar ‘Sweet Brown‘ once rightly said, and players would agree: “ain’t nobody got time for that”.

Animal bite wounds

Miss Croft gets her leg torn up by a big-ass wolf, and then just walks it off! I’d like to see her reaction to something more serious, like a paper cut, or the cinnamon challenge! Seriously though, it’s not mind over matter when you’re bleeding to death.  Animal bites can be nasty: teeth puncture and lacerate, and chewing/tearing action can ‘de-glove’ soft tissue like muscle right off the bone.

Caretoon by Cilein Kearns

Bites contaminate the wounds they create with oral bacteria; and you can bet most wolves don’t brush their teeth regularly. At least not the ones I’ve given dental hygiene questionnaires to. I wonder if rabies is prevalent on the island.. The drama around wolves is great though; I shat the bags (norn’ Irish for ‘was anxious’) every time I heard a howl, foliage rustling nearby, or watched Lara ignore basic post-mauling medical care.

Don’t bathe with rotting corpses

Are these survival tips feeling more obvious and #ridonk as you read? That’s the power of education. You’re welcome. Lara manages to burst open her initial stab wound, and decides to look for a first aid kit (for the first time this adventure), by wading through dirty water full of rotting corpses. It was going so well till the final third of that sentence.. A particularly silly sausage decision given that she has nothing to treat a deep seated infection with, and first aid kits do not usually include antibiotics.

Caretoon by Cilein Kearns

Next, she decides to cauterise the wound with a heated arrowhead. She wasn’t bleeding like crazy on the outside, and that wouldn’t have been the tool of choice for surgical exploration inside herself, so it seems like she was just trying to close the injury.. This medieval practice doesn’t take care of bacteria along the tract of the wound, in cavities, the blood stream, and damaged organs/tissues. Cauterising in an imprecise manner like this causes burns (another injury), which damage the protective barrier of skin, predisposing a new site for infection to take hold in a dirty environment like the island. Well done Lara. *Claps with the back of hands making seal noises*.

Don’t cut off your parachute

I don’t think this one needs explaining.. Maybe she got really confident after defying the odds so far, or realised she was the protagonist of a story not written by George RR Martin, and therefore would probably survive to its resolution.

Caretoon by Cilein Kearns

Conclusion

Prior to playing this title I only knew Miss Croft from Lucozade ads, as my parents weren’t keen on ‘violent’ games when the kids in my house were younger, (a time before we discovered the art of printing fake age-ratings). I have a background training and working in the video games industry, medical illustration, and medicine/surgery; so I play from a triply(?) biased perspective scrutinising (and appreciating) anatomy, injury mechanisms & appearances, and health/biology references (watch out zombie games).

Caretoon by Cilein Kearns

This health caretoon is all in light heartedness though;  Crystal Dynamics really did a spectacular job crafting this Tomb Raider reboot. It’s got a gritty, mature feel, from the action to the acting, and I had a blast joining in for the adventure – a great story led by the writing of Rhianna Pratchett. Injuries acquired in cinematics persist, and so visually Lara is tattooed by her struggles to survive as she progresses through the narrative, and as a character. The game uses vivid death cinematics for Lara which you experience regularly (if you’re as skilled as me), making players vividly aware of the lethality of some actions (eg being impaled by the throat), while ignoring other injuries (above) that can have deadly or debilitating consequences.

Caretoon by Cilein Kearns

While this Tomb Raider game definitely beats most of what’s come before it in terms of realism, and depicting (some) injuries, there’s still definite room for improvement. Which is exciting really, as it already rocks! If unbelievable action, injury mechanisms, or appearances are pushed too far, they risk breaking the audience’s suspension of disbelief (especially on a realistic title such as this). There were many neck-breaking falls, head traumas that would have caused concussions, whiplash, fractures, and intra-cranial bleeds. These, and many more would have at least incapacitated Miss Croft.. That said, I’ll be the first to admit that Lara dislocating her arm on the first jump, or having to hop on one leg after breaking the other, probably would struggle to be as well-paced and exciting an adventure..

Interdigitating Y flaps

Interdigitating Y flaps

Alcohol in pregnancy

Alcohol in pregnancy