Writer's Guide

Writer’s Guide: How to add realistic injuries to your story

No one can deny the fact that including an injury in a story makes it much more interesting to read. But, how do you make sure it looks realistic enough? Because we all know that some shows don’t spend enough time on making an injury look realistic enough. So, let me help you to avoid that from happening!

Reaction to injury

First of all, not everyone responds the same way to certain injuries. One can handle a bullet or knife strike, someone else can’t. Some will yell and grunt, some stay quiet. Some insist they’re fine and refuse help, whereas others think they’re badly hurt, while it’s not as bad. Make sure you pick one way of reacting towards an injury for the character and stick with it throughout the story. Unless you’ve got a good reason to deviate from it.


Common causes are: pain, fear or other emotional forms of stress. It’s usually not a major problem, provided that they wake up within a few seconds. Once someone faints, the pulse would be slow, but recover quickly once they wake up.


There can be multiple different injuries that can occur when this happens, such as: pulse abnormally fast or slow, pale and clammy skin, confusion, dilated pupils, shakiness. One who suffered a shock should be laid down and kept warm.

Minor injuries

This includes bumps, cuts, grazes and bruises. A blow to a bony part of a limb hurts for a while after it happened. It may swell and stiffen. It may also cause a disruption of the movements of the limb for a few minutes. Bruises take a while to appear (mostly a day) and take a long time to fade (from a day to several weeks). Sprained and torn muscles will also stiffen, swell and be painful after a few hours.

Minor head injuries

A minor bump on the head makes a character feel dazed and most commonly suffering from a headache, blurred vision and ringing ears. This mostly clears within minutes. Facial bruising is quite uncommon. Facial bruising is actually not very common. It takes quite a hard blow around the eyes to leave a mark. Minor cuts in the face will hurt and bleed.

Medium head injuries

Concussions are quite common after a hard blow to the head and often followed by temporary unconsciousness. Make sure it stays temporary if you don’t want your character to be permanently damaged. It may also cause dizziness, nausea and a headache. Medium cuts will be painful and messy and there may be scarring.

Severe head injuries

A blow to the head causing long unconsciousness will most certainly result in brain damage, a possible fractured skull and bruising or bleeding within the brain itself. It may kill them right away or later on, as the blood causes pressure on the brain. Severe cuts can damage facial muscles and cause permanent damage. The pain from such injuries would make characters unable to concentrate on anything else.

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Symptoms include: disorientation, memory loss, dizziness, headache, nausea, vomiting, pupils uneven in size, sleepiness. Someone suffering from a suspected head injury should be watched for at least 24 hours, woken every few hours when they’re asleep.

Broken bones

It’s possible that it might not hurt much at all, and it may also be hard to determine an official broken bone when it’s hard to see. The shock and pain is often enough to cause unconsciousness. Severe breaks can cause a part of the bone to come through the skin. This also causes blood loss, seeing as nerves and blood vessels can be permanently damaged. So, as for broken ribs, it may feel uncomfortable, but the initial discomfort will pass quickly. The character may feel fine for a few hours afterwards. It may even be possible that they don’t know they broke anything. A few hours later it’ll start to hurt and breathing will be painful. When the injured person breathes shallowly, lungs may collapse as a result. Broken ribs can therefore puncture a lung or even the heart.

Dislocated limbs

Hurts just as much as broken bones. It can be forced back into place without medical assistance, but it’s not recommended. It may even cause someone to pass out.

Stab wounds/cut wounds

Getting stabbed or cut open is what happens a lot in stories. Most humans often use something else to block the blow (often the hands). Most people injured in a stabbing have injuries on their hands and arms. The arms and legs aren’t protected with much flesh, so a shallow cut may damage the bone and muscle. Severe blood loss can occur if it hit a major blood vessel. When it comes to abdomen, it’ll bleed a lot and often causes fatal damage. When it’s more than 2 inches deep, that is. Slight cuts on the stomach area would affect breathing and damage muscles. More major cuts around this area means the injured character would lose control over their legs.

Blood loss

Major blood loss will cause a fast weak pulse. Say the character is an average healthy person, losing about a litre of blood is enough for them to go into shock mode. Loss of about a litre and a half to two litres (or more) requires transfusion. Loss of more than 2 and a half litres will result in unconsciousness and without transfusion, death.


1st degree burns show red, sensitive skin. Almost like a sunburn. 2nd degree burns are like a blistering on the first layer of skin. 3rd degree burns damage the first two layers of the skin, showing visible scars.

Electrical shocks

Physical marks vary from none to severe damaging, depending on the severity of the shock. Internal damage happens when the electrical current passes the nerves and blood vessels.

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Oxygen issues

Lack of oxygen is bad for you (6-8 minutes causes permanent brain damage). Smoke, chemicals or water inhalation may cause physical damage to the lungs, making breathing difficult (even when the person is ‘safe’).


Last but not least, environments can also cause (severe) injuries. What I mean by that, is cold and heat. Cold may cause frostbite and other risks caused by exposure to extreme cold. Warming should be done slowly to avoid risking blistering of the skin or other complications (such as shock). Frostbites are also shown in severity. 1st degree causes numbness and whitening of skin. 2nd degree causes outer layer of the skin to be frozen, blistering likely when warmed. 3rd degree shows white or blue skin. The skin is hard and cold. And then there’s heat, which is a risk to develop heat exhaustion or a heat stroke. The first is caused by insufficient water and salt intake. Symptoms are: headache, dizziness, fainting, thirst, fast and weak pulse and breathing, clammy skin and cramps. The second is more severe. Symptoms are: hot and dry skin, sweating stops suddenly, nausea, disorientation, hallucinating, abnormal blood pressure, elevated temperature and unconsciousness. Treatment focuses on lowering the body temperature and rehydrating the person.

Love, Deem ❤

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