Tag Archives: Starke is not a real doctor

Q&A: Nailed It

If a character is stabbed and pinned through the hands (like a crucifixion), could they wrench themselves free without bleeding out? I realize they’d be most likely be permanently disabled if they survive, I just want to make sure that “if” is workable.

So, there’s a small historical footnote worth knowing: In Roman crucifixion, the nail would be driven through the wrist, not the hand. The reason being that the hand isn’t structurally sound enough to support the body’s weight.

As for wrenching yourself free from actual crucifixion? Probably not. Someone subjected to that would normally take days to expire. Factor in the blood loss from getting nailed up there in the first place, and being able to break yourself free seems pretty far fetched.

It’s worth noting, there’s very little archaeological data on crucifixions, and only one set of crucified remains dating to the Roman Empire has every been discovered. This leaves us with religious and contemporary documents. Given the time involved, there’s some uncertainty in the details. For example: The size, design and metallurgical makeup of the nails.

If you’re talking about a situation like the character’s hand being mangled by a normal carpentry nail, that’s a little different. The Ulnar Artery loops across the hand, forming the Superficial Palmal Arch, which connects with the Radial Artery. So, damaging this must be bad, right?

Yes, and no. You can bleed to death from tearing the Ulnar artery (or the arch.) This is still an important conduit for blood through the forearm, and no arterial wound is safe. The Radial artery is the one most frequently severed when someone attempts to slit their wrists. So, yes, it is possible to bleed out this way. It’s also extremely unlikely, baring other factors, like a compromised clotting factor, immersion in water, or continued aggravation of the wound. In most cases, your body will clamp down on the damaged artery halting the loss of blood. In fact, emergency first aid for a ruptured artery in the wrist or hand is to keep pressure on the damaged tissue for roughly 5 to 15 minutes, until clotting commences. Depending on the circumstances you could be looking at over an hour before cardiovascular collapse from this injury (if it’s going to happen at all.) So, yeah, you can, theoretically, bleed to death from this, but it’s not going to be fast. Regardless, you can bleed to death from this, so don’t screw around with it.

So how does this happen? The nail goes through, and then you tear it out between the webbing of the fingers. That forces you to sever the Superficial Palmal Arch, causing arterial bleeding. If you’re just yanking your hand off the surface, from whatever it was nailed into, and the nail didn’t damage the arteries, you’ll bleed, but you won’t die from bloodloss.  It doesn’t really matter whether this pulls the nail through your hand or you keep the as a souvenir and implausible, improvised, punch dagger. Additionally, depending on your personal physiology, and the exact point of contact, it’s possible the nail will penetrate outside the Arch, and pulling your hand free, though the webbing, will damage tissue, but won’t be life threatening.

Now, the bad news. If your holding your hand on a surface, someone stabs through it with a knife, and the blade perpendicular to your arm, there’s a real risk the blade itself will sever the Palmal Arch. Again, by itself, this is unlikely to be lethal, but it is something that needs to be taken seriously.

Also, until the wound has clotted, bandaging these wounds will require some real skill. It’s far easier to keep pressure on the wounds by hand (insert a bandage between your hand and the wound when possible), until the initial bleed ends. If the bandage soaks through, then apply a tourniquet. Don’t just slap a bandaid on top and call it good. Also, simply. tightly wrapping a bandage around the hand will not apply pressure where you want it.

This is in contrast to arterial damage near the torso, including in the arm pits and groin, which can result in death from blood loss in under two minutes. It’s an artery, but size and volume moved matters.

One fun detail, if your character takes a fairly normal sized carpentry nail to the hand, assuming it doesn’t specifically pierce anything vital, it can do minimal damage. Obviously, nicking a nerve is permanent. This is in contrast to taking a knife to the hand, where the size of the blade means that it will probably hit something vital.

The puncture wound will suck, and in a modern setting, they’ll need a tetanus booster, and probably an antibiotic, in addition to basic wound care. Surgery can repair non-nerve damage, though the hand won’t be exactly the same again. But this is not something that will your character in the scene.

As always, please remember I’m not a professional hand stabber, so don’t take this as medical advice, aside from, you know, the first aid: keep pressure on bleeding wound that spurts in time with your pulse. Also, as someone who is not a doctor, I recommend you don’t get stabbed through the hand. I hear not healthy.


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Q&A: Contact Poisons

I’ve heard of historical cases of people dying by poison being applied to fabric, accidentally or deliberately. Is contact poison a viable method of murder? Could it be used, not to kill altogether, but to weaken an opponent for someone else to fight?

It depends on the poison. There are a lot of poisonous substances that can be absorbed through the skin, including things like Anthrax, Strychnine and Cyanide. (Technically Anthrax is a biological agent.)

There are poisons that can disorient or impair the victim without killing them. Too many to even start to go into them.

Ironically, the first thing that comes to mind and fits both of these is Lidocaine. Lidocaine, and a number of other similar anesthetics such as Novocaine and Oracaine, are synthetic relatives of cocaine, producing numbness on contact, and they’re commonly used in dentistry. You can kill someone with a sufficient dose, as well. Also, the normal topical administration method is via a gel, not a liquid but the idea is there.

One major, historical, issue with accidental poisonings was arsenic. When used as a dye, Arsenic produces a vibrant green color. This was briefly popular in the 18th century, for wallpaper patterns and paints. In a dry environment, it’s mostly safe, however when you add heat and humidity, low doses can be released as an (effectively) undetectable vapor. This won’t result in an immediate death, but prolonged exposure can result in chronic poisoning.

There’s a bit of history here, if you’re interested: In 1815, after his military defeat, Napoleon Bonaparte was sent into exile on the Island of Saint Helena. He’d previously been exiled to Elba in 1814, after a separate military defeat, only to return to France, and restart his campaigns, so this time he was sent to a far more remote island.  Six years later, on May 5, 1821, he died.

Napoleon’s autopsy listed the cause of death as stomach cancer, there were ulcers found during the procedure, and a family history (though that wasn’t, apparently, known at the time). And, that was that… until the mid 1960s.

This is where things get a little strange. Records kept, both before and after Napoleon’s demise, suggest that he may have died from chronic arsenic poisoning. This includes the symptoms he displayed as his health deteriorated on Saint Helena, as well as how well his body was preserved when it was eventually moved from the island to France in 1840. Additionally, surviving hair samples displayed arsenic traces one hundred times what you would expect today. (The biology involved is that, because arsenic is an element, it doesn’t break down in the body, so it is flushed through various sources, including your hair.)

Into the early 2000s, there was a persistent theory that, because he’d managed to escape Elba, the British had decided to finally finish him off (St. Helena was a British holding). Politically, they couldn’t simply execute him, so the theory held that they dosed his private wine stocks with low doses of arsenic.

The competing argument, of course, is that his wallpaper used an arsenic derived green dye, and that the elevated arsenic content found in the surviving hair samples was the result of atmospheric exposure, probably throughout his life, but particularly during his time on St. Helena.

I am skimming over a lot of details here, there are entire books on the subject of Napoleon’s exile to St. Helena and his eventual death, and rumors that the British were poisoning him, or plotting to kill him existed at the time. So, at some levels, this is nothing new.


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Q&A: Collapsed Lungs

Hi there! I have a character who gets stabbed in the side and into one of her lungs. The wound is deep enough for air to start seeping out and collapse it. I have a fairly decent idea of how it’s going to be treated, but I’m also wondering about blood entering the lung and how to treat that. Google didn’t help much there, I’m afraid. For the record, this takes place during medieval times and I’m aware I’m going to have to use some plot armor for the character to survive.

That’s not plot armor, your character needs magic, superpowers, or modern medical treatment to avoid a rather unpleasant death. If your character is lucky, they die from an infection, if they’re not, then it’s going to be pneumonia.

Okay, if you’re wandering around today, get run through by an especially strange individual wielding a large knife, and your lung is punctured and collapses, that’s bad. However, it is survivable, if you get medical treatment. The lung can be surgically repaired, you can be put on antibiotics, as needed, and your lung can be re-inflated. I’m not sure on all the options for this, but I know one common example is to simply force air into the lung via a plastic tube inserted down the throat.

I’m not 100% certain what getting blood in your lungs will do, but I am sure having blood in your lungs is a potentially lethal situation (even today). In particular, blood quickly coagulates into a solid clot when exposed to oxygen. In your lungs, this means you cannot extract oxygen from the atmosphere, and it’s not going anywhere. Over time clots break down, but the results are not something you really want to deal with internally.

If you’re getting foreign matter of any kind into your lungs, that’s a vector for infection. Lung infections are extremely dangerous and can easily kill you. Symptoms include a fever, increased respiration rate (with an increased heart rate), chest pains, and increased mucus production (which, incidentally is what’s actually causing the problems in the first place, because that stuff is interfering with your ability to breathe in the first place.) If I understand correctly, getting blood in your lungs basically guarantees an infection, or infection like symptoms.

So, in short, without modern medicine, there’s no way to properly treat the collapsed lung. And, assuming the blade wasn’t clean (which, it wasn’t), any medical treatment your character did receive wouldn’t account for concepts like bacterial infection (because that wouldn’t be discovered for centuries), so your character would get sick, and die.

I realize I haven’t written a hard shutdown like this in awhile, but, yeah, this injury, with that level of medical technology is a textbook example of how to kill a character in an extremely painful, and agonizing way.


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Q&A: Don’t Cook This At Home

How long would somebody be able to be burned on an open fire without sustaining life threatening burns? Also i love your blog 😀 Thank you for your time!

I’m honestly not sure exactly how long, but it’s not going to take much time.

A quick caveat: The data I could find was on conductive burns, not convection burns, so there is a little bit more leeway, but this one isn’t going to end well. Also, this is one of those times where I’m having to make an educated guess. I don’t have this particular bit of info internalized, and I can’t find a concrete answer on short notice.

Direct contact with water or steam over 155 Fahrenheit (68C) can result in third degree burns in around a second. For reference: Water boils at around 212F (100C), so even if you haven’t brought it to a boil, you’re already in range for some serious injuries, just messing around with simmering.

An open bonfire tops out at around 1100F (593C). Technically, the sustained temperature will be a bit lower than that, and it will vary by the wood being used. Of course, when you’re talking about temperatures in the 500C range, five degrees difference isn’t going to mean much. (Also, if that wasn’t enough fun, a charcoal briquette can burn at nearly twice that.)

Remembering that third degree burns are life threatening, and remembering that the smoke emitted from the flame will start out at roughly the same temperature as the fire. I’m inclined to say under a second.

It’s not that being set on fire is an immediate death sentence, nor that there aren’t some unusual circumstances where someone could get away unscathed. (Firewalkers are a thing, after all. They rely on a thin layer of moisture on their feet to avoid burning.) There are also plenty of burn survivors who have been, literally, set on fire. But, this is one of those things that can flat out kill someone. Even if they somehow survive the heat, the resulting smoke inhalation will probably finish the job.


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Q&A: First Aid

Wounds and injuries will always happen when fighting. Any advice on treating them? Are ointments and salves a good idea?

It depends on the injury and what you’re applying.

For minor cuts and scrapes, the first thing you want to do is disinfect the wound. Rubbing alcohol works best for this. Turns out, hydrogen peroxide, doesn’t really. Worst case, clean water will clear debris from the wound, and can wash away some potential contaminates. There are other potential disinfectants, though, usually, alcohol is the one that comes to mind for me.

For what it’s worth, even hard liquor will work for this. So if you’re wondering about a western where people are using whiskey or gin to clean a wound, that does work.

On the other hand, ground water, rain water, or melted snow will not, and can present another potential vector for infection. If you boil it first, it can be used to clean a wound, but it wouldn’t have any disinfecting properties.

Once a wound has been cleaned, you can apply a gel to seal the wound over. Most of the time you’re talking about something like petroleum jellies (so Neosporin or Vaseline). These are, technically ointments, if you’re wondering. Another possible (and messier) example would be honey. The stuff is thick enough that it becomes a bacteriostatic barrier, and that can help to seal a wound while it heals.

After that, you can bandage it up and you’re good to go.

Some important details though. Understanding how bacterial infection works is a fairly modern concept. Particularly, understanding bacterial infection and the need to disinfect wounds dates to the mid-19th century. So, knowing you need to use whiskey to clean a gunshot wound in 1895 Texas make sense. Doing the same during the civil war, slightly less so.

More serious wounds will require more involved treatment. Someone who’s been shot or run through will require more extensive medical treatment than just slapping on an ointment and hoping for the best.

For broken bones, you’d need to stabilize and immobilize the break. Yes, setting breaks is a thing. No, you shouldn’t do it unless you’re a trained professional. Also, it’s much harder than TV makes it look.

If someone has been stabbed, and the blade is still sticking out of them, don’t pull it out. Leave that for the actual medical professionals. You’ll do more damage, and increase the bleeding, getting it out, than you would if you left it there. The same thing goes for arrow shafts, bullets, or, really, any other foreign object stuck in someone. Unless it’s actively continuing to kill them, don’t remove it. Seriously, pulling it out, and especially digging it out, will do more damage. There are some rare edge cases, but leave those for the professionals, who know what they’re doing. Pulling the knife out of your buddy can be a fantastic way to kill them. I mean, if you want to pull the knife out of yourself to stab someone else, sure, that’s kinda badass. Stupid, unhealthy, and a terrible idea, but have fun with that.

With bruises, there really isn’t much to do. You can watch it, and make sure that the swelling starts to come down. If it doesn’t, then that’s a much more serious issue. Otherwise, it’s just a sub-dermal (meaning below the skin) hemorrhage (meaning bleeding). You can put ice on it if that makes you feel better, but, really, it’s simply there.

Really, minor bruises are a fact of life for most fights. You’re going to pick some up no matter how “good” you are. Armor does help a lot with these. If you’ve got some anesthetic cream you want to smear on one, feel free. It’s (probably) not hurting anything. You can ice it, if that helps manage the pain, for you. Or you can live with them. Outside of some extremely rare cases, they’re not life threatening.


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Q&A: Blood in the Eyes

Hey! Is it possible to take both of an opponent’s eyes out with a single swipe of a sword without amputating the nose? Thanks so much in advance!

Not exactly what you’re asking, but cutting someone’s forehead so that they’ll get blood in their eyes, temporarily blinding them, was a real tactic. That does work.

Actually taking out the eyes in a single, linear strike, without hitting the nose? I don’t think so. To be fair, even a fairly deep cut to the bridge of the nose wouldn’t amputate, and a slash across the face that would sever the nose wouldn’t connect with the eyes, because of how they rest in their sockets.

Maybe I’m missing something obvious, in which case, I’m sorry. Still, if you want to blind your character temporarily, in combat, cuts to the forehead will do that.


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Q&A: Cerebral Hemorrhages

would it be possible for the blood to come from the brain though? i remember in the Butterfly Effect the main character goes to the doctor who tells him part of his brain bleeds during his time-traveling, which led to his severe nosebleeds, but i’m not sure about the medical/physical accuracy

Yeah, cerebral hemorrhages are a little bit more dangerous than just a nosebleed. Specifically, these can (and usually will) result in strokes, brain damage, and death. In other words, not a medical condition you want to screw around with.

I can’t remember if I’ve ever actually watched The Butterfly Effect, so I don’t remember if that was explained in the film.


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Q&A: Alcohol

Apropos of the ask on paralytic toxins, are there any substances that could be used as a nonlethal “paralytic” against a healthy human target? That, perhaps, interfere with coordination enough to immobilize a person but without stopping crucial body functions? Or does that just bring is back to typical tranquilizers? And, you’ve probably answered this before, but how fast do those work?

Well, you can get them drunk. Alcohol and most mild sedatives can impair someone without actually putting them under. There is an element of risk, but it’s not particularly pronounced. (Unless you’re combining them, in which case things can turn really nasty, fast.) Usually the hard part is when someone wants to actually put someone under, or when they want to administer this stuff covertly via a dart.

Most tranquilizers take about 30 minutes to kick in (with a pretty massive margin for error based on the subject’s metabolism.) Again, this isn’t much of a problem when you’re dealing with a bear wandering around the subdivision, but doesn’t really lend itself to someone sneaking around.

General anesthesia is an exception to this. In that case you’re looking at an onset of under a minute. But, as we’ve discussed before, the problem with anesthesia is, you need someone there monitoring the subject’s vitals to adjust the dosage and keep them alive.


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Q&A: Psychic Bleed

not sure if this counts as a fight question, but in stories (esp tv/movies with high visual impact) that have a character that does psychic power things with their mind or are victims of psychic powers, often they’re shown bleeding from their nose or ears to illustrate when they’ve “overdone it” (re Stranger Things) or if they’re overcoming psychic control (re Get Out) and i’m curious why that is? is it just pressure on the brain and blood coming from the nearest orifice? what are the logistics?

It’s a burst blood vessel. Or, sometimes, multiple ones. This is a real condition that can happen. Not the psychic powers, but if you’ve ever coughed, sneezed, or vomited hard enough to get a nose bleed, same thing. This can also lead to minor hemorrhaging in the eye. Unless it’s happening frequently, this stuff isn’t a serious medical issue, just an annoyance.

Bleeding from the tear ducts or ears is less common, but It can happen. If it’s a one off thing, a ruptured blood vessel in the nose isn’t usually something you’d need to worry about, unless it’s recurring. If it does happen repeatedly, than you should probably see a doctor.


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Q&A: Carotid Strike

(I don’t know of this a question for you or @scriptmedic but I’m hoping you’ll be able to help a little) how effective is the carotid strike actually? Will it actually knock someone out and does it cause brain damage like other knockouts? Is there any way to block against it or lessen the effect? Thank you so much and am very grateful for your blog ))

If I’m bluntly honest, I’m not sure how you could strike the carotid artery in a way that would cut off the flow of blood long enough to render someone unconscious without also killing them.

If you’re deliberately cutting off the flow of blood to the brain by compressing the carotid, that would be a blood choke. As we’ve said before, those can turn lethal with shocking speed. But, I’m not seeing where a strike to the neck would temporarily block the flow of blood long enough to put someone under, without cutting off the flow long enough to kill them.

Assuming you managed to find a way to do this, you’d be dealing with the same problems associated with knocking someone out. You’re cutting off oxygen to the brain and hoping you get a very specific kind of brain damage. I mean, this is the problem here; you’re asking for a way to inflict brain damage without inflicting brain damage.

Even if you did manage to put someone down, as with chokes, you’re talking about the victim being unconscious for a few seconds. So, the value of doing so is fairly limited.

The martial arts I’m aware of that practice strikes to the neck, like Krav Maga, don’t particularly care if the victim survives. They’re more interested in decisively ending a threat and, generally speaking, the dead aren’t much of a threat.

There’s an irony here; you’re describing a kill strike that the victim might be able to accidentally survive. Not, the other way around.

Writers like to use knockouts as a “safe” alternative to killing someone. I’m as guilty of this as anyone. But, the reality is that being knocked unconscious is close enough to killing someone that you really can’t selectively inflict the desired outcome. Similarly, you can’t knock someone out for long periods of time, without inflicting severe brain damage. It can, and does happen, but you can’t choose that result.

Ultimately, this stuff comes from a desire to include, “safe” violence. I’m sorry. There is no such thing. No one who engages in violence has full control over the situation. Some people like to think they do, but they’re deluding themselves. You can have characters who try to do the Batman, “I control all the factors,” but without (some very specifically tuned) superpowers, they really don’t.

Attempting to knock someone out, by any means, means you’re taking on the very real risk that the victim will end up dead. That’s a potential outcome.


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