Tag Archives: Starke is not a real doctor

How realistic is stopping a knife from killing you by grabbing the blade with your hands?

Kind of.
It’s realistic in the sense that it can and does happen. At the same time, it
probably won’t save your life. Knife wounds to the palms, (called, “defensive
wounds,”) are fairly common when someone has been attacked by a knife wielding
opponent. Usually, what happens is they’ll attempt to block the knife by
putting up their hands, palms out, and their palms and fingers will take the
initial assault. That I’m most familiar with the term from autopsies should say
a lot about how well this usually works out for the victim.

If you’re
dealing with a situation, where someone’s trying to stab you and your only
option is to catch the blade with your hand, it is better than dying. However,
it is also a very temporary solution, and one you can’t repeat after using. It’s
also, probably, not your best option.

When you
bleed, your body is trying to do two things; first clean the wound and expel
any foreign objects in it, then seal the wound over to allow the tissue to heal.
Fresh blood is aggravatingly slick. Once exposed to oxygen, blood becomes tacky
and coagulates over the course of a few minutes. (Specific clotting times vary
based on a number of factors. For example: if your character is an alcoholic,
their blood’s ability to clot will be severely impaired.) It only remains tacky
for a few minutes, and will then harden into a solid mass, so the window here
is fairly narrow.

When you
take a knife to the hand, you’re going to bleed all over your hand. That means
your hands will get slick, and have a harder time gripping the blade. This is
before you consider the part where your hand is actually getting cut to pieces.
Eventually the blood will clot (whether you survive long enough to see this or
not), at which point gripping the blade would become easier, but that’s not a
realistic consideration because the fight won’t last long enough to get there.

As I’ve
said before, your body functions on a kind of pulley system. Your muscles pull
on tendons which in turn tense against your skeleton, causing your limbs to
move. When you start cutting tendons, the pulley system starts to break down.
Some of the most delicate pieces of this system are in your hands and feet.
Start carving those apart, and your hand will
not work
. This isn’t an, “oh, I can force my way through on sheer
willpower,” situation. The mechanical components critical to making your hands
work will be damaged or destroyed. The spirit may be willing, but the flesh has
been turned into butterflyed steak. Catching a knife with your hand will stop
that strike, but it means your hand will
not work
again. Yes, if you survive, it can be repaired surgically, but
that’s not going to keep you alive.

The
better option, if you have sufficient manual dexterity to catch the blade is to
catch your opponent’s wrist instead. Again, this isn’t a great position to be
in, and wrist grabs are some of the weakest and riskiest holds, but it is far better than trying to grab their
knife. Your arm or hand might get nicked by the blade, but that is vastly
preferable to taking a direct blade to the hand. Going for the wrist is a
legitimate strategy and a part of some knife fighting doctrine. Granted, your
best option would be to maintain distance, and never let a knife wielder get
close enough to attack, but that’s not always a practical option.

-Starke

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Is it possible to walk, well, attempt to walk, on a broken leg in any way? Would this result in permanent problems, such as a limp after healing? I assume it would…

All I remember about broken legs is the one I got when I was twelve, which was a spiral fracture of the tibia (but the fibula remained intact). After I was helped to my feet, I immediately started falling down again after I tried to put weight on it as the whole thing just gave out. I needed two grown adults to help me get to a nearby bench, which I hopped to, and then got carried out to the car when my mother finally arrived to pick me up. It was pretty terrifying.

Now, that’s not all breaks. So, I suggest you go check out @scriptmedic as they can probably give you a little more help in the medical department than we can.

-Michi

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I was reading one the questions you answered awhile back about gunshot wounds. Sometimes people can still keep fighting. I believe you mentioned that the adrenaline rush could dull the pain. Is it possible that the same can happen if someone was shot in the leg with an arrow? Would they be able to run?

No. A bullet will pass through the victim (usually) damaging
organs and tearing tissue in its path. This can limit mobility, particularly if
it breaks a bone, or if it tears tendons and ligaments. But, the tissue itself
can still move, to an extent.

With an arrow, you’re pinning the muscles together in
specific configurations, and those cannot
move. Your muscles slide over one another as a normal function of movement.
With an arrow run through them, you cannot move the affected area. Walking,
with an arrow through your leg, to say nothing of fighting with one through
your torso or arm is, basically, impossible.

This is also why the advice if someone’s been stabbed or run
through is to keep the victim from moving. If they try to adjust their
position, they’ll do far more damage to themselves than if they lay still. At
the same time, you don’t want to remove it, because the foreign object (that is
to say, whatever stabbed them) will obstruct the flow of blood. Removing it
will cause them to bleed out faster. That’s the tradeoff with bullets, and part
of why they’re so vicious as a weapon.

If you get shot, there’s nothing left to obstruct the flow
of blood, meaning you’ll bleed faster than if someone had shanked you with a
knife (and didn’t retrieve it), or shot you with an arrow. Because it’s
entirely possible you won’t even realize you’ve been shot, you won’t know to
slow down, and if you remain physically active (because you’re in a fight), you’re
very likely to wear yourself out, only to realize after the fact that you’re
not winded, but bleeding to death. And, yes, this does happen in the real
world.

If you’re hit with an arrow or run through, the blood loss
(from a similar injury) will be slower or partially obstructed, and you’ll
have immediate feedback telling you to slow down, but actually bleeding to
death will take longer. (Potentially not much
longer, and there is a greater risk of an arrow or blade severing something
immediately lethal, like an artery, but, as a general concept the idea holds.)

So, no, an arrow will stop you.

-Starke

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When I watch shows that have victims that were “beaten to death” what does that mean? How did they actually die, like from blood loss?

The very
short answer would be: Kinda, sorta, not really. Beaten to death isn’t a cause
of death, it’s how the victim got there. With that in mind, blood loss can be
one possible outcome (it’s just not a very likely one), however it is fairly
likely to play an important role in getting there. Specifically the major
threat here is damage to the internal organs. You’ll still bleed to death, but
very little of it will leave your body.

There
are also other potential causes of death. The one that comes to mind are embolisms.
These are situations where a blood clot breaks free in the bloodstream and gets
caught somewhere “downstream” obstructing the flow of blood. When that “somewhere”
is in the brain, it then kills the victim. These are a seriously fluke cause of
death, because there’s basically no way to cause one to occur deliberately.
They also result in situations where someone can suffer an incredibly minor
injury and drop dead a few hours later. If the character took a boot to the
head mid-beating, then the cause of death could easily be a cerebral embolism
resulting from that specific blow. Not that the coroner could pinpoint which
injury caused it. Identifying a death from an embolism is possible. however.

Of
course, the old favorite, concussions, are still on the table. We’ve talked
about these enough times before. The basic idea is that your brain bounces off
the inside of your skull, resulting in bruising on the brain itself. This is
immediately life threatening. Someone who takes a few too many blows to the
head could easily slip into a coma and never recover (or die), because of brain
damage.

As I
mentioned earlier, critical damage to internal organs can be lethal. The liver
and kidneys are basically just large meat sacks of blood. Rupturing any of
these will kill you without medical
attention. In those cases it would, technically, be bleeding to death, but
damage to the organ itself would (probably) be the official cause of death.

A broken
rib can cause a lot more damage. This (basically) gets back to critical
internal injuries, breaking the bone isn’t what kills you, it’s the broken bone
itself, punching holes in organs you were using.

Finally,
you can (theoretically) bleed to death from bruising. Without a contributing
condition (such as anemia),this isn’t a likely outcome. (I’m not certain if it’s
even possible, outside of some extreme circumstances.) Bruises are (usually) small
subdermal hemorrhages. That means, something tore tissue under the skin, and
you bled, but your skin remained intact, so the blood never left your body.

One
other thing to keep in mind about beatings; if someone’s bringing a weapon like
a crowbar or sledgehammer, those will significantly alter the potential
injuries. Someone who’s skull was caved in by an eight pound sledge might still
be described as “beaten to death,” depending on the characters involved.

-Starke

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Hi there I hope you’re having a good day/night. I was wondering how long would it take to die from a stab in the chest?

We’ve actually been having some horrifically long nights this week, on account of the weather, so, we’re both a bit exhausted at the moment.

I know I’ve gone into depth on stab wounds before. The closest thing I can give you to a coherent answer was this post on blood loss and bleeding to death from last August. You might also want to take a look at our blood loss tag and of course, Starke is not a real doctor, which isn’t all about blood loss, but the topic comes up frequently.

I’m honestly sorry, I can’t offer anything that we haven’t said before (in those posts), but the truth is: bleed out times are directly related to what has been damaged.

-Starke

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Do you suppose that a person who’s spent about 2.5 years training themselves to withstand/ignore pain by say experiencing 4th degree burns over his entire body, would be able to throw one punch before collapsing after being stabbed in the lung?

Okay, so, two problems up front. The first being
that: Fourth degree burns aren’t painful. There may be some exceptions, but the
nerve endings are cooked, so nothing remains to transmit to the brain that this
should hurt, or even that the injury is occurring. The second is that: Fourth
degree burns don’t heal. As I mentioned a second ago, fourth degree burns are
where the tissue has been cooked, the meat itself is dead at this point.

Without immediate and extensive medical treatment,
fourth degree burns are life threatening injuries. These are where the burn
gets into the deep tissue, destroying muscles, ligaments, tendons, and any nerves
unfortunate enough to be affected. Usually, fourth degree burns penetrate to
the bone, so if it’s a limb, that’s not coming back.

Also, note the word I used above, “cooked.” That’s a
pretty good description of the kind of damage we’re talking about here. It’s
not something your character can walk away from.

Second, following up on what I said the other day
about injuries, pain, and adrenaline. If you missed it, the very short version
is that adrenaline actually impairs your ability to feel pain (to a degree), so
if you’re in combat and take a bullet, or get stabbed.

To an extent, none of this matters, a character can
keep fighting with a collapsed lung, but their ability to breathe will be
impaired. Lungs function operate based on controlled air pressure, so when they’re
punctured, they tend to deflate, halving the victim’s ability to breathe. They’d
suffer everything that comes along with hypoxia: Shortness of breath,
lightheaded, easily fatigued, and confusion, (I assume the confusion would take
a few minutes, but I’m not 100% certain). A collapsed lung can also cause the
victim to go into shock.

There is a point to teaching people to manage pain,
and the methods for that, ranging from extremely intensive exercise to some
varieties of very controlled physical abuse, but setting someone on fire does
not qualify as either, and fourth degree burns are something that will halt
your character’s training, it won’t toughen them up, but will turn them into a slab
of meat, cooked well done.

The issue is, a lot of writers take the idea of
things like extreme training, and push it way past any reasonable stopping
point. Fourth degree burns is up there with shooting a character to teach them
to control pain. Unless they have superpowers, it will transition from the
kinds of pain someone can learn from and into actually killing the student. A
character might get to the point where they’re being struck with a staff and
taking the blows without injury through proper muscle control, but you’re not
going to run them through with a sword, or set them on fire. That doesn’t teach
anything, and will seriously injure the student.

Following on that, the purpose of striking a student
is to teach them to take blows without being injured. They’re learning to tense
the muscles so the impact doesn’t cause harm.

Exercise is where you learn to tune out pain.
Someone used to sprinting on wet sand will be far better suited to powering
through pain than someone who was repeatedly set on fire by a sadistic
instructor. Also, I called this extreme exercise earlier, but this stuff is
still pretty tame. It will include things like asking the students to exercise
in unpleasant circumstances, not ones that pose an actual treat to them.

So, in short, yes, they can keep fighting, though it’s
not going to be as simple as they fall over, they’ll slow down, start losing
track of what’s going on, probably get far more seriously injured because they’re
still trying to participate against unimpaired foes, and then collapse.

-Starke

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Watching a James Bond movie, I noticed James gets shot, winces a little and continues on as normal, bleeding and all. Is that plausible? Later in in the movie, he gets shot again, falls unconscious onto a river and survives with recovery. I’ve never been shot but I’d imagine that even if my body is pumping adrenaline, I would be in pain. Is there such thing as “getting used” to getting shot to the point where you can just carry on after an injury? I suppose it also depends on where you got shot.

No, or at least not through that logic.
You don’t build up a tolerance for getting shot, but people can, and do, keep
fighting through gunshot wounds.

It’s fairly common for someone to not
realize they’ve been shot. Adrenaline actually deadens the sensation of pain,
and so they’ll take a bullet, then begin feeling fatigue as they bleed to death
and, eventually collapse. In situations where the bullet missed hitting
anything vital, and the actual bloodloss is slow, they can remain functional
for quite some time. This is one of the reasons you’ll frequently see
characters checking themselves for injuries after a fight. This is also one of
the reasons why you’ll see “professional” characters firing multiple shots in
quick succession. It’s not that one bullet won’t get the job done, it’s that
depending on where it hits, a single wound won’t stop their foe.

Even in situations where the bullet
damages vital internal organs, like the lungs, it’s sometimes possible the
victim still won’t realize they’ve been hit until after the fact. Ironically,
this can include headshots, which are only lethal about 98% of the time.

So, getting shot, or hit by shrapnel, is
something that you can, absolutely, keep fighting through. It’s not that you’re
dealing with a character who’s so badass they can go through the pain, it’s
that in most cases they do not know they’ve been hit. If there is an
unrealistic element to this, it’s that Bond felt the hit, and responded to it, not
that he could keep fighting afterwards.

-Starke

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If somebody gets cut across one of their femoral arteries, what are their options? How long do they have?

In order: dying, and somewhere south of two minutes. Death
may take a little longer, but loss of consciousness will come sooner.

Where the artery is damage will affect how treatable it is. When
you have some distance from the torso (the mid-to lower thigh) you can apply a
tourniquet above the wound and possibly keep the victim alive long enough to
get them medical attention. In the upper thigh or near the groin, unless you
already have EMTs on site, you probably won’t have enough time to effectively
clamp it.

That said, the last
fifteen years have seen an explosion in technologies designed to counter catastrophic
blood loss. This includes things like QuikClot and HemCon. The former
dehydrates blood on contact inducing rapid clotting. The latter becomes highly
adhesive and is supposed to seal into the wound (though the survival rate was reportedly
only around 10%.) Of random interest, early iterations of QuikClot came in
powdered form (the current version is saturated into gauze), it used a
different mineral base, and had an exothermic reaction on contact with blood,
resulting in second degree burns. This saw military use in the early 2000s, and
never made it to the civilian market.

There’s also NovoEight, which, if I’m reading this
correctly, is recombinant blood (or more accurately, just the clotting factor
from human blood). This is sold in powdered form and needs to be reconstituted immediately
prior to use (once reconstituted it only lasts about 4 hours).  Technically, this stuff is intended for
treating hemophiliacs who were seriously injured or going in for surgery.

An earlier iteration, NovoSeven was used experimentally in
the mid 2000s. It can be effective for managing blood loss in cases of severe
trauma, but is also risky to use, as it in can result in arterial thrombosis,
(clotting in the arteries that obstruct the flow of blood). In case it wasn’t
clear, this is a very bad thing,
though preferable to bleeding to death. I don’t know if NovoEight still has
that risk, though, it would surprise me. Neither is actually approved for use
on non-hemophiliacs, but it is an option of last resort. (The primary
difference between NovoSeven and NovoEight appears to be how the drug is
produced, and the potency (NovoSeven is stronger, and indicated for patients
who have no clotting factor, while NovoEight is intended for patients with a
congenitally deficient clotting factor.)

If you can get the victim into surgery, then it’s possible
they may survive. But, this is still an extremely dangerous injury to suffer,
and even medical attention doesn’t mean the victim will survive, only that they
might. From what little I know, the actual procedure is just to clamp the
artery and suture it back together. The problem is that the femoral artery
moves a lot of blood, making it harder to control, and causing the bleed out to occur faster.

So, their options aren’t that appealing.

-Starke

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Do you know a blog one can ask about medical things in regards to writing?

Off hand, The Script Medic comes to mind. Their ask box is closed at the moment, though it should be back up in a couple days.

If you have a medical question, I’ll usually do some spot checking, and muddle through. So long as you remember that my training on the subject is extremely scattershot.

-Starke

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I’m writing a sword-fighting scene where both parties are fairly adept at swordplay. What would be the most realistic way for one of them to injure the other so they are mostly incapacitated and bleed out? I have ideas, but I’m not sure if they are realistic.

Getting stabbed comes to mind.

I’m tempted to leave it at that, but I should probably go into some very basic anatomy.

Your soft tissue (muscles, tendons, and ligaments) form what you could describe as a kind of pulley system across your skeletal structure. They contract and expand, based on electrical impulses from your nervous system, and this is what allows your joints to move, and tie your skeleton together.

When the soft tissue tears or is cut, then the system starts to fall apart. The classic example of this is the Achilles tendon, which, if destroyed will make it impossible to walk on that leg, you simply cannot control the ankle anymore, but even just cuts into the tissue will impair you.

So, getting stabbed or slashed will cause you to lose some function in that limb. How much will be determined by exactly where and how deeply you were hit. But, it doesn’t really take that much damage to the wrong places to completely immobilize someone.

This is a large part of why “first blood,” is such an important concept with sword fights. It’s not just that one of the combatants is losing blood, and at a disadvantage from that. Their injury will also (likely) impair their ability to fight. Inflicting the first injury in a duel is very significant.

As for bleeding out, all that requires is that you lose blood faster than your body can clot the injury. Usually we think of this in the terms of arterial bleeds, where you’ll be dead in minutes at most, but, it’s important to remember that blood loss is cumulative. So someone can bleed to death from non-arterial injuries if they can’t keep the bleeding under control, and their body can’t clot the wound.

This is why sword and knife fights don’t always focus on getting a single killing strike. It’s entirely possible to wear an opponent out through bleed induced attrition.

We’ve discussed hypovolemic shock before. It’s worth remembering, once you’ve started losing serious amounts of blood, you’re not going to be particularly coherent. So, if you were planning for a character to have some deathbed confession while bleeding to death, that’s not really the way the human brain works when it’s losing that much blood.

Incidentally, this also applies to the fight itself. As a combatant loses blood, they’ll pass through those same stages. (Anxiety, transitioning to confusion and disorientation at ~30% blood loss.) These have immediate implications in a fight, where their opponent is looking for ways to exploit any weakness or vulnerability. Also, because the fight is constant physical exertion, they will lose blood faster than they would if they were resting.

Also worth remembering, it’s entirely possible to “win” a duel and still bleed to death afterwards.

-Starke

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