Tag Archives: Starke is not a real doctor

Is there any relatively safe way to knock someone out with no resources but your hands? My character needs to knock this person out so they don’t run off, but he has nothing on him to do so. It’s necessary to the story that he be knocked out. Thank you!

No.

We’ve gone over this, many times, before. There is no safe
way to knock someone unconscious. By definition, you’re specifically attempting
to damage their brain, with the goal of getting it to take a little vacation.

More than that, there aren’t even many reliable means to
knock someone out. Blows to the head can, theoretically, work, but they can
also, just as easily, piss off the person you’re attacking, without much ill
effect.

Tranquilizers take ages to kick in, and are very difficult
to dose. Too much, and you’ve got a corpse. Not enough, and you’ve got someone
who’s groggy, but still ambulatory.

Choking is, in theory, the safest, but the fine line between
unconscious and dead is still something you can’t spot intentionally. Choking
is something that can be practiced in a safe environment, but using it in the
field is incredibly finicky.

And, it gets better.

Strip away all the terminology and a concussion is just
bruising on the brain itself. You get hit, your head gets jostled around, and
your brain bounces off the inside of your skull. You may have been using that
organ for something, and might understand why you don’t particularly want it
getting directly injured. Either way, this will, absolutely, interfere with
your ability to think, remember unimportant information like your name, or
count the number of fingers some well meaning smartass is holding up. Still,
probably won’t knock you out, though.

When you’re talking about knocking someone out, you’re
really asking, “how can I directly assault their brain, without having to
develop psychic powers?” Yeah, that’s never going to be safe. It turns out,
getting the human brain to stop working, temporarily, is a lot like trying to
get it to just flat out stop working in general, and it’s a crap shoot, which
you’ll get.

Concussions are cumulative. This should be fairly obvious,
when you actually think about it. If your brain has been pre-tenderized, it’s
going to be more susceptible to future concussions, and the ones you receive
will be more severe. This means someone who’s had a few before will be knocked unconscious
or killed far more easily than someone with a relatively healthy brain. Even
then, it’s not like there’s a stable baseline of, “you can hit your head this
hard before it kills you.”

Knocking someone unconscious for more than a few seconds is
very bad news. If you’re knocking someone out for more than a minute, there’s
going to be irreparable brain damage. (The specific threshold is usually around
30 seconds, but for each unique brain, there’s equally unique catastrophic
brain damage.) So, you’ve, “safely,” reduced someone to a vegetable. More than
a few minutes and you’ve (probably), “safely,” killed them.

So, what do you actually
do when you need to be somewhere else and someone is intent on getting you to
stick around? Knock them off balance and run. Sucker punches to the stomach are a good option.
If unexpected, they’ll usually wind the victim, and give you a good head start.
Knees to the gut are another classic. One common variation is to knee the gut,
and when they double over, knee them again in the face. Slamming a door in the
face, or knocking them to the ground are also excellent options. Really, there
are a lot of options. The goal is to simply create an opening and escape. You
don’t need to knock someone unconscious to do that. You really don’t want to knock someone unconscious to do that.

-Starke

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In film often when characters get stabbed/assaulted they can often continue to fight or don’t pass out immediately. How does adrenaline or shock factor into the physical reaction, especially when the character isn’t a cop or military and isn’t accustomed to being in these violent situations. How long would they be able to function before they crash? Is it possible to run away or even fight?

Taking these questions in reverse order: Yeah, kinda,
sometimes, and it varies wildly, based on the injuries sustained. Also, it’s
not the adrenaline crash that kills you.

Adrenaline rushes mean that you’re often unaware of injuries
sustained in the moment. I’ve never been fully certain if adrenaline actually
dulls the pain response, or if it simply causes your brain to ignore it. Either
way, while you’re under an adrenaline rush you can suffer injuries and be
unaware of them. It’s why you’ll sometimes see characters (and, for that
matter, real people, with prior experience) checking themselves for injuries
after combat (or any other traumatic event). It is entirely possible to be wounded
and have no idea it’s happened until you’re trying to figure out where all that
blood is coming from.

Depending on what you’ve just been through, coming down off
an adrenaline rush can be deeply unpleasant. Your brain is sure something’s
fucked up, but it can’t pin down exactly what or where, so it’s going to take
that out on you, and everything aches. Adrenaline crashes won’t kill you. (There
may be some weird outliers here for people with heart conditions, but, in
general.) A crash may make you wish you were dead, or make you want to throw up on
people, but it’s not lethal.

In the moment an
adrenaline means that you can suffer (fairly severe) injuries and keep on
fighting. If the injury doesn’t outright disable a limb, you can keep using it,
even if that’s a very bad idea. Getting stabbed or shot is no guarantee that
someone will sit down and peacefully bleed to death. Actually, shooting someone
is a pretty good way to ensure they won’t sit down and bleed to death without
protest.

When you’re trying to figure out how long it will take
someone to die, you’re actually asking about how fast someone bleeds out. This
relates directly to the injuries sustained. Someone who’s had a knife driven
into their neck isn’t going to keep fighting. Someone who had it run through
their bicep or buried in their shoulder blade, probably can.

We’ve covered blood loss before (and I strongly recommend you take a look at that tag, if you haven’t), but that’s the real factor
here that controls if someone can fight. If they still have enough blood in
their body to function. Lose too much, your ability to fight is impaired, and
you’ll eventually fall unconscious and die.

Blood loss is why concepts like, “first blood,” are important
in duels. Once that happens, the clock is ticking for that
character; the longer the fight goes, the more their ability will decay, and
unless they find a way to turn it around, they will die. (Even if they manage to prevail, they may still die without medical attention.)

Fighting through a stab wound is a fantastically bad idea.
Engaging in any physically strenuous activity that raises your heart rate, (for
example: fighting someone, or running away), will speed up blood loss, meaning impairment
kicks in sooner. Still, the point of adrenaline is to keep you functional after
sustaining an injury, so that you can survive.

If someone suffers an injury which disables them in some way,
such as breaking an arm, there’s no powering through that. Adrenaline won’t let
you override shattered bones. The biomechanical pulley system of muscles and
tendons simply doesn’t work with broken bones.

So, the short answer is, “yeah, kinda.” You can keep fighting
after being attacked. So far as it goes, there’s plenty of cases where someone
took a stray bullet and kept on fighting, only to bleed to death later.

-Starke

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Hi, I’ve seen a couple of your posts about knifes and defensive wounds and I was wondering if autopsies can tell which order the injuries were inflicted. Like if someone was knocked out first then stabbed, could that be worked out or would it have to be guessed at. Thanks in advance.

If enough time passed between the injuries, yes. But, we’re not talking about tracking injuries that someone suffered during a fight, this would be wounds that were suffered on different days.

If your characters are trying to piece together a murder, the autopsy is useful for telling them everything that happened, but not the order in which it occurred.

Sorting out what happened to someone right before they died is a bit like those logic games, where you’re asked to take a dozen pictures and rearrange them into chronological order. It involves getting as much information as you can and then recreating a timeline. Sometimes you know when something happened, such as when the victim was last seen in public, and when their body was found. But, what happened between those concrete points needs to be reconstructed.

There’s no magic bullet here. Your investigators need to look at the crime scene, piece together what they find there, look at the victim (and the autopsy report), sort out exactly what happened to them, and assemble all of this into a plausible sequence of events.

All of that said, the autopsy will offer some hints, sometimes. In your example, your victim would lack defensive wounds on their hands, meaning they were unable to defend themselves before being stabbed. Combined with a the headwound, and it’s reasonable to infer they were knocked out first, then stabbed, and that the killer really wanted them dead, or has watched way too much bad TV, because they weren’t willing to settle for the headwound getting the job done.

So, no, the autopsy won’t (usually) tell you, but it can help sort things out.

-Starke

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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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