Dog Brothers Public Forum
Return To Homepage
Welcome, Guest. Please login or register.
November 23, 2014, 02:43:17 AM

Login with username, password and session length
Search:     Advanced search
Welcome to the Dog Brothers Public Forum.
83383 Posts in 2260 Topics by 1067 Members
Latest Member: Shinobi Dog
* Home Help Search Login Register
+  Dog Brothers Public Forum
|-+  DBMA Martial Arts Forum
| |-+  Martial Arts Topics
| | |-+  Blade Wounds by a Surgeon
« previous next »
Pages: [1] Print
Author Topic: Blade Wounds by a Surgeon  (Read 5459 times)
TomFurman
Power User
***
Posts: 99


« on: April 10, 2008, 02:54:48 PM »

This is from a surgeon with martial arts experience. It was posted on www.irongarmx.com . Very interesting.

"Anyway, the upshot is killing someone with a blade isn't as easy as it looks on TV. The scene where someone gets stabbed in the belly, then looks shocked, then drops dead is unrealistic. Either a fair amount of damage needs to be done, some very vital structures injured, or a fair amount of time to pass if the wounds aren't horrendous in order for someone to die from stab or slash wounds.

There's quite a bit of variability as to how folks respond to trauma in general. Some seem to die with minimum injury and others seem to withstand huge blood loss and horrific injuries. I haven't a clue what differentiates these two populations but wish I knew...

I said it before and I'll say it again. In a conflict for my life, I would rely on a blunt force instrument to the head before a bladed weapon to just about any anatomic structure to most quickly stop a threat. It doesn't matter what level of adrenaline you've got or what drugs you may have in your system. If you're struck hard enough in the head, you're going down. Also, the long term implications of a survived head injury are (in general) worse than those of a knife wound you recover from.

Trauma and human response to trauma is very interesting. I don't know if I believe that primates and humans in particular are harder to kill. Hunting injuries to animals are typically(hopefully) quite precise and should result in a rapid humane kill. Fighting injuries to humans presenting to trauma centers are less so. I would guess those folks shot by skilled snipers die quickly, similar to hunting wounds.

Anyway, at risk of being accused of being "disturbing" again, here are some generalities for delivering fatal wounds with a bladed weapon.

First: the blade must absolutely be sharp. I've operated on plenty of folks in which a dull edge pushed structures away rather than incising them. Arteries are relatively thick walled and elastic, a dull edge will displace rather than cut them.

Second: All other things equal, a larger blade will be better.

Third: Relying on a single wound to incapacitate an opponent is a bad idea.

Anatomic considerations: The body's actually pretty well designed and protects the most important structures.
If you want to get to the heart there are two reliable ways: A very sharp and sturdy knife thrust strongly just left of the sternal border around the 4th interspace(about nipple level on a guy) will do it. Otherwise, just go under the sternum(under the xiphoid) and aim at the left shoulder. This is basically how we place a needle in the pericardium to drain fluid out from around the heart.

The flexor/medial/anterior surfaces of the extremites are where the money is. In the arm, that's the inner aspect of the upper arm, the crease at the elbow, the palmar aspect of your forearm. In the lower extremity imagine a line from the crest of your pelvis to your pubic bone. About 1/2 of the way up(usually a bit less actually) you get your femoral artery and vein. If the weapon is directed back and up into the abdomen a bit, you can get the iliac vessels. These are especially hard to get to surgically and can not easily be treated with direct pressure. The femoral artery goes medially down the thigh (there's a deep branch as well) and then behind the knee in the midline roughly. It breaks into three vessels below the knee and is no longer that great a target.

In the abdomen, you'd be trying to get to the aorta or the vena cava. This would be actually VERY difficult with anything you're likely to carry around. There are some posterior approaches taht would work, but I doubt they'd be useful in the middle of a chaotic fight. The liver occupies the right upper quadrant and is a giant target. A large knife and multiple wounds would be necessary and there no guarantee whatsoever that this would end a fight quickly.

Stab wounds to the chest in general are likely to get the lungs which can result in collapse(by pneumo or hemothorax) and bleed quite a bit in general. Here, you might actually do well with a smaller knife, since if the opening in the chest is big enough, they won't get what's called a tension pneumothorax. In a similar vein, a small wound to the heart, like an ice pick doesn't kill by bleeding. The blood gets in the sac around the heart, and when the pressure builds up the heart can't fill. If it can't fill, it can't pump and that's that.

The neck is a tried and true target for bladed attacks. A tracheal injury in and of itself may well do nothing.
The carotid artery is medial to(on the inside of) the jugular vein and is a good target. Honestly, if I were able and wanted to inflict maximum damage from a bladed attack to the neck I would insert by stabbing where I thought the jug/carotid were and direct the knife to the contralateral side and backwards. When withdrawing, I'd try to pull the whole thing over to the other side. Alternatively you could direct it to the other ear(the back of it.) If you make a muscle in your neck, you'll see your sternocleidomastoid muscle. There's an inverted V formed by this muscle as one head goes to the clavicle and the other goes to the sternum. the hollow at the top of this V is a pretty good shot on the carotid and jugular.

If you get stabbed or cut and the guy runs off(or if it's an accident, etc) the treatment is DIRECT PRESSURE. Avoid tourniquets. Don't use pressure points above the injury. Get some rags or whatnot and jam them right on the wound and push HARD. Virtually all extremity injuries and even most neck injuries can be controlled by this maneuver.

Bear in mind that a fatal wound won't necessarily equal stopping your opponent. It does you no good if you get killed and then your opponent dies later in the ED or in the ICU.

Hence my statement about head injuries."



Logged
Kaju Dog
Power User
***
Posts: 492

organ donor


« Reply #1 on: April 10, 2008, 03:20:52 PM »

Good read - Thanks  evil

I picked up on the "avoid using tourniquets"...  Hmmm

I can see his point (with the understanding that) without proper training in the application and use of a tourniquet(s) you may have a false sense of confidense that you have controlled the bleeding. 

This is a "hip pocket" class that I would enjoy giving in more detail with some scenario/practical application drills under stress.   cool

One of the largest causes of fatalities in Vietnam was exsanguination due to improper application of tourniquets.

Hense the focus on teaching Marines, Combat Life Saving skills.

Again, good find and thanks for sharing,

Woof!
Logged

Crafty_Dog
Administrator
Power User
*****
Posts: 31662


« Reply #2 on: April 10, 2008, 06:47:13 PM »

Great post Tom, thank you for sharing it here.

Folks, Dog Dean is highly qualified in these matters, indeed I consider him to be a subject matter expert for Dog Brothers Martial Arts. 

Concerning this matter of tourniquets, in addition to Dog Dean, my readings and conversations with those on the front lines of the War with Islamic Fascism tell me that a lot of folks are regarding tourniquets as Option A for serious bleeding, but speaking of these matters puts me WAY outside my lane and I leave proper discussion to Dog Dean and others qualified to an opinion in these matters.

Crafty Dog



Logged
Sun_Helmet
Power User
***
Posts: 84


« Reply #3 on: April 12, 2008, 12:34:17 AM »

The doctor has basically validated what Sayoc Kali methodologies have been criticized for... multiple vital targeting and the mapping out of those targets. What "experts" used to call overkill is not exactly what it seems.

I disagree with blunt weapons versus a blade's effectiveness though. There's hundreds of stick fights that I've seen with impact weapons but anyone who has tried to fight knife versus knife or  knife versus empty hand could tell you that the knife is quite lethal if the feeder is knowledgeable, cunning and aggressive.

Also, he's limiting his POV on a single premise - human versus human. Ever try to kill a wild animal with a stick? There's a reason tribal societies added a point to those spears. How about a confined space? Or pinned down? Or if one were too injured to generate enough impact power? Or in less ideal environs like in the water? Also easier to transition to the primary weapon.

It's also easier to capture the stick or impact weapon compared to tracking and capturing a bladed weapon. Blood also makes things a bit slippery.

Another thing to consider is that a surgeon is cutting into a less mobile area, in mostly a controlled environment. However, he makes a great point about the vital targets- he's illustrating in good detail that you must have a target in mind and know how to get to it and that one shot does not mean success. So you should have a map and know how to get there in whatever position or scenario you're given.

Lastly, also a great point of how the body is designed to protect the internals. If one raises their arm to deflect or block a blow to the neck, the collar bone shifts position so that it covers the subclavians. You'd have to break or get around the obstruction to get to one of the most vulnerable arterial targets of the human body.


--Rafael--
Logged

--Rafael--
"..awaken your consciousness of our past, already effaced from our memory, and to rectify what has been falsified and slandered."
Jose Rizal, from his 1889 essay, ' To The Filipinos '
Maxx
Power User
***
Posts: 482


« Reply #4 on: July 16, 2008, 04:30:16 PM »

So by what he is saying here in this post is that Slashing would be more effective or I am reading it wrong? Because he seems to say that stab wounds might or could make the important stuff bend and fold around the blade.
Logged

Colby
Newbie
*
Posts: 6


« Reply #5 on: July 16, 2008, 10:25:29 PM »

Hense the focus on teaching Marines, Combat Life Saving skills.


I don't know how true the story is, but I'll pass it along anyway.  I am a former MSG (Marine Security Guard---Embassy Guard, before that I was a grunt), and I heard a story about direct pressure saving a Marine in Russia in the early 90's.  The incident took place at the new/abandoned US Embassy in Moscow when the Russians invaded thier own whitehouse.  One of the Marines on duty peeked out of a hole in the wall and got shot in the neck by sniper fire.  The other Marine on duty applied direct pressure and saved the guy's life. Again, I can't attest to the veracity of the story, but it ceratinly could be true. 
Logged
LtMedTB
Newbie
*
Posts: 33


« Reply #6 on: July 28, 2008, 06:50:44 PM »

Great post Tom, thank you for sharing it here.

Folks, Dog Dean is highly qualified in these matters, indeed I consider him to be a subject matter expert for Dog Brothers Martial Arts. 

Concerning this matter of tourniquets, in addition to Dog Dean, my readings and conversations with those on the front lines of the War with Islamic Fascism tell me that a lot of folks are regarding tourniquets as Option A for serious bleeding, but speaking of these matters puts me WAY outside my lane and I leave proper discussion to Dog Dean and others qualified to an opinion in these matters.

Crafty Dog


I can also confirm that the guys coming back from the sandbox are using tourniquets and questioning the orthodoxy of not using them for life threatening bleeds. Granted, there are some differences between a battlefield and a crime or accident scene. I would personally give a brief trial of direct pressure. It should be fairly obvious if it's not working.

Whether martial arts or emergency medicine, you need to ask yourself, "What's my Plan B?"

Tom
Logged

"Talent is God given. Be humble.
Fame is man given. Be thankful.
Conceit is self given. Be careful."
LtMedTB
Newbie
*
Posts: 33


« Reply #7 on: July 28, 2008, 06:52:47 PM »

The doctor has basically validated what Sayoc Kali methodologies have been criticized for... multiple vital targeting and the mapping out of those targets. What "experts" used to call overkill is not exactly what it seems.

I disagree with blunt weapons versus a blade's effectiveness though. There's hundreds of stick fights that I've seen with impact weapons but anyone who has tried to fight knife versus knife or  knife versus empty hand could tell you that the knife is quite lethal if the feeder is knowledgeable, cunning and aggressive.

Also, he's limiting his POV on a single premise - human versus human.

[snip]

No disrespect to trauma surgeons, but the ones that die never make it to him.

Tom
Logged

"Talent is God given. Be humble.
Fame is man given. Be thankful.
Conceit is self given. Be careful."
LtMedTB
Newbie
*
Posts: 33


« Reply #8 on: July 28, 2008, 06:56:59 PM »

So by what he is saying here in this post is that Slashing would be more effective or I am reading it wrong? Because he seems to say that stab wounds might or could make the important stuff bend and fold around the blade.

I found that a little hard to swallow. Granted, a blunt penetrating object might push the aorta instead of lacerating it, but you'd rather be slashed than stabbed. You can control external hemorrhage.

Tom
Logged

"Talent is God given. Be humble.
Fame is man given. Be thankful.
Conceit is self given. Be careful."
Kaju Dog
Power User
***
Posts: 492

organ donor


« Reply #9 on: July 28, 2008, 11:33:55 PM »

Woof Tom,

I appreciate your input and don't recall seeing you on the site before.  If I didn't say it already, Welcome and Thank you for your contribution to the discussion here. 

 cool

The primary use of touriquets, from my experience in Iraq, was due to the Platnum 6 minutes.  The Marines and Baby Docs are taught that when in doubt, apply a "Proper" touriquet and get the wounded warrior to the next higher level of care ASAP. 

Med Evacs are typically very fast, the pilots and crew are doing nothing short of an amazing job over there!

In addition, if a team/Plt gets pinned down or is unable to get to the next level of care fast, they are taught various other methods to keep the wounded alive as long as possible.  They are NOT allowed to remove a touriquet once it has been applied, BUT they can loosen it a little as needed periodically to allow circulation to the limb.  They are also taught how to apply a good pressure bandage and cover dressings.  Never to remove a dressing/bandage if soaked through, but how to add another bandage/dressing on top of the soaked bandage(s).   

Direct pressure is always first. 

*Our Med Evacs were so quick that sometimes we didnt even get enough time to do a detailed patient assesment before the bird landed. 

No "Stay n Play", Just the "Load n Go" option. 

I used more IV's to wash out eyes and for dehydration Pnts than for SI's. 

There's no better sound in the World, than a Med Evac Helo or Air support comming in when you need it. 

It is certainly a TEAM effort out there. 




Thanks Tom and again everyone else for your contribution to this subject. 

Dog Dean




 rolleyes
Logged

Maxx
Power User
***
Posts: 482


« Reply #10 on: July 29, 2008, 02:50:09 PM »

Dean, That looks like a big knife on your right hand side..Is that what I think it is or something else?
Logged

Kaju Dog
Power User
***
Posts: 492

organ donor


« Reply #11 on: July 29, 2008, 03:05:08 PM »

Dean, That looks like a big knife on your right hand side..Is that what I think it is or something else?

Yep, thats my cold steel fighter right behind Uncle Sams Berretta.
Logged

G M
Power User
***
Posts: 12124


« Reply #12 on: July 29, 2008, 04:16:23 PM »

Is that an upside down Asp on your vest?
Logged
Maxx
Power User
***
Posts: 482


« Reply #13 on: July 29, 2008, 05:35:00 PM »

Dean, That looks like a big knife on your right hand side..Is that what I think it is or something else?

Yep, thats my cold steel fighter right behind Uncle Sams Berretta.

This is alittle off Topic Dean but when I head back how do I get Private Equipment like my Cold Steel Khukri from Point A to back in the Military and or my Cold Steel Kerambit? Do I check them in or?
« Last Edit: July 29, 2008, 05:40:42 PM by Maxx » Logged

LtMedTB
Newbie
*
Posts: 33


« Reply #14 on: July 29, 2008, 05:42:31 PM »

Woof Tom,

I appreciate your input and don't recall seeing you on the site before.  If I didn't say it already, Welcome and Thank you for your contribution to the discussion here. 

 cool

The primary use of touriquets, from my experience in Iraq, was due to the Platnum 6 minutes.  The Marines and Baby Docs are taught that when in doubt, apply a "Proper" touriquet and get the wounded warrior to the next higher level of care ASAP. 

Med Evacs are typically very fast, the pilots and crew are doing nothing short of an amazing job over there!

In addition, if a team/Plt gets pinned down or is unable to get to the next level of care fast, they are taught various other methods to keep the wounded alive as long as possible.  They are NOT allowed to remove a touriquet once it has been applied, BUT they can loosen it a little as needed periodically to allow circulation to the limb.  They are also taught how to apply a good pressure bandage and cover dressings.  Never to remove a dressing/bandage if soaked through, but how to add another bandage/dressing on top of the soaked bandage(s).   

Direct pressure is always first. 

*Our Med Evacs were so quick that sometimes we didnt even get enough time to do a detailed patient assesment before the bird landed. 

No "Stay n Play", Just the "Load n Go" option. 

I used more IV's to wash out eyes and for dehydration Pnts than for SI's. 

There's no better sound in the World, than a Med Evac Helo or Air support comming in when you need it. 

It is certainly a TEAM effort out there. 

Thanks Tom and again everyone else for your contribution to this subject. 

Dog Dean

Thanks for the warm welcome Dog Dean! Awesome photo. Thank you for your service to our country, and especially to our wounded warriors.

Love the tape on the carabiner! Smiley

Tom
Logged

"Talent is God given. Be humble.
Fame is man given. Be thankful.
Conceit is self given. Be careful."
Maxx
Power User
***
Posts: 482


« Reply #15 on: August 02, 2008, 12:20:50 PM »

So by what he is saying here in this post is that Slashing would be more effective or I am reading it wrong? Because he seems to say that stab wounds might or could make the important stuff bend and fold around the blade.

I found that a little hard to swallow. Granted, a blunt penetrating object might push the aorta instead of lacerating it, but you'd rather be slashed than stabbed. You can control external hemorrhage.

Tom

What if you get Slashed across the stomach and get disemboweled? Or if the Slashing disemboweling weapon was long enough to hit organs as it slashed you open?
Or getting a deep slash across the throat? No to mention Arteries that get slashed. Isnt there a greater chance that a slashed Arterie can retracted deeper inside the body making it harder to get your hands on and pinch it off?

I am not a med. Just asking the question.
Logged

LtMedTB
Newbie
*
Posts: 33


« Reply #16 on: August 02, 2008, 01:18:17 PM »

Hi, Maxx.

Anything is possible, and there are a million variables that could alter the equation, but you have to ask yourself, what is the more likely scenario? With a stab, the force is directed inward toward the core, while with a slash the force cuts across the body at an oblique angle. You don't want either, but if I had to choose between a single slash wound or a single stab wound to the body (front, flank, or back) from a street thug, I'd take a single slash wound. A nasty slash to the abdomen could certainly cause an evisceration, but I personally would rather have some of my guts protruding through the abdominal wall than risk damage to the aorta, heart, lungs, spleen, liver, kidney, etc. Could an abdominal slash cut all the way through to a major organ? I suppose, but it seems to me that's a lot of tissue to slash through. If someone is that talented (and strong) with a knife, somehow I don't think you're going to live through the attack, whether slashed, stabbed, or both. The neck, arms, legs, and groin are a little different because some major arteries run close to the surface, so you can cause major damage with a slash if you know what you're doing. Still, you can put a knee into someone's inguinal area to stop the bleeding to the femoral artery (at least there's a chance you can) unlike a stab wound to the liver, spleen, or lung where most of the bleeding is internal. Even the heel of a hand to one side of the neck might control bleeding to a lacerated carotid, but regardless you're in big trouble with a serious knife wound to the neck. Still, I'm going to do some research to see if I can bring some peer reviewed literature to this discussion. I'll let you know if I find anything interesting.

Tom
Logged

"Talent is God given. Be humble.
Fame is man given. Be thankful.
Conceit is self given. Be careful."
LtMedTB
Newbie
*
Posts: 33


« Reply #17 on: August 02, 2008, 01:39:51 PM »

Apparently if the wound is deeper than it is wide, it's a stab wound. If it's wider than it is deep, it's a slash. Suddenly the differences seem trivial. Let's just keep practicing and make sure we don't get caught with either! Smiley

Tom
Logged

"Talent is God given. Be humble.
Fame is man given. Be thankful.
Conceit is self given. Be careful."
Crafty_Dog
Administrator
Power User
*****
Posts: 31662


« Reply #18 on: August 02, 2008, 02:30:43 PM »

"Still, I'm going to do some research to see if I can bring some peer reviewed literature to this discussion. I'll let you know if I find anything interesting."

Looking forward to it.
Logged
LtMedTB
Newbie
*
Posts: 33


« Reply #19 on: August 02, 2008, 10:10:55 PM »

After re-examining the original post in this thread, I don't find much to quarrel with. Sharp knives are better than dull knives, longer knives are better than shorter knives, and it's better to inflict several wounds than a single wound if your intent is to incapacitate or kill. As to whether you're better of stabbing or slashing, you have to compare apples to apples. If a dull knife isn't going to lacerate the great vessels as easily with a stabbing motion, then it isn't going to lacerate the liver, spleen, kidney, or intestines as easily with a slashing motion.

Tom
Logged

"Talent is God given. Be humble.
Fame is man given. Be thankful.
Conceit is self given. Be careful."
pau
Frequent Poster
**
Posts: 74


« Reply #20 on: August 11, 2008, 11:18:04 PM »

great info thanks  grin

well i think this is a perfec example of what this topic is of

http://es.youtube.com/watch?v=_6AQY6T-cMo

REALY REALY GRAFIC WARNING NSFW


a guy is stabed and has his throat cut but te cut dos not go to the jugular veins to the ameisment of ALL he is fine

sorry for my speling  wink
« Last Edit: August 12, 2008, 12:25:47 AM by pau » Logged

guau desde mex ^^

woof from mex ^^
Pages: [1] Print 
« previous next »
Jump to:  

Powered by MySQL Powered by PHP Powered by SMF 1.1.19 | SMF © 2013, Simple Machines Valid XHTML 1.0! Valid CSS!