Blood loss

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Van Canna
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Blood loss

Post by Van Canna »

So you get cut if you go against a knife no matter how good you think you are, right?

How much and how fast will you bleed?
Carotid artery: 1 1/2 inch deep cut results in unconsciousness in 5 seconds and death in 12 seconds.

Brachial artery: 1/2 inch deep cut results in unconsciousness in 14 seconds and death in 1 1/2 minutes.

Radial artery: 1/4 inch deep cut results in unconsciousness in 30 seconds and death in 2 1/2 minutes.

subclavian artery: 2 1/2 inch deep cut results in unconsciousness in 2 second and death in 3 1/2 seconds.

heart: 3 1/2 inch deep cut/stab results in immediate unconsciousness and death in 3 seconds.

Thats about it for arteries. For the jugular and femoral its about the same as the carotids.
Bill, Ian ?
Van
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Post by Van Canna »

We as grunts were always worried about the femoral artery. The medics warned us we had less than sixty seconds to slap a tourniquet on the femoral, before the soldier would bleed out.


:?: :?:
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Post by Van Canna »

Deleted...too big a picture.
Van
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Post by IJ »

I'm not sure about those figures. I'm not a trauma person but have made some observations and can do some math here. Let's start with 3 liters of blood in an average adult:

http://en.wikipedia.org/wiki/Blood

The cardiac ouput of a typical adult is about 5 liters at rest, but let's assume we're not completely zen about our knife attack and say it's ten, because that's also how many fingers I have:

http://en.wikipedia.org/wiki/Cardiac_output

Of this, about 15% goes to the brain, so we're talking 1.5 L per minute:

http://en.wikipedia.org/wiki/Cerebral_blood_flow

Now let's assume that the carotid artery in question carries about 40% of the blood flow in question. It's not 50% because we have vertebral arteries in our spine that do some of the work, and because when arteries are injured, they spasm.

Thus, the blood output of a carotid artery at stress = 2x resting blood flow is 0.6 L per min.

According to Wiki once again, a serious hemorrhage resulting in changes in mental status (class III) occurs with the loss of 30-40% of blood volume:

http://en.wikipedia.org/wiki/Bleeding

Out of our 3 liters that means 1.2 L (let's use the 40% since we are talking about tough, conditioned uechi-ka).

That means you've got about two minutes of single-carotid squirting before your mentation is gone (0.6L/min x 2 minutes = 1.2 L, 40% of 3L). Do I 100% believe this calculation? Naw. But I trust it more than the 5 seconds to unconsciousness listed for a carotid cut.

How could you possibly lose enough blood in 5 seconds to become unconscious? You can completely CEASE blood flow to the head (say, rear naked choke) and last 5 seconds, and there's no way to reduce the cardiac output that quickly by losing volume, because the heart would be pumping blood returning in the veins and wouldn't even be able to perceive a drop in the return of blood for a while longer. The first thing it would notice would be the absence of the blood return from one carotid. Since the brain gets about 15% of cardiac output, the carotid represents at most 7.5% of blood flow, so for at least a while your heart will just work a bit harder, which it does whenever we exercise or wait for American Idol results or whatever. After that, the body can clamp down on the veins, mobilizing mostly stagnant blood for circulation. Then it cuts off flow to the skin, and many internal organs (brain, heart and kidneys last) sending reserve to essential areas. As blood return declines, cardiac output declines too--not good for your brain, but it slows further losses.

This is why:

I've met a guy who had a carotid artery knife transection repaired at UVA med center (later killed by a bullet, proving the aphorism "trauma is a chronic disease with acute exacerbations").

I met a guy in a VA prison who slit his brachial artery in jail and had to conceal what he was doing on consecutive 10 minute suicide checks until he finally passed out.

That soldier in "Black Hawk Down" whose femoral artery was shot managed to get dragged to a building and proceduralized by the medic (without avail) before drifting away from hypotension.

I met a jehovah's witness who had both his arms torn off by a fence post drilling axle that caught his clothes--not only didn't die, he survived without a blood transfusion.

There was discussion that the french medics who saw Diana killed her by not getting her to the hospital and instead trying to resuscitate at the scene--her pulmonary artery was torn, and she was bleeding into her chest. The pulmonary artery receives ALL (the main trunk) or HALF (either branch, right or left to the lungs) of the right cardiac output (equal to the systemic, left cardiac output except in strange situations).

I've read about a man who survived a stab wound to his left ventricle. He thought he'd been punched, but managed to stagger inside his own house before collapsing and was resuscitated with some brain damage.

If you think about it, there's no reason for someone to have "immediate unconsciousness" from a heart stab, since you have a few seconds of blood to work with even if the heart fibrillates completely. Instead, what happens is that the blood spills into the chest (minor) and more importantly into the inflexible sack around the heart, preventing the heart from filling and thus from emptying (cardiac tamponade). Depending on the hole and whether it forms a one way valve or a two way valve, blood might move into the pericardium slowly, or back n forth, slowing the effect on filling, just as a collapsed lung can have a one way hole (results in rapid filling of the chest with air, squishing the lungs, heart, and kinking off the vessels).

I will say that bleeding can be impressive. I had the unique experience of watching someone bleed from their subclavian. I havd been sent to pull a line from a 19 year old's vein (he was seriously brain injured and not reporting symptoms). When I did so, all seemed normal, and I was holding pressure when I noticed his heart rate climb up, to double, and his blood pressure fall, and his skin turn white. This happened over about 3-4 minutes, with him on ICU monitoring equipment the whole time. I called a code blue, and it was probably 15 minutes before anything was done for the kid besides a little IV fluid. What was done was a chest XRay showing new fluid on the line side of the chest (no suprise) and this was followed with a chest tube to drain it. In retrospect, the filling of his right chest with blood probably ceased the bleeding and removing what had collected was potentially dangerous. Anyhoo, kid got through all of this without clinical consequences from his experince, although he was shortly thereafter made comfort care and died. The line was either in his artery, not his vein, or was holding back a nick in the artery, albeit one smaller than a knife induced severing.

Long story short, if someone cuts your radial or brachial artery, keep fighting. You need to remove the threat and you're not gonna die in 5 seconds. I recommend not letting knives into your carotids (which at least you can compress), hearts, or subclavians (can't even compress those).
--Ian
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Van Canna
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Post by Van Canna »

Thanks, Ian...scary but essential knowledge to instill an impetus to fight on 8O

You agree with this?

I moved into a blood choke on one of my students...by intercepting his haymaker...then ducking under his right shoulder...then slamming and wrapping my right forearm around his left side of the neck and locking it with my left hand...then applying a steady increasing pressure.

After 10 seconds he went limp.
Van
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Post by Jason Rees »

I'm with Ian on those times being too short for the most part.

With the heart, it just depends on where you get hit, how much tissue is cut, how much blood leaks out, the health of the heart tissue itself, etc, etc, on and on. In "On Combat," Grossman tells of a woman who was shot in the heart, and had time to chase and repeatedly shoot the perp until they were down, walk back to her house, unload her pistol, and get inside to call 911 before passing out. Clinically died twice, but survived.

The subclavian is the one that you're hosed on. Unlike the heart (where you have so many variables), if the sub-clavian gets cut, you're going to bleed into the chest cavity very, very quickly, and you can't stem the flow like you can the brachial, radial and femoral arteries. Two seconds, five seconds, ten, one-hundred-and-ninety... what does it matter? You're dead.

Fortunately, it's pretty difficult (comparatively) to get to unless they've snuck up behind, or you're already unconcious. Either way I can think of more inviting targets.
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Post by IJ »

Van, it sounds like you MAY be describing the military version of the rear naked choke, where you grasp your hands together and pull back while squeezing. It's good, but I prefer the classic where (if choking with the right) you slip the right arm around the neck under the chin, deep, placing it on your left shoulder, then move your left arm over the choking arm to the back of the head with a knife hand. They say you've got 6-8 seconds but depends on the solidity of the choke and I've seen people drop seemingly much faster if going into it exhausted already.

Tell that student to tap already!
--Ian
Stryke

Post by Stryke »

Dont confuse a blood choke with blood loss

a choke such as the rear naked choke is effective because of an increase in blood pressure rather than a lack of blood going to the brain .
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Post by Rising Star »

Roy Bedard did a very graphic demonstration using a gallon of fruit punch at Winterfest this past January showing how much 'blood' would have to be lost before loc, and worse would occur - We can lose a lot and still be functionable.

John
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Bill Glasheen
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Post by Bill Glasheen »

Stryke wrote:
Dont confuse a blood choke with blood loss
Word!
Stryke wrote:
a choke such as the rear naked choke is effective because of an increase in blood pressure rather than a lack of blood going to the brain .
That I disagree with.

You are right, Marcus, that it's a bit more complicated than stopping blood from flowing to the brain. Other variables come into play.

A rear naked choke, a.k.a. "blood choke", a.k.a. "lateral vascular neck restraint" stops blood flow in the two jugular veins.

Image

These two veins represent all the blood coming out of the brain. Blood flow to the brain involves 4 separate arteries which feed the Circle of Willis.

Image

Well... when you stop blood leaving the brain, then eventually no new blood can go into the brain. Essentially you create a blood flow traffic jam where the movement of all red blood cells comes to a halt. This is made evident by the face turning bright red just before the person passes out.

Image

The brain needs a constant supply of oxygen and glucose to operate. It also is functional in a narrow CO2 and pH band. Without the constant supply of nutrients and removal of waste, consciousness is lost in short order.

The "complicated" part comes in how some people can stay conscious with the RNC longer than other, suggesting that it isn't just blood flow going to zero that causes the relatively quick KO. Other factors many include inadvertent stimulation of carotid baroreceptors and/or chemoreceptors, and possible panic on the part of the person being "choked." All of that would affect your autonomic status in the medullary control centers.

- Bill
Last edited by Bill Glasheen on Mon Jul 28, 2008 1:26 am, edited 4 times in total.
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Post by Bill Glasheen »

I think the issue with a major artery being cut is the inevitability of loss of consciousness. If you can retreat from the battle, it's smart to do so and apply direct pressure. You just might live to fight another day.

Or die another day, as Ian suggested... :(

But if you have no choice, you can fight on. A trainer of LEOs and my firearms instructor used to attend autopsies after LEO kills. On one occasion he attended the autopsy of a man who had his left heart (the big, important part) blown into pieces with a round. That large man fought ferociously for over half a minute after having been shot in the chest. How that happened was truly amazing. But it happened.

By the way, nice analysis, Dr. Ian. 8)

- Bill
Last edited by Bill Glasheen on Sun Jul 27, 2008 10:16 pm, edited 1 time in total.
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Post by Bruise Lee »

Rising Star wrote:Roy Bedard did a very graphic demonstration using a gallon of fruit punch at Winterfest this past January showing how much 'blood' would have to be lost before loc, and worse would occur - We can lose a lot and still be functionable.

John
Humans are very complex physiology, and the status of the cvs is multifactorial. Level of hydration, circulating catecholemines, vascular defects, level of cardiovascular conditioning, pulmonary or renal problems, use of certain medications from aspirin to blood pressure medications) etc - will make huge differences in LOC.
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Post by IJ »

Other factors:

Arteries spasm when injured, and they clamp off flow better when severed rather than incised. Less important is that bleeding ceases quicker with tissue damage due to release of chemical signs of injury that promote blood clotting. Usually clotting by itself won't heal an artery; some kind of pressure, external or created by the buildup of bood at the area, is necessary.
--Ian
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Post by Van Canna »

That explains why in several total decapitation auto accidents I handled, the police photos showed no blood at the point of severance.
Van
Stryke

Post by Stryke »

That I disagree with.

You are right, Marcus, that it's a bit more complicated than stopping blood from flowing to the brain. Other variables come into play.

A rear naked choke, a.k.a. "blood choke", a.k.a. "lateral vascular neck restraint" stops blood flow in the two jugular veins.



These two veins represent all the blood coming out of the brain. Blood flow to the brain involves 4 separate arteries which feed the Circle of Willis.
Increase of blood pressure and a lack of circulation , so In your opinion it still is the starvation that causes unconciousness ?

Interesting
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