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  1. #1
    . Fireforce Tactical's Avatar
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    Default How long does it take to die? Part 2 / Conclusion

    Sharing this from Ed's Manifesto. Bit of a lengthy read but if you read part 1 you will know it's worth every minute spent on it.

    https://www.facebook.com/edsmanifest...410526675947:0

    Unconsciousness and Death
    Surviving an Edged Weapon Attack Part II
    In my first article “Unconsciousness and Death Surviving an Edged Weapon Attack”, I concentrated on anatomical targets specific to arteries and veins. As a result of some feedback from a number of readers, more importantly a poster who goes by the name MikeK, they wanted to know what the body’s reactions would be if a knife instead of hitting a major artery or vein, was to instead, hit the lungs or other major blood organ of the body. MikeK provided a link to an article that was written in 1992 by Dr Niru Prasad titled, “Clinical management of stab wound victims, on site and during transportation to hospital”, which can be located at:
    http://www.doctorniruprasad.com/Clinmanstabonsite.html
    and should be read by all who teach others how to fight or defend against an edged or pointed weapon.

    Of real interest to me in this article, were the following excerpts:
    Penetrating injury to the chest.
    A stab wound sustained to the chest area may cause tension pneumothorax, open pneumothorax, massive hemothorax, sucking chest wound, flail chest due to fracture ribs,and pericardial tamponade. The victim can also suffer from severe respiratory distress due
    to hypoxia, which results from:
    A. Diminished blood volume due to bleeding.
    B. Contusion of the lungs leading to ventilation failure.
    C. Changes in the pressure relationship within the pleural space
    leading to displacement of mediastinal structures and collapse of the lung.
    Since hypoxia is the most important feature of chest injury, early intervention is designedto ensure that an adequate amount of oxygen is delivered to the portions of the lung capable of normal ventilation and perfusion.
    Tension pneumothorax develops when a one-way valve air leak occurs, either from the lung or through the chest wall. The presence of air in the thoracic cavity causes collapse of the lung, mediastinal shift to the opposite side causing interference with venous return, and compression of ventilation to the other lung.
    Open pneumothorax causes noisy breathing, and bubbling air and blood from the wound.
    Massive hemothorax results from the stab wound disrupting the systemic or pulmonary vessel, and occurs with a loss of 1500 cc or more of blood in the chest cavity. The neck veins may be flat due to severe hypovolemia, or distended due to the mechanical effects of the chest cavity full of blood.
    Flail chest develops when a segment of the chest wall does not have any bony continuity with the rest of the thoracic cage.
    Pericardial tamponade is caused by a stab wound to the anterior chest area. This frequently leads to a collection of blood in the pericardial sac and a rupture of the aorta or cardiac muscle.
    Some further potentially lethal chest injuries caused by stab wounds are:
    A. Pulmonary contusion.
    B. Disruption of the aorta.
    C. Tracheobronchial disruption.
    D. Esophageal disruption.
    E. Traumatic diaphragmatic hernia.
    F. Myocardial contusion.

    Stab wound to the chest:
    A. Penetrating trauma to the chest
    B. he moving object penetrates through the chest.
    C. Cardiac tamponade. Penetrating heart wound causes bleeding into the pericardial sac, collection of blood constricts the heart and impairs heart function.
    D. Tension pneumothorax stab wound to the chest puncture's the lungs and creates a valve like opening in the chest wall. The increase in pleural pressure causes mediastinal shift, decrease in cardiac output, and diminished function of the other lung.

    Penetrating trauma to the abdomen:
    A. The moving object penetrates the victim's abdomen.
    The knife wound may penetrate the omentum, stomach, large intestine, pancreas, aorta,
    and inferior venacava.
    B. Stab wound to the lower abdomen may penetrate through the intestines, kidney, and aorta.

    Penetrating injury to the abdomen.
    A. A stab wound to the abdomen frequently leads to hemorrhage from the
    penetration of major vessels or solid organs, such as the liver or spleen.
    B. Perforation of a bowel segment.
    C. Evisceration of bowel, content through a penetrating injury.
    D. Injury to the kidneys and ureters.
    E. Pancreatic injury.
    F. Pelvic organ injury.

    Given the advancements in medicine since the above noted article was written in 1992, I sent this article to be reviewed by Dr Lorne Porayko, whose credentials I mentioned in my first article. After reviewing the above noted information, Dr Porayko stated that the information was “good to go” but also thought that the below noted information should also accompany Dr Prasad’s article from a combative/self protection perspective:

    Specific to chest wounds:
    Dr Porayko wanted to add:
    “Pneumothorax is the most common penetrating injury to the chest that we see and almost every blunt chest trauma patient I see has at least one (the fractured rib acts like the knife, lacerating the parietal pleura). There are 2 types of pneumothorax: simple and tension. A simple pthx is not life threatening. Air enters the pleural space, the lung collapses and either the hole seals in the pleura (the lining of the lung—looks like saran wrap) or a "sucking chest wound" to the chest wall allows egress of the pthx. These will definite tax your ability to fight as the collapsed lung halves your aerobic capacity (=V02max). Tension pthx means that air enters the space through a ball-valve mechanism—air can enter the pleural space from the airways but cannot drain. This usually leads to sequentially increasing intrathoracic pressures with each subsequent breath. Venous return to the right side of the heart stops after about 10 breaths, leading to cardiac arrest. Prior to that, cardiac output drops precipitously so I would estimate that you would be prostrated (down, can't get up, can't fight) after only 1 breath or three.”
    After reading this added information from Dr Porayko, I had a light bulb moment based upon one of my previous articles called, “Gladiator School” that can be located at:
    http://www.personalprotectionsystems...diator-school/
    In this article the following conversation took place:
    “I next asked Bob, if he was going to hit someone with a Shiv, what would be his primary target. I expected to hear; throat, kidney, groin, instead Bob stated; “ under the armpit is the target of choice inside.” This tactic was quite bewildering to me until I asked Bob why. Bob stated that a shiv attack to the throat, kidney, or groin areas were not guaranteed to immediately debilitate/stop an adversary (thus giving the target the ability to fight back), whereas a horizontal strike directly into the armpit would cause an immediate puncture and collapse of a lung which, based upon his personal experience and observations, always caused the victim to buckle (the first thing that came to mind here was the last fight scene from Gladiator the movie when Russell Crowe was stabbed in the side of his rib cage prior to entering the coliseum. In fact when I painted this scene to Bob, he laughed stating “ I saw that movie, in the real world that wound would have immediately collapsed Crowe” ) . From this position, further multiple attacks with the knife to the body could easily take place if needed.”
    The type of attack articulated by Bob obviously caused what Dr Prasad and Dr Porayko have described as a tension pneumothorax, so it was no wonder why Bob’s victims dropped so quickly!!

    Specific to abdominal knife wounds:
    Dr Porayko wanted to add:
    Liver lacerations are often contained by the capsule (Glisson's capsule) at least partially, and take hours to kill someone. Unless the portal vein is hit (one big sucker that conducts 20% of the CO per minute) and that is quite deep and well protected, it would take hours to exanguinate (bleed to death). Kidney lacerations are even more contained as the kidney is a retroperitoneal structure. The renal capsule and the peritoneum will usually tamponade (stop) bleeding and they are rarely lethal. Intestinal lacerations do not kill immediately--- they lead to septic shock within 12-36 hrs.

    CONCLUSION:
    So there you have it, a more complete picture, from a medical perspective, of what “may” happen if you are hit with a knife that cuts or penetrates an artery, vein, lung, or major blood organ, including the heart. All the Doctors that I consulted stated that the risk of unconsciousness and death goes up dramatically in relationship to the number of knife wounds sustained to major arteries, veins, lungs, and blood organs. This is one reason why in my system of edged weapon defence (Pat, Wrap, and Attack) an underlying principle is to minimize the number of time you get hit with the blade by controlling the delivery system. For those who teach others how to fight with a knife, these two articles also provide you with “real” medical information as to the “cause and effect” of specific anatomical targets. Of real interest to me in my research, are the targets of the body that can be attacked in combination with a knife to cause:
    1. Psychological and emotional trauma,
    2. Exanguination from blood loss, and
    3. High likelihood of a very quick physical debilitation

    But alas I cannot share all my secrets.

    One last thing that Dr Porayko stated, and I think is really important to share with all the readers of this article from a survival mindset:
    “I've always been amazed how difficult it is to kill someone!”
    REMEMBER, Just because you are cut doesn’t mean you are going to die; fight, fight, fight !!!
    Respectfully
    ​www.fireforcetactical.co.za

  2. #2
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    Default Re: How long does it take to die? Part 2 / Conclusion

    My advise would be dont get stabbed. Stabwounds to the chest and especially in the middle half are extremely dangerous. A stabwound heart only needs to bleed 150ml into the pericardium or heartsack to cause cardiac arrest.
    Stabwounds above the collar bone is also extremely dangerous as the subclavian artery is basically always cut and death occurs in minutes.
    Liver and renal stabwounds most often needs urgent surgical intervention. Containment by the capsule is in my opinion a myth.
    South African doctors are at the forefront of trauma in terms of numbers treated. The British even send trauma surgeons to Baragwanath Hospital to gain experience before being deployed to Iraq.

    Francois
    MB ChB DA(SA)

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    Default Re: How long does it take to die? Part 2 / Conclusion

    Thanks FFT and Finkelstein

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    Default Re: How long does it take to die? Part 2 / Conclusion

    A lot of this information is interesting but contains numerous errors. Without getting too technical, the list of injuries of stab wounds contains blunt trauma pattern injuries also, which are unlikely to be found with incision/laceration wounds. As to the statement that the subclavian is always cut with stab wounds above the clavicle is not quite correct either - it just runs of risk of being injured. The subclavian is a surprisingly difficult artery to access. I wish liver lacerations took hours to kill people. It would make my life a lot easier! The VO2 description is interesting, but incorrect. VO2 is the oxygen demand of the body. DO2 is the delivery of oxygen which would be effected by the collapse of a lung. The VO2/DO2 mismatch is what drives shock states. Humans can survive quite well on one lung, if its not a tension pneumothorax scenario, as our DO2 normally is far in excess of the VO2.

    One thing that is true is that humans are surprisingly resilient once injured, unless very specific injuries are sustained (like the the tension pneumothorax or aortic injury mentioned).

    South African doctors are exposed to a lot of interpersonal trauma management and I've trained German, Japanese, Spanish and English civilian surgeons. Not all of our trauma is managed well unfortunately, due to deficiencies in training and resources. I agree with Finkelstein's advice - don't get stabbed.

    lithium

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    Default Re: How long does it take to die? Part 2 / Conclusion

    Also noticed VO2 and DO2. It's an ok article, people are tough a helluva lot tougher than you think.

    I recall treating a hijacker that was shot 11 times. He was alive, ventilated yes but alive. He went on to recover eventually.

    I've seen some incedible stuff come through the doors of RK Khan hospital.

    Stay Bladed.

  6. #6
    . Fireforce Tactical's Avatar
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    Default Re: How long does it take to die? Part 2 / Conclusion

    Thanks for the considered critiques and contributions from obviously knowledgeable members. We do appreciate and value it. Sharing articles such as these create valuable opportunities for analysis, discussion and debate which we believe is critically necessary in advancing the Art.

    We are in total agreement with Finkelstein's advice - don't get stabbed ! To that end plan, prepare and practice for knife encounters. EXPECT the UNEXPECTED - be URBAN READY!
    ​www.fireforcetactical.co.za

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