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swatsurgeon
03-10-2009, 10:20
Over the years, I have recognized a few things.
1. Most gunshot wounds (low velocity) are not lethal...remember the data I posted a while back.
Deaths from GSW (not dead on scene, but did not survive to discharge from hospital) Head = 62%, Chest= 28%, Abdomen= 9%, Extremity = <1%
So the moral of the story is shot placement within the confines of each body cavity must be nearly perfect to result in death from hemorrhage....since the advent of present EMS/medical/trauma systems.
High velocity wound are a different story since the permanent and temporary cavities are relatively larger, more unpredictable and result in significantly more injury per body area which translates into significantly more deaths due to hemorrhage in each body region. This makes for a medics and trauma surgeons use of all available resources to have a 'save'; it is not simple but the field care makes a bigger difference for these types of wounds, IMHO so that the patient is able to make it to the trauma center/field hospital for definitive operative therapy. This is not generally the case for low velocity wounds which usually just scoop and run, do less in the field and a patient has the good chance of doing well.

Now, knife wounds which have been around for alot longer than GSW's, can be horrific wounds....the skill of the average knife user can cause death but unless they lacerate something that bleeds alot and fast, the patient 's chances of survival are good. On the other hand, a knife in the hands of a skilled warrior can produce devestating wounds that can either incapacitate or kill (or both serially) and make my job nearly impossible to have a good outcome. I would always rather deal with a GSW knowing there are few expert marksman out there....the knife wounds I have seen over the last many years seem to be getting more frequent and nastier and when the guy on the control end of a knife knows how to make the most damage happen, and makes it happen, the wounds are terrible and I believe more lethal. The analogy is: these wounds are equal to the injuries caused by a shotgun to the body as compared to a single small projectile.
Knives are common and with the economy the way it is and ammunition being scarce/expensive/etc, I expect a lot more knife wounds.....so be prepared. The external wounds will vary as they always have from stabs to slashes....but those with 'advanced' skills whether they are developed on the street or in a classroom will cause wounds that are likely lethal and will not give us much chance of salvage....we will likely have greater disability and deaths caused by these instruments that rival the GSW's of years ago on the streets.

So next time you look at a knife's design....blade shape/curve/attributes, think what kind of damage it was designed to inflict....call me crazy but there is a level of art-form here that now makes sense to me, i.e., blade design. Look at the Spyderco Warrior, the Spartan blades, the Yarborough ,,,,, Just add to the mix training and we have more work, medically speaking, coming to a neigborhood near you.

ss

frostfire
03-11-2009, 07:48
Over the years, I have recognized a few things.
1. Most gunshot wounds (low velocity) are not lethal...remember the data I posted a while back.
Deaths from GSW (not dead on scene, but did not survive to discharge from hospital) Head = 62%, Chest= 28%, Abdomen= 9%, Extremity = <1%
So the moral of the story is shot placement within the confines of each body cavity must be nearly perfect to result in death from hemorrhage....since the advent of present EMS/medical/trauma systems.
High velocity wound are a different story since the permanent and temporary cavities are relatively larger, more unpredictable and result in significantly more injury per body area which translates into significantly more deaths due to hemorrhage in each body region. This makes for a medics and trauma surgeons use of all available resources to have a 'save'; it is not simple but the field care makes a bigger difference for these types of wounds, IMHO so that the patient is able to make it to the trauma center/field hospital for definitive operative therapy. This is not generally the case for low velocity wounds which usually just scoop and run, do less in the field and a patient has the good chance of doing well.

Now, knife wounds which have been around for alot longer than GSW's, can be horrific wounds....the skill of the average knife user can cause death but unless they lacerate something that bleeds alot and fast, the patient 's chances of survival are good. On the other hand, a knife in the hands of a skilled warrior can produce devestating wounds that can either incapacitate or kill (or both serially) and make my job nearly impossible to have a good outcome. I would always rather deal with a GSW knowing there are few expert marksman out there....the knife wounds I have seen over the last many years seem to be getting more frequent and nastier and when the guy on the control end of a knife knows how to make the most damage happen, and makes it happen, the wounds are terrible and I believe more lethal. The analogy is: these wounds are equal to the injuries caused by a shotgun to the body as compared to a single small projectile.
Knives are common and with the economy the way it is and ammunition being scarce/expensive/etc, I expect a lot more knife wounds.....so be prepared. The external wounds will vary as they always have from stabs to slashes....but those with 'advanced' skills whether they are developed on the street or in a classroom will cause wounds that are likely lethal and will not give us much chance of salvage....we will likely have greater disability and deaths caused by these instruments that rival the GSW's of years ago on the streets.

So next time you look at a knife's design....blade shape/curve/attributes, think what kind of damage it was designed to inflict....call me crazy but there is a level of art-form here that now makes sense to me, i.e., blade design. Look at the Spyderco Warrior, the Spartan blades, the Yarborough ,,,,, Just add to the mix training and we have more work, medically speaking, coming to a neigborhood near you.

ss

swatsurgeon, this may go without saying:

1. In reference to your earlier topic http://www.professionalsoldiers.com/forums/showthread.php?t=4933&highlight=.22. So regardless of the caliber, most if not all low velocity GSW's lethality depends on shot placement. Yet, a minor looking wound can still be fatal.

2. By the shotgun injuries analogy, you mean that the fatal cases you worked with always involve multiple stab/slash wounds.

Do I understand your posts correctly?

Thank you for the knowledge

ff

swatsurgeon
03-15-2009, 14:14
swatsurgeon, this may go without saying:

1. In reference to your earlier topic http://www.professionalsoldiers.com/forums/showthread.php?t=4933&highlight=.22. So regardless of the caliber, most if not all low velocity GSW's lethality depends on shot placement. Yet, a minor looking wound can still be fatal.

2. By the shotgun injuries analogy, you mean that the fatal cases you worked with always involve multiple stab/slash wounds.

Do I understand your posts correctly?

Thank you for the knowledge

ff

as to #1, yes,,,depends on what the permenant cavity injures,
#2, the analogy was that a shotgun can damage alot more tissue typically than a single smaller projectile (high velocity excepted)...a knife that has a single wound channel (permenant cavity if you will) injures what it lacerates....a person who knows how to really utilize a knife can cause more external or internal damage....not just the straight thrust/slash that is typical of "amateurs".

ss

Red Flag 1
03-15-2009, 16:48
FWIW,

My military anesthesia residency took me to several places for training. One TDY was to Bexar Co Hospital in San Antonio, TX. for a trama rotation. While there, a patient with multiple stab wounds came to the OR for exploration. This was in 1976. CT was new and not always an option. The patient was a 68 yo female with six stab wounds to the abdomen. Surgery, Psych , and Int. Med all described the patient as "unstable". Blood covered the bulk of the abdomen with physical pressure being applied as she presented to the OR. The patient was a 68 y/o female who had engaged in mortal combat with another 68 y/o female over a 72 y/o male. The four inch knife, that was the assult weapon, actually made it to the OR just after skin incision.

After a combative awake emergency intubation, anesthesia was induced and a midline incision was made to explore the abdomed. With the four inch blade as a reference, the expectation was that six or more inches of thrust would have easily damaged structures within the abdomen. After two hours of running the bowel, and other intra-abdominal structures, no intra-abdominal injury was found.

This patient was "massively short" for her weight. I expect that the other 68 y/o "perp" just did not have the physical ability to use the knife to create more damage.

As SS points out, knife wounds are always problamatic. On inital assesment, the wound looks "small". In the field, 18D's have only their eyes and training to rely on. As with the case above, CT/MRI is out of reach. The only barrier to diagnosing intra-abdominal events, is the abdominal wall!!


Bottom line, IMMHO worry about knife wounds , big time!!

Second, be the 72 y/o man!

Great thread SS!

RF 1