Stabbing vs. Cutting

**kungfumonkey** · Posted On: 6/04/2006 12:12am

Hypothermia occurs when the core body temp drops below 95 degrees F, right? If your midsection has several gaping slashes in it then I would imagine that your core body temp would begin to fall for several reasons. 1- loss of fluids. 2 exposure to the air, which would rapidly cool your guts below 95 degrees.
These guys are paramedics, which means when they see the people, they are still bleeding. They have to deal with this stuff on a semi-regular basis. I imagine that as a nursing grad student by the time you see a patient they are pretty stable most of the time, and if they aren't stable then they at least have stopped leaking.

**dwid** · Posted On: 6/04/2006 5:38am

I guess the point is that if you have lost enough fluid volume that your core temperature is dropping, hypothermia is the least of your problems. As far as exposure to air, as long as you're perfusing well, the exposed parts should not see a substantial drop in temperature (unless the environmental temperature is extremely low), so any degree of hypothermia would, I would think, be secondary to hypovolemia. So again, minor problem compared to the fact that you've lost a couple of liters of fluid. Maybe the paramedic's right, I've just never heard of it.

For the record, though, you are right that I don't see patients when they are still all open wounds. I've worked with some very critical patients, though, and some nurses work with the most critical patients- the people who work med flight are typically nurses and nurse practitioners, not paramedics/EMT's. The training for EMTs is a lot like the training for basic combat medics, it is very specific/specialized with little in the way of theory. EMT's need to know one thing basically, how to stabilize a patient until someone else can fix them. It's a great skill and I respect it a lot (my brother's an EMT, among other things). However, there isn't a lot of physiology training provided, typically.

**dwid** · Posted On: 6/04/2006 6:00am

Okay, so the thread got me thinking, so I looked at one of my physiology texts at the info on shock. One of those compensatory mechanisms I referred to earlier is that the body shunts blood away from some systems in an effort to ensure that critical systems (Brain, Lungs, Heart) are perfused. Two systems that are considered non-critical in this context are GI and Skin, so you may well see a temperature drop due to decreased blood flow to these systems. However, again, this drop in temperature is secondary to the degree of shock, and is a small problem compared to the fluid volume deficit you are facing. In the case of a sudden loss of a lot of blood as in multiple traumatic injuries, I would think symptoms of hypothermia would take a lot longer to manifest than would other symptoms of hypovolemic shock. Further, there are a lot of other secondary problems related to hypovolemia. For example, another "non-critical" system is your kidneys, so people with a lot of blood loss might go into kidney failure. In any case, the main problem is still loss of fluid volume, and as long as that's going on, all the warm blankets in the world/dialysis/whatever you can do for the secondary stuff isn't going to save someone. You've got to fill the pump and close the breach.

**vigilus** · Posted On: 6/04/2006 9:11am

Basic first aid. Someone is hurt put a blanket on them :)

A few years ago a police officer died from shock. During a gun fight his hand was knicked by a bullet. Not serious at all so he just ignored it. A little bit later he went into shock and died.

Lots of people think they can avoid going into shock or they can tough the **** out. No way.

**dwid** · Posted On: 6/04/2006 9:21am

Originally Posted by GuiltySpark

Basic first aid. Someone is hurt put a blanket on them :)

A few years ago a police officer died from shock. During a gun fight his hand was knicked by a bullet. Not serious at all so he just ignored it. A little bit later he went into shock and died.

Lots of people think they can avoid going into shock or they can tough the **** out. No way.

Yeah, shock is a real bitch.

BTW, the other side of the blanket thing, the ABC's of trauma are:
Airway, Breathing, Circulation, Disability (assess responsiveness/neuro status), and Expose (Undress the patient as much as possible in order to more thoroughly assess for all injuries). Anyway, dressed or undressed, someone in shock clearly feels subjectively cold, shivers, etc... I had just never thought of this as legit hypothermia.

**kungfumonkey** · Posted On: 6/05/2006 2:32am

good info. I need to get certified again.

**Grashnak** · Posted On: 6/06/2006 10:03am

Interesting topic. I wonder if there is a difference between the type of injuries sustained in a knife attack by someone trained in bladed combat versus some shmuck who grabs a steak knife.

I could imagine a trained individual preferring to cut at specific points (arteries, tendons etc) versus committing to a thrust which would seem to leave you more open. A quick opening of the femoral artery would leave your attacker cold and unhappy really quickly...

**Ryno** · Posted On: 6/06/2006 10:28am

Living in Seattle where people wear rain coats for 10 months out of the year, I'd say there should definitely be a preference for thrusting. Even a good serraded blade can get obstructed by enough clothing.

Personally, I see slashing as a defensive tactic, and thrusting as the primary offense. If someone takes a swing at me (with whatever) and I have a knife and intend to use it, I might slip and cut their arm, but I'd be looking to bury a thrust into them as quickly as possible.

Slashing is iffy. It may or may not cause much damage, depending on what they are wearing, how sharp the blade is, etc. A thrust will cause major damage, no matter what.

Personally, if I see flashy slashing, and I just think someone is fucking around. If I were forced to use a knife on someone, it would be life or death, and I'd try to make my point as quickly as possible.

**Grashnak** · Posted On: 6/06/2006 11:43am

Originally Posted by Ryno

A thrust will cause major damage, no matter what.

I'd just point out that this isn't actually true. There are lots of places on the human body where you and take a penetrating wound and oddly enouch suffer minimal serious damage. I'm sure we've all read the various "miracle" stories about people being shot/stabbed/impaled/etc and walking around fine the next day because they basically only suffered minor tissue damage when the object missed everything vital.

But ya, in general, a thrust is gonna hurt.

**TCDD** · Posted On: 6/10/2006 5:22pm

From a medical point of view (and damnit that hilarious video from the LA olympics of the judge getting hit with the javelin) unless a thrust hits an organ or blood vessel, as i previously mentioned, you can be fine, especially if the blade is left in (ideally) or pulled straight out (not too good), you are really fucked if it is twisted, as fighters trained to do in the middle ages, that way your opponent bleeds slowly...slowly to death

I seem to recall reading somewhere (in fact i think it was in the book blackhawk down) that the amour peircing bullets that the americans were firing were going straight through people and not killing them, just making neat litltle holes with no wound trauma unless they hit bones or organs...knives are the same

I suspect its actually better to have a peircing wound rather than a slash on your limbs as a small punture wont rip the big muscle tissues and is much less likely to severe arteries etc. and less nerve endings will be affected.