jaholder1971
Member
I don't think the 18 wheeler comparison is too far off: She had as much chance to survive either, but she did. One tough broad (offered as a term of admiration).
Will you die if shot in the heart PART II: Maybe not
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I'm not a physician, but a pharmacist. If you look at the anatonmy of the heart and related vessels, you will understand that if the left ventricle is "blown out" the animal, person so affected will not live but a few seconds. Circulation, ie blood pressure will fall to almost zero immediately. With a good hit with from a 357 would result not only in the tearing/cutting but also a large amount of hydrostatic shock which effectively kills tissue in degrees that vary in distance from the actual wound channel, due primarily due to the velocity of the projectile. Also consider a hollow point was "probably" used. One cannot be certain of this but a direct hit to the heart would most certainly be fatal.
If the heart were nicked then one's chance of survival would be greatly increased, but not guarenteed. Remember there are many smaller arteries and veins on in in the heart muscle itself which must remain intact for the heart to function.
A discussion of this scope and depth is really beyond the level of comprehension of most media writers and reporters. With the education and training I have had I do not really feel comfortable trying to give a definite answer. Only a physician, and one who deals in trauma would best be qualified to answer. Even then it would need to be on a case by case basis and no one can predict or say what the hand of God can do.
If the heart were nicked then one's chance of survival would be greatly increased, but not guarenteed. Remember there are many smaller arteries and veins on in in the heart muscle itself which must remain intact for the heart to function.
A discussion of this scope and depth is really beyond the level of comprehension of most media writers and reporters. With the education and training I have had I do not really feel comfortable trying to give a definite answer. Only a physician, and one who deals in trauma would best be qualified to answer. Even then it would need to be on a case by case basis and no one can predict or say what the hand of God can do.
Penetrating heart injuries: one article suggests that 80% of these are fatal.
Sugg WL, Rea WJ, Ecker RR, Webb WR, Shaw RR. Penetrating wounds of the heart: An analysis of 459 cases. Journal of Thoracic and Cardiovascular Surgery 1968;56(4):531-545.
Here is Mayo's article citing the above:
http://www.medicine.mcgill.ca/mjm/issues/v01n01/cardiac.html
And an interesting case involving a multichamber gunshot wound to the heart:
http://www.chestjournal.org/cgi/reprint/101/1/287.pdf
A case that I found very interesting back in Johannesburg in the late 90s, was one involving a young man and his jealous ex-girlfriend.
I was working a trauma shift in the X-ray department one night and there was a significant disturbance at the reception area. A young man was being dragged into the casualty department by some friends, and there was a knife handle sticking out of his chest anteriorly. Trailing these men was a very sedate and meek looking young woman who sat down on a chair while the doctors rushed to get this guy into resus.
It turned out that this knife was a long bread knife, with a rounded tip up front. It further turned out that this meek, small woman had stabbed this man (her ex-boyfriend) in a fit of jealousy over his new girl.
They did an open thoracotomy right there in resus and managed to get the knife out and sew up the guy's heart. I don't recall which chamber was involved, but I remember it was perforated good and proper. The guy survived though, with rapid intervention.
There was a case I read of online a few years ago where a guy got shot through the heart and survived. There were intra-operative photographs of that one, and it was very interesting seeing the damage done. They showed the perforated lung too. I think people are a bit more wary of posting those cases now. I should have documented that at the time.
Sugg WL, Rea WJ, Ecker RR, Webb WR, Shaw RR. Penetrating wounds of the heart: An analysis of 459 cases. Journal of Thoracic and Cardiovascular Surgery 1968;56(4):531-545.
Here is Mayo's article citing the above:
http://www.medicine.mcgill.ca/mjm/issues/v01n01/cardiac.html
And an interesting case involving a multichamber gunshot wound to the heart:
http://www.chestjournal.org/cgi/reprint/101/1/287.pdf
A case that I found very interesting back in Johannesburg in the late 90s, was one involving a young man and his jealous ex-girlfriend.
I was working a trauma shift in the X-ray department one night and there was a significant disturbance at the reception area. A young man was being dragged into the casualty department by some friends, and there was a knife handle sticking out of his chest anteriorly. Trailing these men was a very sedate and meek looking young woman who sat down on a chair while the doctors rushed to get this guy into resus.
It turned out that this knife was a long bread knife, with a rounded tip up front. It further turned out that this meek, small woman had stabbed this man (her ex-boyfriend) in a fit of jealousy over his new girl.
They did an open thoracotomy right there in resus and managed to get the knife out and sew up the guy's heart. I don't recall which chamber was involved, but I remember it was perforated good and proper. The guy survived though, with rapid intervention.
There was a case I read of online a few years ago where a guy got shot through the heart and survived. There were intra-operative photographs of that one, and it was very interesting seeing the damage done. They showed the perforated lung too. I think people are a bit more wary of posting those cases now. I should have documented that at the time.
jkingrph
Like you, I'm not a physician, but from the biology and health courses I have taken I think I have a pretty good understanding of the "fundamentals" of the circulatory system. I agree that if someone's left ventricle is "blown out," which implies not a simple piercing (as with a knife), but lots of tearing, ripping, and shock trauma, blood circulation is going to be nil or close to it. Unconsciousness would follow in seconds, and brain death in minutes.
Any result different from the above would have to be a very rare occurrence indeed.
K
Like you, I'm not a physician, but from the biology and health courses I have taken I think I have a pretty good understanding of the "fundamentals" of the circulatory system. I agree that if someone's left ventricle is "blown out," which implies not a simple piercing (as with a knife), but lots of tearing, ripping, and shock trauma, blood circulation is going to be nil or close to it. Unconsciousness would follow in seconds, and brain death in minutes.
Any result different from the above would have to be a very rare occurrence indeed.
K
Fatal and incapacitating are very different things. What is fatal? It is a sliding slope.
What is fatal 10 minutes from medical care might not be fatal 5 minutes from medical care.
In terms of defense, damage and trauma that is enough to actualy force a person into incapacition immediately is far above what is fatal most of the time. Contrast this with willing incapacitation where the trauma, pain and shock of the injury causes the person to flee or fall as a subconscious/involuntary psycological reaction. Most are the later, but someone trained or otherwise in a different state of mind(perhaps due to drugs) can continue to will actions until the physical body ceases to function as long as the nerves upon which those functions travel are intact.
Depending on the injuries this can be seconds (before incapacitation, minutes before irreversable brain damage due to lack of oxygen), or minutes. A serious heart injury will usualy only be seconds before incapacitation. However if surgery was immediately undertaken on the spot (obviously it never would unless in a hospital) and the loss of blood pressure remedied by fixing the wound, while IV fluids were administered to make up for lost blood, what would 99% of the time a fatal wound could be survived. Since surgeries are not performed in the field this pretty much means anything that cannot be survived longer than an emergency response, and corrosponding arrival to the hospital is what you would call fatal. The emergency personel can more or less extend this window depending on the injury with IV making up for blood loss, and ventilators, pure oxygen making the most of limited breathing function, and other procedures mainly in line with trying to keep the circulatory system functioning even if artificialy until arrival. Then there is the time for assessment and prep, incisions etc.
So fatal is a hard assessment to make. Are you trying to determine fatal, or incapacitation? Unsurvivable fatal injuries to the heart will not immediately incapacitate. The loss of blood pressure, preventing circulation, and removing the blood already oxygenated in the blood through immediate heavy blood loss by serious damage to the heart will make them unconscious within a matter of seconds, but seconds is plenty of time to return fire if they were so inclined. Luckily the instinctive reaction is usualy to psycologicly incapacitate themselves due to shock. With total irreversable damage to the circulatory system, the brain will suffer permanent damage within 3 minutes, and be pretty much dead several minutes afterwards. Since there will still be some oxygen already present from the last moments of function, and some blood still oxygenated present, this window is increased because there is still oxygen present for the brain in minor quantities after circulation fails. But this only adds a short undetermined amount of time. However this is in determining fatal, the person will obviously be unconscious prior to that time passing. Thier survival will depend on what others do or do not do and the time frame it is done in.
It is not a video game where the person has a health bar and if that goes to 0 they are dead. However for contrast lets pretend it is. A person could drop into negative numbers and function at least a few seconds, or only drop to 50, and die minutes or hours later.
Also it depends on the medical fields ability to repair certain tissues. Technology is not yet advanced enough to replace certain tissues. So if too much tissue is missing, sewing it up obviously won't work that well. Can't really grab some artificial heart tissue to use as a patch, as the heart is a muscle. So any patch would be non functional tissue.
Now if an artificial heart was used the real heart would certainly die, so they wouldn't pick that option, for several reason, one is obviously they do not just have spare artifical body parts laying around, and the other is that policy would leave many people with artificial hearts and poorer qualities of life and low life expectancies that could have successfuly had the real heart repaired. When working with limited amount of time, what they decide they are going to do needs to be right, as once in the middle of the procedure there will usualy not be enough time to change courses.
So what is the real question? Fatal as in eventualy dead? Fatal as in immediately not a threat to you? (which is not necessarily fatal.)
Or incapacitated? Are you thinking of this in a shooting situation from your perspective as the person inflicting damage and what wills top the threat, or really care more about whether the injury will certainly cause death at some point?
Now imagine every tool, life support and artificial part was available in some fantasy hospital for every situation, and they had the insight to know the extent of the injuries. They could replace, or sew up the heart, get it going, sew together the arteries, sew in tubes where the artieries were missing and fix surely fatal injuries, and if done prior to the patient's brain going too long without oxygen, have them recover. However a week later these tubes could be rejected by the body or one come loose or tear, the heart be rejected, and the person then die from complications resulting from the injury.
The same can be said for minor heart related injuries. The heart is a well tuned muscle, nicks and cuts or scrapes can interfere with the proper function of that muscle at a later date. So perhaps the person will die at a later time from a heart attack cause by an irregularity brought on by the scar tissue from the wound. Does that qualify as fatal?
What is fatal 10 minutes from medical care might not be fatal 5 minutes from medical care.
In terms of defense, damage and trauma that is enough to actualy force a person into incapacition immediately is far above what is fatal most of the time. Contrast this with willing incapacitation where the trauma, pain and shock of the injury causes the person to flee or fall as a subconscious/involuntary psycological reaction. Most are the later, but someone trained or otherwise in a different state of mind(perhaps due to drugs) can continue to will actions until the physical body ceases to function as long as the nerves upon which those functions travel are intact.
Depending on the injuries this can be seconds (before incapacitation, minutes before irreversable brain damage due to lack of oxygen), or minutes. A serious heart injury will usualy only be seconds before incapacitation. However if surgery was immediately undertaken on the spot (obviously it never would unless in a hospital) and the loss of blood pressure remedied by fixing the wound, while IV fluids were administered to make up for lost blood, what would 99% of the time a fatal wound could be survived. Since surgeries are not performed in the field this pretty much means anything that cannot be survived longer than an emergency response, and corrosponding arrival to the hospital is what you would call fatal. The emergency personel can more or less extend this window depending on the injury with IV making up for blood loss, and ventilators, pure oxygen making the most of limited breathing function, and other procedures mainly in line with trying to keep the circulatory system functioning even if artificialy until arrival. Then there is the time for assessment and prep, incisions etc.
So fatal is a hard assessment to make. Are you trying to determine fatal, or incapacitation? Unsurvivable fatal injuries to the heart will not immediately incapacitate. The loss of blood pressure, preventing circulation, and removing the blood already oxygenated in the blood through immediate heavy blood loss by serious damage to the heart will make them unconscious within a matter of seconds, but seconds is plenty of time to return fire if they were so inclined. Luckily the instinctive reaction is usualy to psycologicly incapacitate themselves due to shock. With total irreversable damage to the circulatory system, the brain will suffer permanent damage within 3 minutes, and be pretty much dead several minutes afterwards. Since there will still be some oxygen already present from the last moments of function, and some blood still oxygenated present, this window is increased because there is still oxygen present for the brain in minor quantities after circulation fails. But this only adds a short undetermined amount of time. However this is in determining fatal, the person will obviously be unconscious prior to that time passing. Thier survival will depend on what others do or do not do and the time frame it is done in.
It is not a video game where the person has a health bar and if that goes to 0 they are dead. However for contrast lets pretend it is. A person could drop into negative numbers and function at least a few seconds, or only drop to 50, and die minutes or hours later.
Also it depends on the medical fields ability to repair certain tissues. Technology is not yet advanced enough to replace certain tissues. So if too much tissue is missing, sewing it up obviously won't work that well. Can't really grab some artificial heart tissue to use as a patch, as the heart is a muscle. So any patch would be non functional tissue.
Now if an artificial heart was used the real heart would certainly die, so they wouldn't pick that option, for several reason, one is obviously they do not just have spare artifical body parts laying around, and the other is that policy would leave many people with artificial hearts and poorer qualities of life and low life expectancies that could have successfuly had the real heart repaired. When working with limited amount of time, what they decide they are going to do needs to be right, as once in the middle of the procedure there will usualy not be enough time to change courses.
Keep in mind the guy survived long enough for this procedure because the knife kept the wound small by plugging the very injury it created. Had the knife been pulled out he would have likely not survived. However had the knife been left in and been disturbed even more serious injury would be created. So he was lucky.
So what is the real question? Fatal as in eventualy dead? Fatal as in immediately not a threat to you? (which is not necessarily fatal.)
Or incapacitated? Are you thinking of this in a shooting situation from your perspective as the person inflicting damage and what wills top the threat, or really care more about whether the injury will certainly cause death at some point?
Now imagine every tool, life support and artificial part was available in some fantasy hospital for every situation, and they had the insight to know the extent of the injuries. They could replace, or sew up the heart, get it going, sew together the arteries, sew in tubes where the artieries were missing and fix surely fatal injuries, and if done prior to the patient's brain going too long without oxygen, have them recover. However a week later these tubes could be rejected by the body or one come loose or tear, the heart be rejected, and the person then die from complications resulting from the injury.
The same can be said for minor heart related injuries. The heart is a well tuned muscle, nicks and cuts or scrapes can interfere with the proper function of that muscle at a later date. So perhaps the person will die at a later time from a heart attack cause by an irregularity brought on by the scar tissue from the wound. Does that qualify as fatal?
paramedic70002
Member
This is the highroad; let's keep it that way.
"shot through the heart with a .357 Magnum, left ventricle blown out",
------------------------------------------------------------------
Just let me say a few things here:
I wrote that without reviewing the supplied material.
I was paraphrasing what Massad Ayoob said about the incident after HE interviewed Ms. Lim. I have not yet been able to find the original Ayoob article, I'm sure it's out there somewhere in somebody's Ayoob Files.
"shot through the heart with a .357 Magnum, left ventricle blown out",
------------------------------------------------------------------
Just let me say a few things here:
I wrote that without reviewing the supplied material.
I was paraphrasing what Massad Ayoob said about the incident after HE interviewed Ms. Lim. I have not yet been able to find the original Ayoob article, I'm sure it's out there somewhere in somebody's Ayoob Files.
mjrodney
Member
I started to write a detailed account of what was a terrible and tragic event, but I thought better of that and erased it in favor of simply saying that a despondent ex-co-worker put two rounds thru his sternum using a short barreled DA only revolver.
Fifty feet away from my window. In the parking lot.
Two rounds, maybe 10-15 seconds apart. Barrel against the sternum. His thumb was found in the trigger guard.
This would indicate, of course, that he had to have been alive after the first shot. And not totally incapacitated.
Fifty feet away from my window. In the parking lot.
Two rounds, maybe 10-15 seconds apart. Barrel against the sternum. His thumb was found in the trigger guard.
This would indicate, of course, that he had to have been alive after the first shot. And not totally incapacitated.
Art Eatman
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Chill out. Calm. Cool. Collected. Polite. Courteous.
Folks can at least fake being grownups. Heck, I've been doing that for well over half a century.
Art
Folks can at least fake being grownups. Heck, I've been doing that for well over half a century.
Art
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