Venous Bleeding

Castle: Dying From Medical Inaccuracy

/ Jordyn Redwood / Leave a comment

Personally, I loved the show Castle. Sadly, it’s been cancelled and perhaps it’s for the best– especially if Season 8, Episode 21 entitled Hell to Pay is any indication of the attention to detail they were giving their medical/forensic scenarios.

The following is the assessment medical examiner, Lanie Parish, gave concerning New York’s latest murder victim.

“He bled to death from a wound in his left side. My guess is whatever he was stabbed with punctured his subclavian artery. After that he would have had about thirty minutes to an hour tops.”

There are TWO major problems with the above assessment.

First, your right and left subclavian arteries are located just below your collar bones. So, if you’re stabbed in the left side, it’s really hard to hit that sucker. That got me thinking about what is on your left side that could cause brisk bleeding. Your spleen is located on your left side tucked pretty nicely under your lower left ribs. Perhaps they meant splenic artery which would have been appropriate for the scenario.

Second is the time frame. If you have a severed artery, the bleeding will be severe and deadly if not controlled in a matter of minutes. There is no way this character would have survived thirty to sixty minutes– I’d give max time at ten minutes and that might be pretty generous.

So Castle, at least go out on a high note with a medically accurate death scenario.

Seven Medical Posts for Authors on Blood Loss and Bleeding to Death

/ Jordyn Redwood / Leave a comment

How fast a person can bleed to death is a very common question among authors and I’ve done several posts on the topic. About a month ago, I got a comment asking a variation of the question.

It’s as follows:

Although I’ve worked in an animal clinic for years, I wasn’t sure how much of what I’d seen there translated to the human side. I’m currently editing someone’s manuscript and the injuries in a couple of scenes struck me wrong enough to do some digging before revision. A couple of things I’m still looking for is how long a person remains conscious with arterial or venous bleeding (in one scene, this is from a femoral injury) and whether/how much accelerated heart rate from exertion speeds bleeding?

Jordyn Says:

It’s hard in medicine to give actual time frames. The best demonstration I ever saw of how fast it took to bleed out was from a physician that drilled a hole into a two liter bottle of pop and then squeezed it mimicking a heartbeat. He said the size of the hole could be equated with an injury to the popliteal artery (which is behind your knee) and that bottle was empty in about two minutes.

Devastating injuries to larger arteries (your aorta for instance) can cause the patient to bleed out (hemorrhage or exsanguinate) in 1-2 minutes. It’s fast. For instance, if you rupture your descending aorta in a hospital and they know exactly what is wrong with you, and even have a couple of IV’s in place, your chances of survival are still not awesome.

Some general rules:

Arterial bleeding is faster than venous bleeding. This is because the pumping action of the heart causes more brisk blood loss. That being said, all bleeding can lead to death if not controlled. It’s probably safe to assume that bleeding from an artery without any intervention could lead to unconsciousness in one to three minutes and death in under five minutes.

Uncontrolled venous bleeding might take upwards of twenty minutes or days. Again, if not controlled in any way. Again, this could be variable. The author has a lot of leeway.

Does a fast heart rate accelerate bleeding? Yes. The faster your heart beats, the more blood spills, particularly from an arterial bleed. This is a double edged sword because your body will compensate by increasing your heartbeat during blood loss to compensate for all those red blood cells on the pavement and not in your body carrying oxygen.

Here are other posts on the topic of blood loss:

Author Beware: Arteries vs. Veins.

Author Beware: Arterial Bleeding vs. Venous Bleeding.

Killing my Arteries: Truth or Die by James Patterson. Can IV drugs be given in an artery? 

Pregnant Woman Bleeding to Death.

Pregnant Woman Bleeding after Delivery.

Bleeding to death from gunshot wound to the arm and back? What organs can be hit to bleed but not be lethal?

What other questions do you have about characters bleeding to death?

Author Question: Exsanguination

/ Jordyn Redwood / Leave a comment
Heather S. asks:

I came across your website while browsing for some information for a project. I am currently a nursing student and am doing a project on arterial bleeding. I am trying to find specific exsanguination times for the major artieries in the body. I have had no luck after searching online and multiple medical books. I just need a simple answer, i.e carotid artery 2-20 minutes. I have a few times, however, I feel that they are inaccurate. Please see below:

I-stock Photo

Carotid – 2-20 min

Brachial – 5-60 min
Femoral – 5-60 min
Aorta – 1-2 min
Popliteal – 5-60 min

I would greatly appreciate your help as it seems you are extremely interested in medicine. This might go on to help your other readers as I came across the questions dated January 12, 2012 where you discuss exsanguination. Thank you!

Jordyn Says:
Your question is not an easy one.

Any major artery (and the ones listed are major) that is completely severed will likely lead to the patient’s death in less than five minutes. I saw a demonstration once where a physician simulated this happening.

He took a 2 Liter bottle (an empty pop bottle) and filled it with water. He drilled a hole into it (to simulate arterial severing) and then squeezed it at a regular rate to simulate the heart pumping. That bottle was empty in a matter of three minutes. Yes, we timed it.He said the diameter of the hole he drilled equated to the popliteal artery which is behind your knee.

However, the injury may not be a complete separation which is why you have the varying time lengths. Of course, if the person gets some type of medical treatment (like a pressure dressing that stems the bleeding) they may last a lot longer as well.

I know this answer isn’t a clear cut answer but in medicine . . . they usually aren’t.

Heather’s Follow-up Question:
Could I say the smallest time is the fastest time to bleed out without medical attention and the longest time is a small bleed from an artery?

Jordyn Says: Yes, this is reasonable. 

Medical Question: Exsanguination

/ Jordyn Redwood / Leave a comment
Dee asks: How long would it take a character to bleed out if they were shot in the arm and the back? What organs can be hit to bleed but not be lethal?
Jordyn says:
If an artery is hit, bleeding out (exsanguination) can happen very quickly. Like a matter of minutes. So, if you want these people alive, I wouldn’t have the bullet hit any artery. You have several major arteries in your chest (aorta, pulmonary artery, etc) and the brachial artery in your arm that lies under your bicep. A truly severed artery will pump blood out with each heart beat and the bleeding is hard to control. So, I would go for venous bleeding which can also be dangerous but will allow more time and can be easier to stop.
Dee asks: I’d like the character to be in the hospital for a few days. What is the option there?
Jordyn says:
You’d asked what organ could be hit but not be lethal. I would personally go with a lung injury if there is a bullet to the chest/back. The lung could collapse and cause bleeding as well. This would require placement of a chest tube to resolve so they’d be hospitalized for 3-5 days depending on how the lung re-inflated.
Keep in mind, venous bleeding can be deadly as well. If some of the larger veins are hit like the subclavian vein which is up by your clavicle– bleeding could be swift enough if not stopped to cause death. All bleeding can lead to death if it’s not stemmed (either by your blood clotting or by someone applying pressure to keep the blood in place until the blood clots). I once heard a coroner give a talk about a man who was drunk and on Coumadin which is a blood thinner. He dropped a knife onto his foot and happened to cut an artery. Well, in his drunken state, he didn’t realize how serious it was and he bled to death. Sad but true.

Author Beware: Arterial Bleeding vs. Venous Bleeding

/ Jordyn Redwood / Leave a comment

I’m going to start doing these “Author Beware” posts every now and then. When you see that heading, it signals I’m doing a post on something a published author has written that medically is questionable. Now, I won’t name the author or book, just the situation. So, if you know the book and/or author, please keep it close to the vest. This is merely for learning purposes.


geology.com

In two novels recently, I’ve come across inaccurate descriptions of venous versus arterial bleeding. One novel in which a character had slit his wrists clearly described arterial bleeding but called in venous bleeding. Another novel described a puncture wound to the neck and a “geyser” of blood from the wound yet the character made it to the hospital with a dressing around his neck.

First, what is the difference between arterial and venous bleeding? A short anatomy lesson first. Arteries are on the forward side meaning this is blood that has just left the heart. In order for your heart to get blood through the body, it has to pump. The heart’s pumping is something you can feel… it’s called your pulse. Whereever you feel your pulse is an artery.

Venous blood is on the return side. This is blood that has off loaded its oxygen and is on its way back to the lungs. There’s not as much pressure, per se, in those vessels.

When you puncture an artery, it spurts, pretty dramatically, with each heartbeat. I saw a demonstration once of how long it would take someone to “bleed out” from an untreated arterial bleed to the knee which houses the popliteal artery. Now compared to some, this would be a smaller sized artery compared to your aorta. Any guesses?

About three minutes.

Venous bleeding doesn’t have the characteristic spurting with each heartbeat. It generally oozes though it can ooze quite a bit. Venous bleeding can also be deadly if there is enough of it left untreated.

Arterial bleeding is generally harder to control than venous bleeding. You have to apply a lot of pressure to get it to stop. Hence, my dismay at how a character who sustained an injury to his neck, likely the carotid artery, could have made it to the hospital with a simple dressing in place.

What do you think?