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.
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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.
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?
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.
See more: Can You Put A T8 Bulb In A T12 Fixture S? Will Led Tubes Work In My T12 Fixtures
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?