Cut-Throat Old Ladies

How much strength dose it take to cut a throat? Can an old lady do it?

I'll be honest. When I got this question in my inbox, I thought to myself, 'how should I know'? And then I thought 'how do I find out'? Questions like this, which seem to be so specific that the knowledge would really only help the questioner sometimes turn into real gems. In this case, my second-thought led me to a wonderful resource that I feel compelled to share with all of you who read this modest little effort of mine.

It took me three tries and strong Google-fu to find anything even close to what I was looking for, but of all the research I've done over the many years I've been doing this, both formally here and informally at Forward Motion and NaNoWriMo forums, this excites me more than any of the rest of it.

The resource I've found details, with step-by-step illustrations, nine methods for silently taking out a sentry by stealth, several of which would allow even someone with minimal physical strength to effectively kill a much stronger individual, both quickly and silently.

Again, just for the sake of my conscience, PLEASE, PLEASE, do not try this at home (or anywhere else but your fiction-verse). Don't even try it in demo mode with a willing partner and a blunt instrument. You can do SERIOUS damage to the structures of the neck and even cause death just from some of the initial steps prior to the actual cutting of the throat.

The full story, with illustrations - Sentry Removal

From what I know about physiology, these techniques look like they would be pretty effective, some more quiet and requiring less physical strength than others. For the sake of brevity, I'll focus on the first (illustration below). The idea here is to stun the sentry or victim using a blow to the neck/shoulder junction with the handle of the knife, then pull that person back against the attacker's body and let the weight of the victim slide down toward the floor. The weight of the victim would provide all the force required to actually cut the neck.

One of the first things you get taught in nursing school is if a patient is falling, slide them down your own body. It's possible to control the "fall" of a much larger/heavier person without injuring yourself if you use this technique. Using this technique while allowing the victim's weight to pull the knife through the tough, fibrous structures of the neck would allow even a very under-powered person to kill any opponent whose neck they could reach.

I could see this information applying to my own fiction and I can certainly see a wide-spread appeal for this type of information among the folks with stomachs strong enough to read this blog. Great question!

*****This blog is written for fiction writings, for the purpose of writing fiction. Information herein is not intended for use by real people, pets, trees, or imaginary friends. Arizela is not responsible for information used for purposes other than those expressly intended*****

Animal Attacks

So your character is wandering along, minding his own business when out of nowhere a vicious creature leaps on him intent on lunch. The intrepid hero manages to fight the beast off, or perhaps the plucky heroine rescues him for a change, but he's not without battle wounds. Now what?

What kind of creature was it?

• Small animals like rabbits, rats, and squirrels tend to cause small, painful bites and marks, but unless your character is a hemophiliac, chances are he'll survive.
• Camels, horses, and other large grazing animals can do some major damage with bites, particularly if they occur on the head or face. Another concern with these animals is crushing injuries from hoofed kicks which can be serious or fatal depending on the force of the blows.
• Domestic cats and dogs come in all shapes and sizes, and their damage capacity varies just as much. The ferocious neighborhood chihuahua isn't likely to cause nearly the trauma that crazy old Bill's trio of abused pit bull guard dogs could. Likewise and ancient rolly-polly tabby cat is less likely to eat your face than a muscular tom in his prime.
• Large predator animals, be they tigers, lions or bears (or wolves, coyotes, primates, etc) are the biggest risk. Harder to fight off and with much more advanced weaponry than the average racoon, these big carnivores and omnivores mean business. Their survival depends on their ability to turn the next guy into ground chuck rather than being served up themselves. Big cats in particular come along with an increased risk of infection because they routinely lick their claws, dragging mouth germs all over these 5cm to more than 8cm long weapons.
• Humans (yep, we're animals too, folks) typically only bite during altercations of some sort (and in undead movies). Our teeth can do a lot of damage to hands and faces, but like the grazing animals above, the damage is usually limited to the cosmetic rather than the life-threatening (vampires and zombies aside). The big risk here is that human bites are much more likely to become infected than most animal bites. Yes, your mouth is dirtier than your dog's.

First things first - stop the bleeding

In an emergency situation, the ABC's of triage apply - Airway, Breathing, and Circulation. Most survivable animal attacks are going to endanger the third category, circulation. No blood means no circulation means bye-bye birdie, so the goal of first aid is to keep the blood where it belongs, on the inside. If the blood isn't gushing out, washing the wound in clean running water is recommended to prevent infection, but stopping the bleeding is more important and more immediate a need.

All but the deepest and deadliest injuries in a normal, healthy person are going to respond to pressure. Obviously if the animal has ripped into the abdominal cavity or neck or sliced through an artery, your character had better hope there's a rescue chopper on standby. But for flesh wounds, pressure is your friend. To stop most bleeding, apply direct pressure to minor wounds for 5-10 minutes without peeking. Even for deeper gashes, direct pressure will often stop or slow bleeding until further help can be organized.

Minor scratches can be cleaned with soap and water and covered with a clean bandage. Puncture wounds, deep scratches or wounds on the face should be attended to by a medical professional if at all possible. If your character is enjoying the good life in 1810, however, cleaning the wound with clean water and using stitches to close the wound is about the best you can hope for.

Special cases: Facial and scalp wounds

Face and scalp wounds bleed. A lot. Bleeding from scalp or facial wounds, even small cuts, can be pretty significant. Get pressure on it as soon as possible and seal the wound with stitches or surgical-grade bonding liquid (aka medical grade super glue).

Second step - Preventing Bugs

Infection is the most significant risk associated with wounds that are not immediately life-threatening (these include uncontrollable bleeding, penetrating abdominal, head, or chest wounds, neck injuries, head injuries). Keeping wounds clean and covered helps in any setting. In the modern world, small cuts can be covered with a thin layer of antibiotic ointment like Neosporin, Polysporin, or Bacitracin. Large, penetrating wounds may require surgery and/or prophylactic (preventive) antibiotics via either oral or IV methods.

If an infection occurs, symptoms usually start 2-5 days from the initial injury or sometime during the healing process for major wounds (which can take months). Symptoms include redness of the skin around the wounds (see photo, child with infected dog bites to face), increased pain, heat or warmth at the site and on the surrounding skin, foul-smelling drainage or pus (creamy or chunky textured drainage in any of several common colors including yellow, rust-brown, green, pink, blood-tinged, or white), and delayed healing. If the symptoms don't get any worse, minor wounds usually clear up on their own after a few days or a week in healthy individuals. However, folks who are very old, very young, immune-compromised (prone to getting infected), diabetic, or who have circulation issues, or folks who have deep or large wounds, or whose infections are caused by "super bugs" (antibiotic-resistant germs) can get very sick, very quickly and even die from skin infections.

Signs your character needs a doctor, shaman, or undertaker - fever, chills, generalized feelings of weakness, ill ease, fatigue, red-streaks along the skin starting at the wound and tracing lines outward, irregular heartbeat, or difficulty breathing. These symptoms may indicate a life-threatening spread of infection into the blood stream or other body organs. Some few people recover without aid from this sort of infection, but there is a high risk of death.

Third, consider the source

Bites from your fellow humans typically occur during a fight of some sort. In those situations where there is a likelihood of blood from another person entering an open wound, special tests for HIV and hepatitis are recommended.

Small animals, particularly rodents, can be carriers of Yersinia plague (aka The Black Death, see also Rare Diseases: Yersinia Plague). Yes, even in modern times, Yersinia plague can cause deadly disease, but modern antibiotics can cure the plague if given within a very narrow time frame. Seeking medical attention can be life-saving, particularly in regions where animal carriers of the plague are more common, like the US west.

Wild dogs, stray pets, raccoons, and large predator animals are considered to have rabies unless proven otherwise. Rabies is a disease which, if left untreated, leads invariably to madness and death. Treatment consists of giving a series of vaccine injections after exposure but before symptoms develop. Once symptoms show up, best start digging the grave.

Domestic dogs and cats are considered free of rabies if they have been vaccinated or if they could not possibly have come into contact with wild or unvaccinated animals.

Special Case: Bats in the Attic

Though bats are small mammals not birds, these tiny bug-eaters can harbor rabies virus. Bats are responsible for most of the cases of human rabies that occur in the US. According to the Centers for Disease Control, Rabies can be confirmed only in a laboratory. However, any bat that is active by day, is found in a place where bats are not usually seen (for example, in a room in your home or on the lawn), or is unable to fly, is far more likely than others to be rabid. Such bats are often the most easily approached. Therefore, it is best never to handle any bat. Bats have tiny, needle-sharp teeth that can penetrate the skin and infect a human without even leaving a mark, so if a Sunny Susie awakes to a bat flying around the ceiling, she'd best get the bat tested for rabies, or she could end up looking like this:

Just kidding!

Cuts on the inner forearm

A question recently hit my in-box from an author who has a character being tortured for information. In the scenario, the author intended to have the protagonist "stabbed on the inside of his forearm and the knife gets dragged through the flesh towards the wrist a couple of inches." The protagonist needs to be worried, but able to walk a good distance and not pass out or die from shock.

The trouble with using a knife as a torture device is that unless the torturer is very skilled at what he does and knows anatomy very well, he's as likely to kill as extract information. In this particular case, there are two decent sized arteries running along the inside of the forearm, the radial and ulnar arteries (see photo). Stabbing down into the flesh and dragging the blade toward the wrist is almost sure to hit at least one of them.

Slashed wrists is a common method of attempted suicide which is widely known to not be terribly effective because by the time the artery gets to the wrist, it's pretty small. It can take hours to bleed to death from a slashed wrist, but cut the artery higher up the arm and you've got bigger problems. Shock can set in pretty quickly - my best guess being within ten minutes. And after that, you've got some time to stabilize the victim, but he's not going to be doing much to help you as he will likely be unconscious or too confused to function.

If your victim gets away within minutes of the cut and applies pressure directly to the wound and then gets help, chances are good with surgery and perhaps blood transfusions that the victim will live.

If you want a lot of pain, an alarming amount of blood but not truly immediately dangerous, you could go with any major muscle group that isn't near a major artery. Muscle bleeds a lot. Some locations that are pretty choice, the calf muscle, the muscles of the outer forearm, the top of the thigh or outer thigh area, the shoulder. Think meaty parts that aren't near pulse-points. The muscle will likely stop working for a while, but with some stitches will generally heal up pretty well.

Alternately, cuts that bleed an alarming amount, hurt a lot, and are generally unlikely to cause death are cuts to the ears, scalp or forehead. Try not freaking out when someone slashes you across the forehead and there's blood running into your eyes.

*****This blog is written for fiction writers, for the purpose of writing fiction. Information herein is not intended for use by real people, pets, trees, or imaginary friends. Arizela is not responsible for information used for purposes other than those expressly intended*****

Rib Injuries

Question: What are the differences, symptoms, severity, and complications of rib injuries, and how much do they hurt?

Ah, ribs. Those grand old things that protect all your most vital organs. What lay-people generally think of as a ribcage aren't just bones though. They are actually composed of twelve bones on either side of the chest, plus thick, tough cartilage (like in your nose, only stronger), and the sternum (breastbone). All 24 long, curved rib bones attach to the spinal column in the back (backbone), but in the front, only some of them are attached at all. The top seven on either side are attached to costal cartilage which attaches directly to the sternum. The next three pair are attached to costal cartilage which attaches to another cartilage rather than the breastbone, and the bottom two pairs, called "floating ribs" don't attach in the front at all.

In the above computer modeled ribcage photo, the white areas indicate bone and the golden-yellow areas are costal cartilage. The area circled in pink is a small tip of bone called the xyphoid process, which can be broken off pretty easily. In a living body, there would also be muscles called intercostal muscles in between each long rib bone to connect each bone to the one above or below it.

Types of Injuries

There are three basic types of injuries that can happen to the ribs: Fractured or broken bones, bruised bones, and torn cartilage. "Cracked" ribs are broken ribs - there is NO difference between cracked and broken ribs, however breaks can have varying severity - anything from a little "crack" to a complete break across the entire thickness of the bone. The symptoms for all three are going to be pretty much identical.

• Pain, especially when taking deep breaths, coughing, laughing, bending, twisting, lifting weight, or pressing over the injured area.
• Possibly bruising over the injured area
• Crunching or grinding noises or sensations with movement
• Actual deformities in the shape of the chest over the injured area (a dent, basically)
• Difficulty breathing (either from the pain or as a complication of a fracture - see below)

How do rib injuries occur?

Anything that causes a trauma to the chest can injure the ribs. Contact sports, fighting, car crashes, and CPR are some of the most common causes of damaged ribs. I once had a doc tell me that if you're doing CPR chest compressions and you DON'T feel ribs breaking, you aren't doing it right. While not a really good rule of thumb, it is true that CPR chest compressions often result in broken ribs, especially in the elderly and small children. It is important not to be afraid of breaking ribs though, when doing CPR. Most people would rather be alive to complain about the rib pain later.

How are they treated?

In modern medicine, all three injuries are basically treated the same way:

• Rest - avoid anything that makes the area hurt, except breathing.
  
• Ice, on for 10-20 minute and off for 20-30 minutes. Rinse and repeat.
  
• Over the counter pain medications - preferably in the NSAID (non-steroidal anti-inflammatory drug) class such as aspirin or ibuprofen because these drugs treat inflammation/swelling as well as pain, unlike tylenol(acetaminophen)
• Deep breathing exercises to prevent pneumonia if breathing is troublesome.

In days past, docs used to apply rib splints or compression dressings (think ace wrap) to help "support" the ribs and prevent them from moving around too much. This decreased the amount of pain associated with breathing and coughing and whatnot, but in turn significantly increased the risk of pneumonia and death as complications. Oops.

We don't do that so much anymore, although applying some firm, consistent pressure with a hand over the injured area only when coughing or sneezing, or doing something else short term that causes increased pain can be effective at decreasing pain. These days compression dressings and splints are only used in cases that are VERY severe.

What nasty little surprises can my characters expect me to spring on them down the road?

Ah, complications. They do make a story interesting. The complications of rib injuries are going to vary by the injury a bit.

• Pneumonia - All three types of injury can cause significant pain with breathing, encouraging the person to take very shallow breaths. If the person keeps this up for a few days or a couple of weeks, chances are good that the person is going to regret it later, in the form of a solid case of pneumonia. The lungs produce mucous constantly. Kind of ichy, but there's a good reason for it. Germs, dust, and other nasty things that shouldn't find a home inside your lungs get trapped in the mucous and coughed up. If you don't take breaths that fill your whole lungs up with air, over time the mucous can thicken up and "collapse" the air sacs inside the lungs, along with their collected germs. Viola, pneumonia. Symptoms of pneumonia include fever, chills, coughing up stuff from deep in the lungs(usually yellow, tan or green in color), wheezing, and difficulty breathing. If not treated or overcome by the body's natural immune abilities, pneumonia can quickly lead to blood stream infections (sepsis), shock, and death. Or it can linger around for a long time and cause a gradual worsening or leave permanent damage (short breath, wheezing).
• Punctured lung - this is usually going to show up pretty quickly and only in severely broken ribs (think massive trauma to the chest, like smashing against a steering wheel while not wearing a seatbelt in a 50mph car crash). The space between the injured lung and the ribs will fill up with blood(hemothorax) or air (pneumothorax), squishing the lungs over in the process and making it harder and harder to breath. If there is air moving from the lung into the space, the lungs and eventually the heart will get smooshed over to one side (away from the injury) until they can't expand anymore and the person basically suffocates and the heart can't refill with blood to pump anymore. This is called a tension pneumothorax and MUST be treated immediately.
  

This illustration depicts the insertion of a chest tub, a flexible tube that is placed into the space that fills up with stuff to allow the blood or air to drain back out. Just sticking a tube into the wound isn't going to help much though. Chest tubes use basic principles of pressure differentials to "seal" the tube so air and blood can leak OUT but air and germs can't get back IN.

All this scientific stuff is neat, but how does it FEEL?

Speaking from experience, broken ribs HURT. And by hurt, I mean it sort of feels like someone is sticking a high-heeled shoe straight into your lungs and giving it a little twist. That said, it is certainly possible to battle through the pain, especially when the injury is fresh and all those endorphins (brain chemicals that tell your brain to ignore pain) and adrenaline are sloshing around inside you. I personally took three good swings with a baseball bat at the jackass who broke two of my ribs before the pain hit. (He was much bigger and stronger than me. The bat evened things out nicely) After the pain hit, I did a lot of walking humped over, holding my side, and generally being miserable for a couple of months. Life went on.

How long does it take to recover?

Bruised ribs and torn cartilage usually take 3-4 weeks to recover. Fractured bones, 6-8 weeks. However, this rate is GREATLY impacted by numerous factors and the healing can take MUCH longer. This is great news for our intrepid writer, as you can really play with the time factor here. My personal rib injury still gives me significant trouble off and on 15 years later.

Factors that increase time to heal:

• Old age
• Osteoporosis or generally weak bones
• Reinjuring the area (like the folks who continue to play football with cracked or broken ribs)
  
• Not resting enough (like that character who's going to be dodging bullets or swinging swords)
• Other injuries - the body has limited resources and not all things are equal
• Nutrition - bones and cartilage require certain components to heal, like calcium and especially protein. Healing will still happen for folks with very poor diets, because the body will rob from other areas eventually, but proper nutrition will help speed healing and prevent infection
• Infection - infected tissue doesn't heal. Basically, the body has other things on its mind if it's trying to put out fires
• Severity of the injury - a complete break along the full thickness of the bone is going to take longer to heal than a partial fracture. Likewise, multiple rib fractures or multiple torn cartilages will not provide adequate support for each other to heal and may slow the process down a bit
  

Rib injuries can be a nice way to give your characters unpleasant lives for a while and make things just that much harder on them, but by themselves they aren't going to keep a determined hero or villain out of action most of the time. They'll hurt enough to discourage athletics, but those endorphins and adrenaline can work magic even here in the real world.

Infected Cuts

Q: What do infected cuts look like?

A: First off, there is likely to be an angry red color around the margins that extends anywhere from a few millimeters to several inches (reasonable size for a smallish cut 1-5cm). The area will be swollen, tender to the touch, and warmer than the surrounding skin.

The wound may drain blood, clear fluid, or pus or a combination of these. Pus colors range based on what the infectious organism is, and can include yellow, yellow-green, green, white, or tan/beige, but can also be tinted pink by blood getting into it. Blood from a wound that is infected will often be very dark or have clumps of pus floating in it.

The wound may form a moist-looking yellow scab or a dark, hard scab as it attempts to heal - these are both composed of dead tissue and the wound will heal faster and cleaner if they are removed and the wound bed is kept moist but not sopping wet. That said, constantly picking at a wound is a bad idea, too.

The best treatment for a small cut is to wash with soap and water, and cover with a clean dry bandage (and an ointment like Polysporin if modern era). Try to keep it clean and don't do what my son does and leave the bandage on for two weeks or until it disintegrates in the shower.

Large or deep cuts may require sutures or some sort of adhesive glue meant for surgical application (no, please don't use SuperGlue. It works like a charm, but non-toxic really isn't meant to read: safe to pour into open wounds). Again, washing the wound, keeping it clean, and keeping the wound-bed moist or the sutured cut dry will aid healing.

Infected minor cuts rarely turn into systemic problems, but if the red margin of the wound starts to look streaky or the red starts to follow veins in streaks, this is a sign of serious, potentially fatal infection of the bloodstream and needs emergent treatment. Likewise, a sudden, serious increase in pain, or severe swelling of the area can indicate serious infections.