You'll have to raise a rib.
[panting]
Operating on yourself for little wounds,
if you have anesthesia, doable, with mirrors.
I've done it a couple times on myself.
Hi, I'm Peter Rhee.
I'm a trauma surgeon for about 30 years,
and I also served about 24 years
with the United States Navy.
I'm back to look at more battle-wound scenes in movies
and judge how real they are.
OK.
[gunshot]
[gasping]
I give him a lot of points for the way that he dropped,
and that's what almost everybody does in real life,
is when you get shot, you just drop.
It wasn't these dramatic Hollywood type of
blown-back-from-a-little-handgun type of thing.
I'm going to take away points for how big the wounds are.
A sniper usually uses a bolt-action
hunting type of rifle
about three-tenths of an inch in diameter.
If you shoot them, it'll make a tiny hole.
I had one guy who was sentry, Marine Corps.
It was from the sniper of a Ramadi,
and we did a thoracotomy on him.
So he bled out his entire cavity into the chest,
but the entry and exit, tiny little hole.
No blood on the skin.
Covering fire!
What happened?
Sniper.
They didn't waste time,
they just dragged him out of there.
He's not moving his arms and legs,
so he could've hit the spinal cord,
but the trajectory looks like it did not.
'Cause right there, from that,
the moulage, it's more of the trapezius muscles
rather than the carotids.
Overall, you know,
what I was criticizing was too small and minor.
I'll give this a seven.
He's way past go. Who's next?
Over here, sir!
Col. Moody, sir.
Yeah. Mm-hmm. Most of our tents look like that.
The Marine Corps started doing this early in my career.
We started outfitting those things
and deciding all the little instruments
and gauzes that we were going to put into it.
And then the Army has these tents that, put together,
you can make bigger and bigger spaces.
But they had very nice fabricated metal shelves in there
and things like that. Those things are not available.
GSW to the abdomen.
Let's stabilize until we get him to an OR.
Give me some wet bandages and an occlusive dressing.
All out of those. I need a laryngoscope,
an ET tube. I need to intubate.
So, it looks like it's a triage area.
But what I didn't like right away,
he starts barking orders to that woman behind him.
He's talking to her like she's his assistant,
and she's got her own patient.
And then what he has is a GSW to the abdomen,
which is a gunshot wound to the torso,
to the abdomen itself.
And then the lady tells you
that she's got an emergent airway that she has to do.
Very rare from trauma unless you've got facial injuries.
Moody, sir. Sandstorm's coming.
Command's ordered us to move back.
Hunt. We'll take your GSW in the APC.
So, not very realistic.
When I was in Iraq, when we got sandstorms,
there were pretty bizarre stuff that that would come in.
And what you do is you hang tight.
Don't drive, stay indoors.
Doesn't make sense to me that they're going to
take everybody there in that situation and scenario,
get into APCs, which is armored personnel carriers,
and they just get into ambulances is all it is.
By the time they load them into the vehicles, trust me,
it's going to take well over an hour, an hour and a half.
So during that time period,
those patients would be dying as well.
[explosion]
[loud moaning]
So, this is a common scenario
where you would get an IED.
When you're inside these vehicles
and you get blown up from underneath,
they actually don't get penetrating injuries.
You get blunt trauma.
So when the guys come out,
the guy has a lot of fragmentation injuries.
Got it.
The hand was swelling so much
it would've popped the finger right off.
Save the arm. You gotta tourniquet it.
[screams]
None of this makes sense.
He's got an obvious neck injury, which is high priority.
So if they're dying to have somebody
with blood in their mouth,
this would be a time to do it. Right?
There's three things we're worried about in the neck.
That's your carotid artery,
your trachea, and your esophagus.
He's trying to tell him to
cut the arm off with a tourniquet,
and he was fussing around with a ring.
Again, life over limb.
And then, he's got plenty of tourniquets.
That's an ambulance.
And he uses his web belt from his pants.
I give this a two. Two out of 10.
I love this scene.
This wound was created by a sharp stick.
Eventually, the main thing is that
it's going to get infected.
Wood is notorious for just having
all sorts of germs and bacteria in it.
So getting it out reduces the burden of the bacterial load
and the fungus load and everything else.
Go Sylvester!
I was freaking out here
'cause it looked like he's going to burn his biceps.
When we do electrocautery in the surgery,
it's pretty brutal, and we do actually burn
a lot of the tissue.
So I wouldn't mind doing that
if the skin holes were bigger.
But his skin holes are usually tiny,
so not like he's got a big gaping wound in the back.
When you put gunpowder inside there,
I have no experience on this whatsoever myself,
but I'm just using my imagination,
that when you light it,
it's going to go this way, not this way.
So you are going to cause more tissue injury inside as well.
Using gunpowder to cauterize
and also to sterilize is theoretical,
but I think that's pretty hokey.
I'd give this about a four.
Don't try this at home!
The kid's got an infected arm.
But he seemed very bright in this scene,
so he was very aware, which is unfortunate,
because he's going to get the arm cut off
while he's awake, without anesthesia of any type.
It's all right.
The little knife
makes it look like one slice and it's done.
It's not. First, you gotta slice the fleshy tissue.
In the forearm, it's got muscle and stuff inside
protected by the bones.
Can't use a slicing type of knife to go through the bone.
You gotta have a saw.
We use what's called a Gigli saw,
which is a little cutting wire,
or we actually use a saw.
The best saw is a hacksaw,
but the surgical saws are going to be OK.
I've never caused that kind of pain,
where I gave them something to bite on.
Normally what we do in that situation
is we open up the wounds and let it puss out.
And they don't need to necessarily amputate the arm.
But life over limb.
You will amputate the arm in order to save a life.
I'm assuming that he might've had a fracture underneath it
or they tried to get it to heal and they couldn't.
You'll have to raise a rib.
[panting]
Operating on yourself for little wounds,
if you have anesthesia, doable, with mirrors.
I've done it a couple times on myself.
They even did that in the 1800s.
The issue that I have with this particular clip
was raising the rib.
If you hit the rib, it's very, very painful.
The ribs are extremely sensitive.
Hi, sir.
She'll patch up nicely.
And what he was really doing is going after the bullet.
We normally don't take out all the bullets that we find.
If it's easily palpable and we can find it,
it's in soft tissue, then we'll pluck them out.
But most of the bullets do OK in the body.
But in the movies, they always make it look like
if you get the bullet out, you'll live,
and if you don't take the bullet out, you'll die.
It's good. It's good overall.
They're pouring sulfur on it.
It is an antibiotic. It's an antibacterial.
If you got a fractured leg, you got a gash or wound,
if you put sulfur on it, it helps.
Doesn't really stop the bleeding.
He keeps saying, "Am I shot in the spine?"
That's so smart of him to say that.
And if he is, he's paralyzed.
Paralyzed legs won't kill him.
But if he's bleeding a lot,
It really makes a huge difference
whether it's a handgun or if it's a rifle.
The guns that they used to use in World War II
that Germany had, there were two kinds.
One was from a rifle and a machine gun,
which are these large bullets which are very fast,
but they'll make tiny little holes actually on the entry.
But in the exit, they'll blow it out.
They carry submachine guns.
The bullet coming out of there
is no different than a handgun.
So those will typically not create as much of an exit wound.
If it's a rifle, when it goes out the back,
it's a large hole.
And it's also called a cavitation wound.
Overall, I'd give this an eight out of 10.
Battalion aid says he's got an open chest wound.
There's blood pouring through the pressure bandage.
I think he's got a lacerated aorta.
He diagnosed that because the dressings are bleeding
that he's got a hole in the aorta.
It could be coming from anywhere.
I can't get in there. You got a knife?
As soon as I get my hand in there,
I'm going to compress the aorta against his spinal column
and try to stop the bleeding.
If he came in with a hole
that you could fit your hand into,
then you can go in there
and manually compress the aorta blindly
at whatever area that you want to.
So, he's going to take a knife
and make the skin incision bigger.
But you can't get your hand in between the ribs.
You have to actually split the muscle all the way
front to back on the ribs
in order to get a retractor,
which is a vise, reverse vise,
that splits your ribs open
so we can get into the chest cavity
so we can put a clamp on the aorta.
We cut off the blood to his spinal cord
for more than 20 minutes,
he stands a good chance of winding up paralyzed.
When you put a clamp on the aorta,
he's right, if you do it too long,
then your organs below the clamp will die.
But it preserves the blood from above the clamp
to keep your heart and brain alive.
Step through.
Get his head and shoulders flat, right on the floor.
Klinger, we're going to need more ice!
When they cool him from the bucket of ice,
that's called external passive cooling,
where you let the heat go
from your body to the ice and melt the ice.
That takes a long time to cool the core.
So it's a waste of time.
You have to do what's called active internal cooling.
You can only do it with a pump or something.
It would go to every cell in your brain,
every cell in your heart, every cell in your body.
And that's a very efficient way to exchange heat.
Here's the graft, doctor.
Here goes.
If you stick a piece of aorta from another person into him
that will give you maybe three or four days
before that blows out, because it's not your aorta.
It's not been matched.
And when it's the wrong transplant,
it will blow out, and you'll die.
From a feasibility medical standpoint,
this is, like, a 1 ½ to two.
Appears to be lodged between the femur and the muscle.
We're on our way up right now.
OK, so, pause here for a second.
Who put those clamps on there, OK?
And what are they clamping?
And where did he get the X-ray from?
How did he notice it was her X-ray?
By the way, the X-ray of a little old lady
with hardly any soft tissue and has no fracture.
She's got a 20-millimeter unexploded ordnance in her leg.
What?
There's a 4-meter blast radius.
Any movement could set it off.
He acts like this is going to be a fusing of a bomb
that if you hit the wrong fuse, it's going to go up.
This is a 20 millimeter.
20 millimeters are what they use in Vulcan guns,
in Gatling guns on helicopters, and airplanes.
You know, F-22s, F-18s.
These things are highly stable,
even the high-explosive ones.
So when they hit a tank,
then they will fragment and explode,
but pulling them out of a leg
is not going to cause an explosion.
Clamping or repairing?
Clamping.
And that's a round, not a projectile.
They've got its casing still in the back.
It's only the projectile that comes out of the barrel.
And those blue gloves are not sterile.
The blue gloves are just disposable gloves.
They don't have hats on, masks on.
They're doing this in the lobby or somewhere like that.
And I worked in Los Angeles in that ER for five years,
and I started the Navy trauma-training center there,
and the lobby never looked that nice to me.
She's hemorrhaging.
In the military, in a situation where
there's an actual explosive in the body,
we will set them off to the side outside of the facility,
where no one's going to get hurt,
take care of everybody that needs to get taken care of
urgently, emergently,
get a team of volunteers to go out there.
They'd put a stronghold around them and then do the thing
for the metal that they're going to get.
In a civilian setting, none of this stuff makes any sense.
I'd give this a zero out of 10.
Let me see, let me see.
Nicked the artery.
It'd be OK if he didn't say there was an artery,
but didn't look like it was bleeding much at all.
And there was not a swelling or a hematoma underneath it.
So from a medical standpoint of all of this,
that wound there won't kill him.
And then his sewing, the techniques were not good.
Civilians have a tendency to try to use in the movies
the ringed forceps, the ringed instruments
in the thumb and then the first finger.
It's usually for your fourth finger, and you control
the rest of the instruments with the other two.
Doesn't tie a knot, and he bites it off.
When you sew, you could do a running stitch, which is fast,
but then he bites off and then leaves that thing down
without tying at least the knot.
So that's going to unravel.
Here, just below my floating rib.
Be sure not to hit my --
All right.
Be sure not to graze my --
That's a little too medial for me.
He hit him right in the clavicle.
Up here, if it goes into clavicle,
it could be very problematic.
And then you get a little lower,
you can get a lot of nerves.
Choice locations are OK.
Medical-wise, obviously he did
such a bad job of doing that up there.
I'd give it a five, five out of 10.
None of that's going to do any good
until we get that arrow out of him.
Good.
OK, got it.
So, that doesn't make any sense to me.
The arrow, if he got shot front to back,
it has already caused the damage where it resides.
So why would you pull it out the other side?
The only time I would pull it through
is if it's a target arrow and it doesn't have a tip
and there's feathers in the back that you can't pull out.
Now, that's got a razor tip to it.
If it went front and didn't come all the way out
to the back, it didn't pierce the skin,
it has already injured what it's going to injure.
Just pull it out the front.
Why cause more injuries by cutting him surgically
and then cutting more muscle?
You just go get it again for -- ah, wow.
Distilled spirits is 40%.
So it has some antibacterial properties.
You won't get any contaminants into the wound,
whether you use rum, vodka, gin, whiskey, bourbon.
It doesn't matter.
I give this a four out of 10 max.
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