Who is Kentucky Ballistics and why did he almost die on his YouTube channel?
Hey Interns, I’m Dr. Chris Raynor and I am not your everyday ortho. I teach you about injuries,
orthopedic surgery, and medical topics in a way that is easy to understand and entertaining.
Today for medical rounds I am going to look at the recent injury of the YouTube content creator,
Kentucky Ballistics. His video talking about his recent injury came up in my feed a while ago
and I found myself drawn to it. In his video, he detailed what happened at the time of his injury,
what injuries he suffered, and the care that he received following his injury.
If you want to learn more about exactly what happened, you can watch his video on
his channel. He has over 15 million views, so it has definitely been well received. In this video,
I am going to go over his injuries in more detail and provide a medical perspective on
the treatments that he received. I hope to give those of you without a medical background a better
understanding of what occurred. This is definitely going to be a longer video so buckle up.
I should say that although this is not a firearm video, unfortunately for Scott,
a firearm was involved in his injury. Although, the injury was no fault of his own,
if you are going to use a firearm be sure to do so at a suitable range and follow all the
appropriate safety guidelines for the range, and the particular firearm you are using. As
Scott can attest, accidents can happen at time. Scott, aka Kentucky Ballistics, was injured on
April 9, 2021 when his Serbu RN-50 rifle exploded. He was firing sabot light armor penetrator,
or SLAP rounds, that unbeknownst to him, had been tampered with and some of which were
overloaded with gun powder. During the course of his range session, he shot several of these
rounds successfully before the accident occurred. However, at the end of his session, he decided to
shoot one more round. Of course, this was the round that caused the malfunction of the rifle.
Scott discusses the incident in detail,
so I will briefly show what happened and then discuss the injuries.
When the rifle exploded Scott suffered a number of injuries of various severity. The
list of injuries suffered includes a comminuted right orbital fracture with transient blindness,
a nasal bridge fracture, a lacerated jugular vein, a punctured right lung,
and a displaced fracture of the left index finger. While most of these were serious,
both the jugular laceration and the lung injury were much more sore, and could have proved fatal
were immediate action not undertaken. Fortunately for Kentucky Ballistics, he was not filming alone,
and he did not lose consciousness when he was injured. His previous training in first aid,
and the quick actions of his father helped him to survive these injuries.
With a punctured lung, air from inside the lung would be allowed to escape the lung and
enter into the chest cavity. Over a short period of time, air outside of the lung,
but inside the chest, would compress the lung from the outside and not allow it to expand,
making air entry into that lung impossible. With enough air inside the chest cavity,
the trachea and the opposite lung are also compressed and displaced away from their normal
position. This is called a pneumothorax, and If left untreated, could result in an complete
inability to breathe, and eventually death. This is not an injury that can be readily treated
in the field, as it requires an interventional procedure, and sometimes actual surgery to fix.
The lacerated jugular vein was particularly worrisome for several reasons. First,
as Scott pointed out in his video, you can’t apply a tourniquet to the neck to gain control of the
bleeding between the laceration and the heart. A tourniquet at neck level would occlude the airway,
stop breathing, and eventually result in loss of consciousness and death. Not a good thing,
and certainly not the desired outcome. Second, the laceration involved a jugular vein which is one
of the main vessels for blood flow leaving the most energy hungry organ of the body,
the brain. The carotid and vertebral arteries bring a large volume of blood under pressure to
the brain. The jugular veins allow all of that blood to exit the brain en route to the heart
after the oxygen it carries has been consumed by the brain. Disruption of this flow from the
brain prevents its return to the heart which can eventually allow the pump to fall out of prime.
At worst, the flow of blood is unrestricted and blood volume falls quickly. At best,
the flow of blood is tamponaded by pressure, and the flow of blood is slowed to a speed that can
be accommodated by the vessels on the other side of the neck. Blood volume continues to decrease,
but at a slower rate. Collateral veins on the other side pick up some of the slack,
but only to a certain degree. Third, the injury to the jugular vein poses more of a problem than does
an arterial injury. The cross-sectional makeup of an artery and a vein are different. An artery is
a high pressure blood vessel. To accommodate the flow of blood under high pressure, it’s walls are
thick and contain muscle cells. Arteries do not contain valves. The flow of blood in arteries
is controlled by contraction and relaxation of the muscle fibres in the walls that expand
or contract the lumen of the artery and the volume available for blood flow.
To increase blood flow to an area, muscle cells in the arterial wall relax. To decrease blood flow,
muscle cells in the arterial wall contract. When an artery is lacerated, initially blood escapes
the vessel very quickly under high pressure. However, muscle fibres within the wall immediately
begin to contract causing the artery to spasm and contract. Eventually, this results in constriction
of the injured artery limiting ongoing loss of blood. A vein is a low pressure blood vessel.
Its walls are thin and do not contain muscle cells. It depends on valves for the control of
blood flow. When are artery is lacerated, blood will escape relatively slowly under low pressure.
But, without muscle fibres within the cell wall, the vein is unable to spasm and contract,
and without the application of external pressure, it continues to bleed....and bleed....and
bleed, until it is either ligated or sewn shut, or cauterized. So although,
a vein laceration is a lower pressure injury, it is still problematic for several reasons.
Scott demonstrated great calmness and presence of mind when he used his shirt and his thumb
to apply pressure to the the bleeding wound in his neck. Well done. Definitely surgeon-approved.
10:00 Scott mentions his awareness of his heart rate and its relationship to the rate of bleeding.
Obviously, with this type of injury, it is normal to become excited and certainly anxious
once the severity of injury becomes apparent. As excitatory hormones are circulated through the
body in response to the Fight Or Flight reflex, it takes significant effort to rally oneself
and to restore a calm composure. It was also quite a good idea to force himself to talk in order to
remain conscious. As mentioned previously, the brain is quite hungry for oxygen and nutrients,
so loss of consciousness in the context of hemorrhage or uncontrolled bleeding,
is a sign of impending shock where blood loss leads to organ failure and death. Again,
great clarity of thought in this high pressure, life or death situation.
12:00 Scott notes that although there were no outward signs of injury to his chest,
radiographs in the Emergency Department revealed a hemothorax, a condition where the chest fills
with blood within the chest cavity, but outside the lung. A hemothorax behaves in much the same
way as does a pneumothorax, except that with a hemothorax, the deformation is caused by blood
rather than air. The chest cavity can accumulate over 1.5 L of blood (5-6 units). A hemothorax
can result in shock by several methods: massive bleeding that results in inadequate blood volume
to keep all the critical organs perfused with blood, and venous pressure where the retained
blood within the chest cavity compresses the vena cava and stops the return of blood to the heart.
12:09 Scott mentions that they had to perform an awake intubation. This is the process where
they place a breathing tube down the trachea to ensure that there is a protected airway so that if
the patient loses consciousness, they can still be mechanically ventilated to keep them alive.
This technique is indicated if there is a reasonable chance that you might lose the airway
during the process of intubation. It is generally not that pleasant an experience, but was necessary
here given the injury to Scott’s neck and the lack of clarity as to the full extent of his injuries.
In the circumstance of a questionable airway, it is the safest way to place a breathing tube..
12:15 Here Scott is describing the technique used to place a chest tube. A chest tube is a flexible
clear tube that is placed into your chest cavity form the outside, that is attached to a suction
apparatus that evacuates the air or the blood that is trapped within the chest cavity. The chest tube
allows the evacuation of the chest cavity so that the external pressure that is compressing the lung
or vena cava can be relieved. It’s placement requires a small dissection between two ribs,
and the insertion of the tube bluntly into the chest cavity. If performed when awake,
this too is not a fun procedure to experience. As the chest is evacuated the lung is more
able to expand into the available space on inspiration, and it becomes easier to breathe.
13:53 Scott describes a thoracotomy, a procedure where the chest cavity is formally opened in a
surgical procedure to expose the contents of the thorax. In this case, it appears that they
entered the chest cavity through the sternum, so this was technically a sternotomy. The chest
cavity is usually closed with wires after the procedure in the thoracic cavity is completed.
14:06 Generally, a large adult male will have a blood volume of approximately 6L. This equates
to approximately 12 units of whole blood, or 24 units of packed red blood cells in total. Given
the degree of blood loss that he experienced during the injury and the subsequent surgery,
Scott was transfused with 5 units, most likely packed red blood cells.
This would have been a volume of approximately 1.25-1.5L of blood overall, which would represent
1/5 to 1/4 of his total blood volume. For the record, that is a lot of blood.
14:24 The jugular vein is one of main vessels drawing blood away from the brain. Occlusion of
this vessel will not cause a stroke in the same way occlusion of an artery supplying the brain
would. Occlusion of an artery will impede oxygenated blood from entering the brain,
which will starve the brain of necessary oxygen, and eventually cause the death of brain tissue,
or a stroke. The jugular vein contains blood that has left the brain after the oxygen has already
been extracted. Occlusion of this vein will cause blood that is exiting the brain to back up
into the brain, causing edema or swelling of the brain that could ultimately prove
fatal. It is certainly correct that the time that we can keep the flow clamped is limited,
so it is always important for surgeons to work as expediently as possible
to complete the vascular repair so that they can resume blood flow in as
short a time as possible. A stroke upon resumption of blood flow is certainly possible,
but this is something that generally occurs on the arterial side rather than the venous side.
14:45 Fortunately, the fracture in Scott’s hand could be stabilized with a closed
reduction and percutaneous pin fixation. These are generally pins that are placed through the skin,
into the fracture to hold it in place until the fracture has healed. Usually,
these pins remain in place for 6-8 weeks, after which time they are removed.
14:57 Scott also describes the three incision approach used to repair his orbital and facial
fractures, that included a supra orbital incision, an infra-orbital incision,
and a transbuccal incision within his mouth.
15:50 For several days after his surgery, Scott remained connected to a number of tubes
that were draining his chest. As mentioned, these tubes were connected to a reservoir
that would measure the amount of drainage of fluids from the chest cavity after the repair.
These tubes would remain in place until physicians determined that there was no
further drainage into the chest cavity. In Scott’s case, this was about three days.
Overall, Scott was in hospital for 6 days,
which is a pretty short period of time for an injury that could have easily taken his life.
Shout out the the trauma team at Vanderbilt Hospital in Nashville.
17:14 Love Scott’s upbeat outlook on the whole incident. Obviously, he loves what he
does and plans to continue to filming content upon recovery. judging from the caption on his shirt,
when life gives you lemons, you make lemonade. Well played sir, well played.
So those are my thoughts on how Kentucky Ballistics almost died.
Thanks for watching, I will see you for rounds next week. As always,
that’s been a word from Dr. Chris, not your everyday ortho.