You'll have to raise a rib. [panting] [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. I'd give this a good
seven or eight out of 10. More sulfur, Mellish. 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. It wasn't meant to be a
hemostatic agent, as you call it. Am I shot in the spine? Am I shot in the spine? 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, and the spinal injuries bleed a lot, that's what's going to kill him. Easy, easy. Put some pressure on it. Wait, I got an exit wound. How big is the hole? About the size of an acorn. The medic, he knows that he's paralyzed, and that's why he says,
"Check for a hole in my back." And if it's big enough to
be the acorn, like he says, that means that it was
probably an exit wound. 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. Thanks for watching. If you enjoyed this video,
click on the link above.
