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January 4, 2009 6:39 PM   Subscribe

What happens when someone gets stabbed in one of the main neck arteries with objects of varying dimensions?

So I'm a big fan of both the TV show Dexter, and also general horror movies and the like. I've been getting very conflicting information! Dexter stabs his victims in the neck with a syringe before doing his handywork. I've also seen in various video games and movies a special type of "syringe gun" used to instantly deliver medicine.
This conflicts somewhat with horror movie depictions of arterial wounds in that seemingly even the smallest cut will send gallons of the ol' kroovy spewing about the room.
Of course there are issues of size related to the hole, but I'd always been under the impression that the neck veins were special and different from the others. In addition, I've never actually SEEN someone outside of a fictional setting use the neck vein to deliver drugs.
Can't someone inform me?
posted by GoingToShopping to Health & Fitness (9 answers total) 2 users marked this as a favorite
Don't confuse veins and arteries. Arteries lead straight from the heart and have a high pressure, so cutting one of those will lead to spurting blood. For this reason, Mother Nature has put most of our arteries a good distance under the skin. Veins have much lower pressure and slower-moving blood, so cutting one will lead to oozing and dripping but not spurting. Veins tend to be closer to the surface.

That said, I don't think the neck vein is ever used to deliver medication, most likely because even though it's a vein, there's a lot of blood moving through, and hence it's more likely to keep bleeding and not heal up properly.
posted by echo target at 6:57 PM on January 4, 2009

Actually, though medical professionals don't like doing it, the jugular vein can be and is used to deliver medicine, but only as a kind of last resort if no other vein is available. The advantage is that because it's a big vein, you can deliver a lot of liquid or medicine in a hurry. The disadvantage is that due to its location it's quite uncomfortable for the patient, and even minor movement poses a risk of infiltration, etc.

Other than that though, echo target is correct. The veins are under relatively low pressure, and even a minor application of force will stop venous blood movement. The arteries in the neck are under quite a bit of pressure, i.e. the full measure of your blood pressure. As echo points out, arteries tend to be a lot deeper, and thus harder to cut, but when severed they do indeed produce the kind of fountains you see in the movies. A sudden decapitation can produce a spray extending several feet. You'll probably only get one good jet before the body runs out of blood, as an adult male only has about five liters of blood.

In that sense Dexter isn't that far off: the blood containers you see in the Ice Truck Killer's apartment are about that big and could realistically contain all of the blood from one adult human.
posted by valkyryn at 7:11 PM on January 4, 2009

Veins in the neck can be, and are, used by some injection drug users, but usually only when other veins are not available. It's not a very good option, for perhaps obvious reasons, but it is used for delivering drugs. What makes the Dexter version unrealistic (one reason) is the speed with which he locates good veins and injects into them. It's a little harder to hit them that it appears in the show.
posted by gingerbeer at 7:14 PM on January 4, 2009

I always assumed that Dexter's syringe was going into arteries, and not veins. Thank you for correcting my conflation though! Would it be practical to do what he does then, or is the immediate incapacitation/kidnapping bit pure hollywood?
posted by GoingToShopping at 8:35 PM on January 4, 2009

This may be a bit off the central topic, but there is footage of an NHL goalie by the name of Clint Malarchuk who got an artery sliced by a skate blade during a game. The blood really does come squirting out in buckets like a horror movie. (The guy lived, by the way.) So that part is also true.
posted by kosmonaut at 9:15 PM on January 4, 2009

Actually, I just checked and I guess it was his jugular vein, in fact.
posted by kosmonaut at 9:17 PM on January 4, 2009

For another somewhat off-topic sports related incident, back in the 90's Dallas Cowboys star receiver Michael Irvin stabbed a teammate in the neck with scissors when the guy wouldn't give up his seat in the barber's chair.
posted by citron at 9:46 PM on January 4, 2009

To start off: Dexter, nor anyone else, could successfully inject anything into any neck vessel (artery or vein) accurately on a frequent basis. Especially on a struggling victim.

1) Arteries are under high pressure. They pulsate and shoot blood out. Accidentally put a decent-sized needle into a decent-sized artery, and if you don't hold strong pressure for a good several minutes, the artery will start pushing blood out into the surrounding connective tissue, causing a large blood collection called a hematoma. Get a rapidly expanding hematoma in the neck, for example, and you start compressing other vital structures like nerves, veins, and the trachea (windpipe).

When doctors do cardiac catheterizations (for coronary artery problems), they go in through the femoral artery. After the procedure, they leave a 10-20 pound weight over the groin for the next several hours to prevent hematoma formation.

2) The external jugular vein is, for all intents and purposes, a vein like one in your arm or hand. It has valves, is on the smaller side, and is a "peripheral vein." You can see it running down someone's neck if they strain or get flustered. Pops right out. We put IVs into it fairly frequently when we can't find anything better peripherally, and you can connect it to IV fluid just like any other vein.

3) The internal jugular vein is a central vein. It is large and lacks valves. It runs between the muscle bellies of the neck muscles. It connects near the heart with the external jugular vein. We put large catheters into this vein frequently with critically ill patients, so that we can either give massive amounts of fluids quickly or give multiple IV drugs at the same time or run some tests on the pressures in the heart and lungs. Nowadays, most of these "central lines" are put in under ultrasound guidance, so you don't either a) go too deep and accidentally hit the common carotid artery (see #1) or b) go too far and puncture a lung.

So sorry, Dex. You're all make-believe.
posted by gramcracker at 11:47 PM on January 4, 2009 [4 favorites]

I routinely place internal jugular lines in patients and don't have much to add to gramcracker's response. I will mention that if you completely sever or seriously lacerate the common or internal carotid artery the blood pressure in the brain may drop precipitously and cause rapid loss of consciousness (although not always, because the brain is also supplied by the carotid on the other side as well as the basilar artery, and all three are interconnected via the Circle of Willis so there is a good deal of redundancy there). As for the syringe gun you mention, it may be based on pneumatic vaccination guns such as the Med-E-Ject that were widely used in mass vaccination programs prior to the 1980s, when it was discovered that sharing vaccination equipment was not such a good idea (even before HIV was well understood). They are still used in some areas, though.
posted by TedW at 7:33 AM on January 5, 2009

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