So my character (16 yr old girl) got a deep cut (inches across) from a dagger across her torso and is knocked unconscious. (She falls onto her back) She had just enough time to contact her friends before she got knocked out.

Minutes pass (not sure how many) and she loses a bit more than 2 liters of blood. This is where her friends find her. I'm pretty sure the blood loss would be enough to make her go unconscious at this point. (Is it?) But if they gave her a blood restoring elixir (Au where there are like healing herbs made into medicine) to keep her stable until reinforcements arrive, she would survive, correct?

If the elixir wasn't present/possible, how would (and could) she survive?

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    $\begingroup$ Are you explicitly asking about the blood loss, the type of injury, or a combination of both? $\endgroup$ – Andrew Fan Jul 18 '19 at 4:01
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    $\begingroup$ Welcome to Worldbuilding.SE Kieran, glad you found us. Please check out our tour and help center. $\endgroup$ – Cyn says make Monica whole Jul 18 '19 at 4:03
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    $\begingroup$ Also, welcome to the madhouse that is WB.SE! Please, if you haven't already, take a look at the tour and help center so you can get a better idea how to refine your questions! $\endgroup$ – elemtilas Jul 18 '19 at 4:03
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    $\begingroup$ If you're willing to have a magical elixir, or a mundane elixir made from herbs that exist in an alternate universe, you can basically write the rules for what is possible and what isn't. It's important if you're going to do that though, that you establish those rules and stick to them, so that readers understand what is and isn't possible. $\endgroup$ – Pasqueflower Jul 18 '19 at 5:12
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    $\begingroup$ As a real life example of a similar scenario... I have a buddy who was completely drunk and got in a fight at a bar. Both guys only got a hit or two in before they broke up and went home. My buddy went to sleep a little sore and woke up with a blood soaked mattress. Turns out the guy he fought had stabbed him just under the left shoulder blade with a 3 inch knife. Went to the hospital and healed up, no problem. Not sure how much blood he lost, but it was a good amount. He is, however, about 6'4" and 280 pounds of dude. $\endgroup$ – Steve-o169 Jul 18 '19 at 19:08

The Scenario is UNLIKELY

As the query stands edited & clarified:

Your character should actually be in relatively good shape when her friends reach her! She will almost certainly survive, no RL, no magical herbs needed.

The wound you describe is entirely superficial. A slash across the abdomen that does not enter the peritoneal cavity has basically cut through skin & subcutaneous fat, with those layers' relatively small blood vessels.

It's a little unclear what you mean by a "deep cut" measuring "inches" that doesn't involve the internal organs. On a healthy and not terribly chubby girl, there's only about an inch of everything until you get right down to the wobbly bits inside. So I'm guessing the slash is inches long, which makes sense, because skin and muscle and even fat are not easy to slice through.

Reality Check:

You didn't tag it, but your question begs for one. The reality is there just aren't enough major arteries or veins on the belly to cause a blood loss of two litres. That's an awful lot of blood and to lose that amount, you need some very serious arterial damage. A nick in the vena cava or one of the renal vessels will do it; but you say there's no internal organ damage, and the great vessels are too deep.

Short answer: the amount of blood loss you want doesn't jive with the injury you describe.

I suspect: that she passed out due to a vaso-vagal response. The sight of blood --- and to your character, a dagger slice will burn and seem like she's being gutted, and blood will be everywhere no doubt --- may be enough to make her faint. (The very thought of being stuck with a needle and/or losing blood is enough for many to faint!).

She landed on her back which is good. Keeps the wound clean. There's a 33% chance she'll land with her legs slightly elevated above her head, which will help conserve blood in her head.

Her friends arrive after a few minutes (say five) and find her to be a bloody mess. Those that don't faint or hurl their breakfasts immediately can do some basic shock and injury first aid to stabilise her wound and her overall condition.

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    $\begingroup$ So if the she were cut near a renal vessel, that would merit that much blood to spill. Got it, thank you! $\endgroup$ – Kieran Jul 18 '19 at 4:36
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    $\begingroup$ @Kieran -- Yes, the renal vessels are direct branches off the descending aorta & ascending vena cava. Those are deep and your dagger wielding crazy will probably have to "stab" rather than "slice" or "cut" our girl. The attacker will have to very likely cut through stomach or intestine and probably some liver in order to get at the deep vessels. That's a lot of internal organ damage. A wound to the great vessels will pretty much be fatal wounds. Her friends will almost certainly find a corpse if she's been that badly wounded. $\endgroup$ – elemtilas Jul 18 '19 at 4:43
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    $\begingroup$ she may also pass out from the pain itself, rather than just the sight of her own blood. $\endgroup$ – jwenting Jul 19 '19 at 11:03
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    $\begingroup$ @jwenting -- That too. Vaso-vagal response can cause one to faint from just about anything. You can even self-induce! $\endgroup$ – elemtilas Jul 19 '19 at 15:19
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    $\begingroup$ @Blueriver -- I've a doctorate in Common Sense Statistics (in which I determined scientologically that half of all statistics are 99% wrong at least a third of the time). In reality, there are hundreds of permutations of ways a fainting or unconscious person can fall (interesting work done by Rene le Fort focusing on facial fractures, e.g.). I figure that, with a semi-controlled fall onto a natural surface, she'll either land with her head down slope (good for shock symptoms), with her head up slope (not so good for shock) or roughly horizontal. Common Sense 33% chance either way. ;) $\endgroup$ – elemtilas Jul 19 '19 at 23:15

You actually don't need to give your patient a magical elixir, there's already a product out there that is used in the field that does exactly what you want to do; it's called Ringer's Solution. This needs to be given as a transfusion, but once that is done the body can survive that kind of loss.

To get into the basics, 2 litres of blood represents around 40% of the average human's blood supply. Sure, transfusions get blood back into the system, but in battlefield conditions (I'm thinking the dagger attack here) typing blood and getting supplies for transfusions into the field is time consuming and often just not possible if the patient is to survive. But, at 40% loss, your concern is not the lack of haemoglobin, but the lack of volume. Your patient is going to go into shock (hence the unconsciousness) and die due to the heart trying to pump around fluid that just isn't there.

This is where Ringer's Solution comes in. It's basically there to expand blood volume and can be added to anyone's blood supply, regardless of type. There is even some scientific evidence to say that patients treated with Ringer's actually recover faster because the lack of red blood cells in their now diluted blood triggers bone marrow to work overtime to replace what seems to have been lost, whereas with a full blood transfusion the bone marrow doesn't get that message.

I don't have the facts at hand, but my understanding is that there are used to be1 a lot of battlefield medics that actually carry this solution for impromptu transfusions in the battlefield to give wounded soldiers a fighting chance. This would be the same for your patient as well. Of course, none of that matters if your patient is still bleeding profusely so the use of something like Ringer's should always be in concert with pressure bandages and the like to stem the bleeding so that you don't end up supplying needed volume only to dilute the blood below the level that can support oxygen transport through the body.

1. It turns out my knowledge was a bit out of date on this and this practice has been discontinued because the use of volume expanders makes coagulation harder and therefore increases the bleeding. Thanks to JSM for pointing this out.

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    $\begingroup$ As far as "magic" goes though, this is very much in Clarke's Third Law territory. In our world pre-Enlightenment, the idea of injecting some rejuvenating liquid was completely magical. And we can't justify it as the invention of one genius doctor, because Ringer's work stands on top of 200 years of research and scientific process from dozens of outright geniuses and thousands of "merely" talented people. In the typical fantasy context, twinkly fairy magic is more believable than someone inventing this. :) $\endgroup$ – Graham Jul 18 '19 at 16:21
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    $\begingroup$ Medic here. This is no longer current advice. In fact, the gold standard in trauma medicine is to give whole blood in the first instance. Crystalloid (Ringer's, etc) just dilutes the clotting factors and increases the bleeding. $\endgroup$ – jsm Jul 18 '19 at 16:52

Losing two liters of blood in and of itself is life-threatening but would not necessarily cause someone's death (assuming this is an adult human or someone with a similar blood volume).

Exsanguination is losing enough blood to cause death...People can die from losing half to two-thirds of their blood. The average adult has about 5 to 6 liters of blood in their body (women, and people who weigh more, have more blood). This means a person can die from losing 2 1/2 to 4 liters of blood. To compare, this is five to eight times as much blood as people usually give in a blood donation. Children and babies have much less blood than adults, and can exsanguinate by losing much less blood than adults. Exsanguination is often called bleeding to death or bleeding out. It is a medical emergency. (ref)

If your character is still alive when her friends find her, and they are able to completely stop the bleeding (not just blood that goes on the ground but internal bleeding too), that should be enough to save her life. Especially if the elixir also restores her blood to its full volume. And assuming that there are no other injuries that are life-threatening in and of themselves (for example, if her heart was damaged or the blade went into her lungs).

If the elixir didn't exist, her friends would have to stop the bleeding with pressure. This would not be possible if the injury was to a major artery, not without surgical equipment. If the injury is to a limb, you can use a tourniquet, but obviously that doesn't work on a torso. This will stabilize her for a short time, enough for paramedics to take over, if they are available quickly.

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    $\begingroup$ The protagonist is a girl, not an adult. She'll have about four liters of blood. This is definitely fatal. $\endgroup$ – RonJohn Jul 18 '19 at 18:55
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    $\begingroup$ @RonJohn Please see my comments on your answer. It is life-threatening but not definitely fatal by any means. $\endgroup$ – Cyn says make Monica whole Jul 18 '19 at 19:24

The most important question is not if she has died, but what is the ambient temperature?

If it is very cold (below freezing) then death is not an immediate issue. The curious case of Anna Bagenholm proves our understanding of death leaves something to be desired. Anna had the misfortune of falling through ice and drowning. Her body temperature then plummeted and she was on face value clinically dead. But given the ambient temperature doctors managed to resuscitate her hours later.

There's the awful case of Frank Gardner, a BBC journalist shot and left for dead in Saudi Arabia. His life was saved, although he is now disabled and suffers chronic pain. Gardner's survival hinged upon the skill of the South African gunshot specialist surgeon in the hospital he was rushed to. Along with a number of drugs which were used to both stop the flow of blood from the wounds, and to stop his blood generally starting to clot (which occurs before death). The latter prevented multiple organ failure from concluding.

Gardner's injuries included multiple gunshots which had caused devastating internal injuries to the stomach and intestines. Surgery ended up removing some of his intestines and other organs. The severity of the injuries led to immediate complications, various infections which took weeks to heal with intensive care. In your case the injuries sound less problematic.

So long as she can get medical attention quickly the blood loss in itself is not a problem. There are various blood substitutes whose purpose is to carry oxygen instead of blood. But there have also been trials for new techniques which seem as exciting as ghoulish. One 2014 trial conducted by UPMC Presbyterian Hospital in Pittsburgh, Pennsylvania, USA, is worth mentioning and further reading.

The gist is that the patient who has suffered severe blood loss from violent trauma has all of their blood replaced with cooled saline solution. This drops their body temperature, which puts them into a medical coma and reduces metabolic function, essentially preventing the onset of decay, thus putting them in 'suspended animation'. Once they are in this state, they can be moved to a medical facility, their wounds fixed up, and then blood transfusions can occur and they can be resuscitated.

If the patient has access to the correct climate, drugs, medical techniques, then survival is very possible yes.


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