A 34-year old man in the Russian city of Kazon, known only as Vladamir, was filmed at a hospital after getting in a “drunken knife fight.” At the hospital, the man was filmed with a knife sticking out of his back. The blade went so deep into him that only the handle was visible.
Astonishingly, when the nurses began to work on him, the man got up and said that he needed to have a smoke. He started to walk towards the outside, passing concerned patients and stumbling along the way. The staff was worried that he would fall again and hurt himself even more.
The nurses called after him:
‘are you mad?’
It’s winter outside. Come back.
The nurses were not kidding either, the temperatures outside were reportedly as low as -10C, and the man was wearing nothing but underwear. Vladamir seemed like a tough guy, but in the video, you could tell that he was having trouble supporting his whole body as he walked.
Vladamir didn’t actually have any cigarettes of his own, and was hoping to bum a smoke from one of the other patients. As you could imagine, people were a bit horrified after being approached by a wounded man with a knife sticking out of his back. Nurses had an easier time talking him back inside the hospital once he realized that he wasn’t going to be able to find a cigarette.
The nurse leading the man inside could be heard saying:
“Young man, you are going to die now. Let’s go, have an injection, and you go home.”
“Yes, we’ll make one injection and let you go home. Come on, come with me. Go, go. Keep going. Go and lie down.”
A representative with the regional health authority in Tatarstan said that the man underwent a successful surgery and was in stable condition.
There are a number of possible explanations for the man’s behavior, the most likely being that he was in Neurogenic shock. According to Wikipedia:
Extreme pain causes neurogenic shock by overexciting the parasympathetic nervous system. This results in a significant decrease in heart rate (Bradycardia); which in turn decreases the pulse and leads to a dangerous drop in blood pressure [shock].
The parasympathetic nervous system is involved in decreasing the heart and pulse rate, thus lowering blood pressure.
The signs and symptoms of neurogenic shock are similar to other types of shock, except the heart rate slows down, as well as warm, dry, and flushed skin due to venous pooling secondary to loss of vascular tone. In non-neurogenic types of shock, the heart and pulse speed up. But in the textbooks, neurogenic shock refers to a state where due to spinal cord or CNS injury peripheral release of catecholamines does not occur. This causes loss of vasomotor tone and resultant accumulation of blood in peripheral vessels and shock. This lack of circulation forces muscles to process energy using a form of metabolism called Anaerobic metabolism. A drop in blood pressure must occur as it is a kind of shock. A drop in heart rate will occur, but only if the spinal cord injury involves areas above (Proximal) vertebrae T-6. Below T-6 the heart rate will not be affected, but blood will accumulate in the lower extremities causing warm, dry, and flushed skin. How severe burn or excruciating pain causes neurogenic shock is not clear.
Overexcitation of the parasympathetic nervous system causing neurogenic shock, doesn’t relate to conventional textbooks.
Ways neurogenic shock is managed in the medical field is by Vasopressors to help sustain an adequate blood pressure. Examples of Vasopressors are Dopamine, which acts mainly on the Alpha -1 receptors to cause vasoconstriction which in turn raises blood pressure due to less space in the arteries. Dobutamine, which acts on Beta-1 receptors in the body to cause an increase in heart rate. This increase in heart rate raises blood pressure.
This may be the most likely because it involves an injury to the spinal cord and extreme pain, both of which were variables in Vladamir’s encounter. It is also probable that he was numbed from a high blood alcohol content, considering that it was reported that the wound was the result of a drunken fight.