Stab wound

Management

Stab wounds can result in various internal and external injuries. These wounds are typically caused by low-velocity weapons, meaning the damage is usually confined to the weapon's path, unlike gunshot wounds which often affect surrounding tissues. The abdomen is the most commonly injured area in cases of stab wounds. Interventions that may be needed depending on severity of the injury include airway, intravenous access, and control of hemorrhage. The length and size of the knife blade, as well as its trajectory, are critical factors in assessing and predicting which internal structures may have been damaged. Special precautions should also be taken to prevent further injury from a perpetrator to the victim in a hospital setting. Similarly to treating shock, it is important to keep the systolic pressure above 90mmHg, maintain the person's core body temperature, and for prompt transport to a trauma center in severe cases.

To determine if internal bleeding is present a focused assessment with sonography (FAST) or diagnostic peritoneal lavage (DPL) can be used. Other diagnostic tests such as a computed tomography scan or various contrast studies can be used to more definitively classify the injury in both severity and location. Local wound exploration is also another technique that may be utilized to determine how far the object penetrated. Observation can be used in place of surgery as it can substitute an unnecessary surgery, which makes it the preferred treatment of penetrating trauma secondary to a stab wound when hypovolemia or shock is not present. Laboratory diagnostic studies such as a hematocrit, white blood cell count and chemical tests such as liver function tests can also help to determine the efficiency of care.

Surgery

Surgical intervention may be required, but it depends on what organ systems are affected by the wound and the extent of the damage. Typically a surgeon will track the path of the weapon to determine the anatomical structures that were damaged and repair any damage they deem necessary. Surgical packing of the wounds is generally not the favored technique to control bleeding as it can be less useful than fixing the directly affected organs. In severe cases when homeostasis cannot be maintained the use of damage control surgery may be utilized.

Epidemiology

Stab wounds are one of the most common forms of penetrating trauma globally, but account for a lower mortality compared to blunt injuries due to their more focused impact on a person. and stingray injuries, however, most stab wounds are caused by intentional violence, as the weapons used to inflict such wounds are readily available compared to guns. Stabbings are a relatively common cause of homicide in Canada

In Canada, homicides by stabbing and gunshot occur relatively equally (1,008 to 980 for the years 2005 to 2009). In the United States guns are a more common method of homicide (9,484 versus 1,897 for stabbing or cutting in 2008).

Stab wounds occur four times more than gunshot wounds in the United Kingdom, but the mortality rate associated with stabbing has ranged from 0–4% as 85% of injuries sustained from stab wounds only affect subcutaneous tissue. In Belgium, most assaults resulting in a stab wound occur to and by men and persons of ethnic minorities.

History

Some of the first principles of wound care come from Hippocrates who promoted keeping wounds dry except for irrigation. Guy de Chauliac would promote removal of foreign bodies, rejoining of severed tissues, maintenance of tissue continuity, preservation of organ substance, and prevention of complications. The first successful operation on a person who was stabbed in the heart was performed in 1896 by Ludwig Rehn, in what is now considered the first case of heart surgery. In the late 1800s it was hard to treat stab wounds because of poor transportation of victims to health facilities and the low ability for surgeons to effectively repair organs. However, the use of laparotomy, which has been developed a few years earlier, had provided better patient outcomes than had been seen before. After its inception, the use of exploratory laparotomies was highly encouraged for "all deep stab wounds" in which surgeons were to stop active bleeding, repair damage, and remove "devitalized tissues". Because laparotomies were seen to benefit patients, they were used on most every person with an abdominal stab wound until the 1960s when doctors were encouraged to use them more selectivity in favor of observation. During the Korean War, a greater emphasis was put on the use of pressure dressings and tourniquets to initially control bleeding.

References

Bibliography

References

1. (2014). "Marx".
2. (2009). "Taber's cyclopedic medical dictionary". F a Davis Co.
3. Mankin SL. (September 1998). "Emergency! Stab wound". [[The American Journal of Nursing]].
4. (January 2003). "Self-inflicted abdominal stab wounds". [[Injury (journal).
5. (August 2007). "Guidelines for the management of haemodynamically stable patients with stab wounds to the anterior abdomen". [[ANZ Journal of Surgery]].
6. (June 2006). "Missile and explosive wounds". Surgery.
7. Campbell, John Creighton. (2000). "Basic trauma life support for paramedics and other advanced providers". Brady/Prentice Hall Health.
8. (2014). "Marx".
9. (2009). "Emergency care and management of patients with stab wounds". Nurs Stand.
10. (2014). "Marx".
11. Edgerly, Dennis. (June 7, 2012). "Patient Suffers Multiple Stab Wounds: A 19-year-old male was stabbed multiple times in the chest". Elsevier Inc..
12. (2008). "ATLS: Advanced Trauma Life Support for Doctors". American College of Surgeons.
13. (2014). "Marx".
14. (2010). "PHTLS: Prehospital Trauma Life Support". Mosby/JEMS.
15. (2014). "Marx".
16. Kenneth D. Boffard. (2007). "Manual of definitive surgical trauma care". Hodder Arnold.
17. (2012). "Moore".
18. (2012). "Tintinalli's Emergency Medicine Manual 7/E". McGraw-Hill Professional.
19. (2011). "A unique nail gun injury to the heart with a delayed presentation". Interactive Cardiovascular and Thoracic Surgery.
20. (May 2012). "How to mend a broken heart: a major stab wound of the left ventricle". World J Emerg Surg.
21. (May 2010). "Surviving a transfixing cardiac injury caused by a stingray barb". The Journal of Thoracic and Cardiovascular Surgery.
22. Eades, Chris. (2007). "Knife crime: review of evidence and policy". Centre for Crime and Justice Studies.
23. (2010). "Manual of forensic emergency medicine: a guide for clinicians". Jones and Bartlett Publishers.
24. "Homicides by method".
25. . ["Murder Victims, by Weapons Used"](https://www.infoplease.com/us/crime/murder-victims-weapons-used). *Sandbox Networks Inc*.
26. (August 1996). "Stab wounds associated with terrorist activities in Israel". JAMA.
27. (2011). "Assault induced stab injuries: epidemiology and actual treatment strategy". [[Acta Chirurgica Belgica]].
28. [http://www.unodc.org/gsh/en/data.html UNODC Homicide Statistics 2013], used two tables: [http://www.unodc.org/documents/gsh/data/GSH2013_Homicide_count_and_rate.xlsx Homicide counts and rates, time series 2000-2012] & [http://www.unodc.org/documents/gsh/data/GHS2013_Mechanism.xlsx Percentage of homicides by mechanism, time series 2000-2012]. Retrieved May-20-2014
29. [https://www.fbi.gov/about-us/cjis/ucr/crime-in-the-u.s/2012/crime-in-the-u.s.-2012/offenses-known-to-law-enforcement/expanded-homicide/expanded_homicide_data_table_8_murder_victims_by_weapon_2008-2012.xls Murder Victims by Weapons (FBI)]. Retrieved May-20-2014
30. [https://www.usnews.com/opinion/blogs/robert-schlesinger/2011/12/30/us-population-2012-nearly-313-million-people U.S. Population 2012: Nearly 313 Million People]. Retrieved May-20-2014
31. [http://www.scotland.gov.uk/Publications/2013/10/6416/3#para34 Chart 9: Victims of homicide by main method of killing, Scotland, 2012-13]. Retrieved May-20-2014
32. [http://www.nrscotland.gov.uk/news/2013/scotlands-population-at-its-highest-ever Scotland's Population at its Highest Ever]. Retrieved May-20-2014
33. (July 2018). "Police Statistics on Homicide Victims in New Zealand 2007 - 2016". New Zealand Police.
34. "National Population Estimates: At 30 June 2016". Statistics New Zealand.
35. [http://www.aic.gov.au/publications/current%20series/tandi/401-420/tandi417.html Knife crime: Recent data on carriage and use] {{Webarchive. link. (2017-05-17 . Retrieved May-20-2014)
36. [http://www.immi.gov.au/media/publications/statistics/popflows2008-09/pop-flows-chapter1.pdf Australia's population]. Retrieved May-20-2014
37. [http://www.parliament.uk/briefing-papers/sn04304.pdf Knife crime statistics]. Retrieved May-20-2014
38. [https://www.theguardian.com/news/datablog/interactive/2013/aug/01/every-person-in-england-wales-dot-map#7/52.730/-1.923 Every person in England and Wales on a map]. Retrieved May-20-2014
39. (August 2009). "Treatment of war wounds: a historical review". [[Clinical Orthopaedics and Related Research]].
40. Sharpe, William. (June 17, 1961). "Laceration of the Heart: Repair and Recovery: 1877". Journal of the American Medical Association.
41. Oliver, J.C.. (1899-01-09). "Gun Shot Wounds of the Abdomen with Report of Fifty Eight Cases". Academy of Medicine of Cincinnati.
42. DeBrun, Harry. (December 1926). "Essential immediate treatment of trauma". The American Journal of Surgery.
43. (2014). "Marx".