Stab wound

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Stab wound
Classification and external resources
Beauchamp kills Sharp.jpg
A depiction of Jereboam O. Beauchamp stabbing Solomon P. Sharp.
ICD-10 X99
ICD-9 E966
eMedicine topic list

A stab wound is a specific form of penetrating trauma to the skin that results from a knife or a similar pointed object that is "deeper than it is wide".[1][2][3][4] Most stabbings occur because of intentional violence or through self infliction.[5] The treatment is dependent on many different variables such as the anatomical location and the severity of the injury.

Management[edit]

Stab wounds can cause various internal and external injuries. They are generally caused by low velocity weapons, meaning the injuries inflicted on a person are typically confined to the path it took internally, instead of causing damage to surrounding tissue which is common of gun shot wounds.[6] The abdomen is the most commonly injured area from a stab wound. Interventions that may be needed depending on severity of the injury include airway, intravenous access, and control of hemorrhage.[5][7] The length and size of the knife blade, as well as the trajectory it followed, may be important in planning management as it can be a predictor of what structures were damaged.[1][3] Special precautions should also be used to prevent further injury from a perpetrator to the victim in a hospital setting.[8] 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.[1][9]

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.[10] 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.[11]

Surgery[edit]

Surgical intervention may be required but it depends on what organ systems are affected by the wound and the extent of the damage.[3] It is important for care providers to thoroughly check the wound site inasmuch as a laceration of an artery often results in delayed complications sometimes leading to death.[1] Typically a surgeon will track the path of the weapon to determine the anatomical structures that were damaged.[12] In severe cases when homeostasis cannot be maintained the use of damage control surgery may be utilized.[13]

Epidemiology[edit]

Hilt mark left from a knife

Stabbings are a relatively common cause of homicide in Canada[14] and the USA.[15] Typically deaths caused by stabbings are due to organ failure or blood loss. They are the mechanism of approximately 2% of suicides.[16] Most stab wounds are caused by intentional violence, as the weapons used to inflict such wounds are readily available compared to guns.[17]

In Canada homicides by stabbing and gun shot occur relatively equally (1,008 to 980 for the years 2005 to 2009).[14] In the United States guns are a more common method of homicide (9,484 verses 1,897 for stabbing or cutting in 2008).[15]

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.[7][8][18] Most assaults resulting in a stab wound occur to men and persons of ethnic minorities.[19]

History[edit]

Some of the first principles of wound care come from Hippocrates who promoted keeping wounds dry except for irrigation.[31] 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.[31] 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.[32] 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 laparotomys which has been developed a few years earlier had provided better patient outcomes.[33] During the Korean war a greater emphasis was put on the use of pressure dressings and tourniquets for initially controlling bleeding.[31]

References[edit]

  1. ^ a b c d Rosen, Peter; John J. Ratey MD; Marx, John A.; Robert I. Simon MD; Hockberger, Robert S.; Ron Walls MD; Walls, Ron M.; Adams, James L. (2010). Rosen's emergency medicine: concepts and clinical practice. St. Louis, Mo: Mosby/Elsevier. pp. 456–7. ISBN 0-323-05472-2. 
  2. ^ Taber, Clarence Wilbur; Venes, Donald (2009). Taber's cyclopedic medical dictionary. F a Davis Co. p. 2189. ISBN 0-8036-1559-0. 
  3. ^ a b c Mankin SL (September 1998). "Emergency! Stab wound". The American Journal of Nursing 98 (9): 49. doi:10.2307/3471869. PMID 9739749. Retrieved 2011-09-30. 
  4. ^ Abdullah F, Nuernberg A, Rabinovici R (January 2003). "Self-inflicted abdominal stab wounds". Injury 34 (1): 35–9. doi:10.1016/s0020-1383(02)00084-0. PMID 12531375. Retrieved 2011-09-30. 
  5. ^ a b Sugrue M, Balogh Z, Lynch J, Bardsley J, Sisson G, Weigelt J (August 2007). "Guidelines for the management of haemodynamically stable patients with stab wounds to the anterior abdomen". ANZ Journal of Surgery 77 (8): 614–20. doi:10.1111/j.1445-2197.2007.04173.x. PMID 17635271. Retrieved 2011-09-30. 
  6. ^ Christopher McLean, Jonathan Hull (June 2006). "Missile and explosive wounds". Surgery (Oxford) 22 (6): 194–7. doi:10.1383/surg.2006.24.6.194. 
  7. ^ a b Campbell, John Creighton (2000). Basic trauma life support for paramedics and other advanced providers. Upper Saddle River, N.J: Brady/Prentice Hall Health. ISBN 0-13-084584-1. 
  8. ^ a b Bird J, Faulkner M (2009). "Emergency care and management of patients with stab wounds". Nurs Stand 23 (21): 51–7; quiz 58. doi:10.7748/ns2009.01.23.21.51.c6769. PMID 19248451. 
  9. ^ Edgerly, Dennis (June 7, 2012). "Patient Suffers Multiple Stab Wounds: A 19-year-old male was stabbed multiple times in the chest". Journal of Emergency Medical Services. Elsevier Inc. Retrieved July 17, 2012. 
  10. ^ ATLS: Advanced Trauma Life Support for Doctors. American College of Surgeons. 2008. pp. 113–9. ISBN 978-1880696316. 
  11. ^ PHTLS: Prehospital Trauma Life Support. Mosby/JEMS. 2010. ISBN 0-323-06502-3. 
  12. ^ Kenneth D. Boffard (2007). Manual of definitive surgical trauma care. London: Hodder Arnold. ISBN 0-340-94764-0. 
  13. ^ Garth Meckler; Cline, David; Cydulka, Rita K.; Thomas, Stephen R.; Dan Handel (2012). Tintinalli's Emergency Medicine Manual 7/E. McGraw-Hill Professional. ISBN 0-07-178184-6. 
  14. ^ a b http://www40.statcan.ca/l01/cst01/legal01-eng.htm Homicides by method
  15. ^ a b http://www.infoplease.com/ipa/A0004888.html Murder Victims, by Weapons Used
  16. ^ Riviello, edited by Ralph J. (2010). Manual of forensic emergency medicine : a guide for clinicians. Sudbury, Mass.: Jones and Bartlett Publishers. p. 18. ISBN 978-0-7637-4462-5. 
  17. ^ Eades, Chris (2007). Knife crime : review of evidence and policy. London: Centre for Crime and Justice Studies. ISBN 1906003068. 
  18. ^ Hanoch J, Feigin E, Pikarsky A, Kugel C, Rivkind A (August 1996). "Stab wounds associated with terrorist activities in Israel". JAMA 276 (5): 388–90. doi:10.1001/jama.1996.03540050048022. PMID 8683817. 
  19. ^ El-Abdellati E, Messaoudi N, Van Hee R (2011). "Assault induced stab injuries: epidemiology and actual treatment strategy". Acta Chirurgica Belgica 111 (3): 146–54. PMID 21780521. 
  20. ^ UNODC Homicide Statistics 2013, used two tables: Homicide counts and rates, time series 2000-2012 & Percentage of homicides by mechanism, time series 2000-2012. Retrieved May-20-2014
  21. ^ Murder Victims by Weapons (FBI). Retrieved May-20-2014
  22. ^ U.S. Population 2012: Nearly 313 Million People. Retrieved May-20-2014
  23. ^ Chart 9: Victims of homicide by main method of killing, Scotland, 2012-13. Retrieved May-20-2014
  24. ^ Scotland’s Population at its Highest Ever. Retrieved May-20-2014
  25. ^ Police Statistics on Homicide Victims in New Zealand for the period 2007 - 2011. Retrieved May-20-2014
  26. ^ New Zealand in Profile: 2013. Retrieved May-20-2014
  27. ^ Knife crime: Recent data on carriage and use. Retrieved May-20-2014
  28. ^ Australia’s population. Retrieved May-20-2014
  29. ^ Knife crime statistics. Retrieved May-20-2014
  30. ^ Every person in England and Wales on a map. Retrieved May-20-2014
  31. ^ a b c Manring MM, Hawk A, Calhoun JH, Andersen RC (August 2009). "Treatment of war wounds: a historical review". Clinical Orthopaedics and Related Research 467 (8): 2168–91. doi:10.1007/s11999-009-0738-5. PMC 2706344. PMID 19219516. Retrieved 2013-08-04. 
  32. ^ "History of Cardiac Surgery - Stephenson 3 (2008): 3 - Cardiac Surgery in the Adult". Cardiacsurgery.ctsnetbooks.org. Retrieved 2011-10-10. 
  33. ^ Oliver, J.C. (1899-01-09). "Gun Shot Wounds of the Abdomen with Report of Fifty Eight Cases". Academy of Medicine of Cincinnati: 354–75. Retrieved 2012-02-04.