|Classification and external resources|
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". Most stabbings occur because of intentional violence or through self infliction. The treatment is dependent on many different variables such as the anatomical location and the severity of the injury.
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 gunshot wounds. 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. 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. Special precautions should also be used 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. 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.
Surgical intervention may be required but it depends on what organ systems are affected by the wound and the extent of the damage. 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. Typically a surgeon will track the path of the weapon to determine the anatomical structures that were damaged. In severe cases when homeostasis cannot be maintained the use of damage control surgery may be utilized.
Stabbings are a relatively common cause of homicide in Canada and the USA. Typically deaths caused by stabbings are due to organ failure or blood loss. They are the mechanism of approximately 2% of suicides. Most stab wounds are caused by intentional violence, as the weapons used to inflict such wounds are readily available compared to guns.
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 verses 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. Most assaults resulting in a stab wound occur to men and persons of ethnic minorities.
|Sharp Instrument Homicides by Selected Countries|
|% Of Homicides Where
Sharp Instrument Is Used
|Year of Incidents|
|United States of America||1589||0.51||11%||2012|
|England & Wales||193||0.34||39%||2012|
|Saint Vincent and the Grenadines||11||10.08||44%||2010|
|Trinidad and Tobago||56||4.22||16%||2011|
|Bosnia and Herzegovina||4||0.10||8%||2010|
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. During the Korean war a greater emphasis was put on the use of pressure dressings and tourniquets to initially control bleeding.
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