Stab wound

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Stab wound
Beauchamp kills Sharp.jpg
A depiction of Jereboam O. Beauchamp stabbing Solomon P. Sharp.
Classification and external resources
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 gunshot 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 gunshot 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 laparotomy, 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 to initially control 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.