Clinical Management of Stab Wound Victims PDF Print E-mail
Written by Dr. Niru Prasad   

Introduction

Given the tremendous increase in the crime rate in United States, it is very important for paramedics to learn the basic concept of initial assessment and stabilization of severely injured patients. Trauma is one of the major leading causes of death for Americans under forty and the initial assessment and stabilization of the patient strongly influences the ultimate outcome for the severely traumatized patient. Most jurisdictions require that injuries arising from acts of violence such as gunshot wounds, stab wounds be reported to the local police. A fundamental point to remember regarding blunt and penetrating trauma is that a patient who has been stabbed may also have been beaten and kicked and subsequently has sustained both blunt and penetrating injury to the body. Pathophysiology of the stab wound.

A. Penetrating injury to the body usually results in a hemorrhage from the penetration to a major vessel or solid organ.

B. Perforation of a segment of bowel or bladder.

The victim usually presents with altered mental status, hypoxia, paralysis, unequal pupils, shock, or active major bleeding. The signs and symptoms depend upon which part of the body is involved. Stab wound to the head and neck area. Penetrating injury to the head causes an altered level of consciousness, which is the hallmark of brain injury. A stab wound to the head area may produce brain contusion, concussion, and massive intracranial hemorrhage due to epidural, subdural, and subarachnoid hemorrhage. All foreign bodies protruding from the skull should be left as they are, since they act like taemponade to control the bleeding. Penetrating injury to the neck area causes:

A. Hemorrhage due to laceration of a major vessel.

B. Paralysis due to damage of the spinal cord or fracture of a cervical vertebra.

C.   Hypoventilation due to paralysis of intercostal muscles and involvement of C3 through C5 spinal cord segments.

Stab Wound to the scalp area causing extensive laceration.

A. Bleeding from a scalp laceration may be extensive, often flap type laceration.

B. The flap should gently be replaced over the wound.

C. Compression is applied with a dry sterile bandage.

D. Once bleeding is controlled, the dressing can be secured with a soft roller bandage.

 

Penetrating injury to the chest.

A stab wound sustained to the chest area may cause tension pneumothorax, open pneumothorax, massive hemothorax, sucking chest wound, flail chest due to fracture ribs, and pericardial tamponade. The victim can also suffer from severe respiratory distress due to hypoxia, which results from:

A. Diminished blood volume due to bleeding.

B. Contusion of the lungs leading to ventilation failure.

C. Changes in the pressure relationship within the pleural space leading to displacement of mediastinal structures and collapse of the lung.

Since hypoxia is the most important feature of chest injury, early intervention is designed to ensure that an adequate amount of oxygen is delivered to the portions of the lung capable of normal ventilation and perfusion. Tension pneumothorax develops when a one- way valve air leak occurs, either from the lung or through the chest wall. The presence of air in the thoracic cavity causes collapse of the lung, mediastinal shift to the opposite side causing interference with venous return, and compression of ventilation to the other lung. Open pneumothorax causes noisy breathing, and bubbling air and blood from the wound.

Massive hemothorax results from the stab wound disrupting the systemic or pulmonary vessel, and occurs with a loss of 1500 cc or more of blood in the chest cavity. The neck veins may be flat due to severe hypovolemia, or distended due to the mechanical effects of the chest cavity full of blood.

Flail chest develops when a segment of the chest wall does not have any bony continuity with the rest of the thoracic cage.

Pericardial tamponade is caused by a stab wound to the anterior chest area. This frequently leads to a collection of blood in the pericardial sac and a rupture of the aorta or cardiac muscle.

Some further potentially lethal chest injuries caused by stab wounds are:

A. Pulmonary contusion.

B. Disruption of the aorta.

C. Tracheobronchial disruption.

D. Esophageal disruption.

E. Traumatic diaphragmatic hernia.

F. Myocardial contusion.

Stab wound to the chest:

A. Penetrating  trauma to the chest

B. The moving object  penetrates through the chest.

C. Cardiac tamponade A penetrating heart wound causes bleeding into the pericardial sac, collection of blood constricts the heart and impairs heart function.

D. Tension pneumothorax stab wound to the chest puncture's the lungs and creates a valve like opening in the chest wall.  The increase in pleural pressure causes mediastinal shift, decrease in cardiac output, and diminished function of the other lung.