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A stab wound is a specific form of penetrating trauma to the
skin Skin is the layer of usually soft, flexible outer tissue covering the body of a vertebrate animal, with three main functions: protection, regulation, and sensation. Other cuticle, animal coverings, such as the arthropod exoskeleton, have diffe ...
that results from a
knife A knife ( : knives; from Old Norse 'knife, dirk') is a tool or weapon with a cutting edge or blade, usually attached to a handle or hilt. One of the earliest tools used by humanity, knives appeared at least 2.5 million years ago, as evidenced ...
or a similar pointed object. While stab wounds are typically known to be caused by knives, they can also occur from a variety of implements, including broken bottles and ice picks. Most stabbings occur because of intentional
violence Violence is the use of physical force so as to injure, abuse, damage, or destroy. Other definitions are also used, such as the World Health Organization's definition of violence as "the intentional use of physical force or Power (social and p ...
or through self-infliction. The treatment is dependent on many different variables such as the anatomical location and the severity of the injury. Even though stab wounds are inflicted at a much greater rate than
gunshot wound A gunshot wound (GSW) is a penetrating injury caused by a projectile (e.g. a bullet) from a gun (typically firearm or air gun). Damages may include bleeding, bone fractures, organ damage, wound infection, loss of the ability to move part ...
s, they account for less than 10% of all penetrating trauma deaths.


Management

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 The abdomen (colloquially called the belly, tummy, midriff, tucky or stomach) is the part of the body between the thorax (chest) and pelvis, in humans and in other vertebrates. The abdomen is the front part of the abdominal segment of the torso. ...
is the most commonly injured area from a stab wound. Interventions that may be needed depending on severity of the injury include
airway The respiratory tract is the subdivision of the respiratory system involved with the process of respiration in mammals. The respiratory tract is lined with respiratory epithelium as respiratory mucosa. Air is breathed in through the nose to th ...
,
intravenous Intravenous therapy (abbreviated as IV therapy) is a medical technique that administers fluids, medications and nutrients directly into a person's vein. The intravenous route of administration is commonly used for rehydration or to provide nutrie ...
access, and control of
hemorrhage Bleeding, hemorrhage, haemorrhage or blood loss, is blood escaping from the circulatory system from damaged blood vessels. Bleeding can occur internally, or externally either through a natural opening such as the mouth, nose, ear, urethra, vag ...
. The length and size of the knife
blade A blade is the portion of a tool, weapon, or machine with an edge that is designed to puncture, chop, slice or scrape surfaces or materials. Blades are typically made from materials that are harder than those they are to be used on. Historic ...
, as well as the trajectory it followed, may be important in planning management as it can be a predictor of what structures were damaged. There are also special considerations to take into effect as given the nature of injuries, there is a higher likelihood that persons with these injuries might be under the influence of illicit substances which can make it harder to obtain a complete medical history. Special precautions should also be taken to prevent further injury from a perpetrator to the victim in a
hospital A hospital is a health care institution providing patient treatment with specialized health science and auxiliary healthcare staff and medical equipment. The best-known type of hospital is the general hospital, which typically has an emerge ...
setting. Similarly to treating
shock Shock may refer to: Common uses Collective noun *Shock, a historic commercial term for a group of 60, see English numerals#Special names * Stook, or shock of grain, stacked sheaves Healthcare * Shock (circulatory), circulatory medical emergen ...
, 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 A trauma center (or trauma centre) is a hospital equipped and staffed to provide care for patients suffering from major trauma, major traumatic injuries such as Falling (accident), falls, motor vehicle collisions, or gunshot wounds. A trauma cent ...
in severe cases. To determine if internal bleeding is present a focused assessment with sonography (FAST) or
diagnostic peritoneal lavage Diagnostic peritoneal lavage (DPL) or diagnostic peritoneal aspiration (DPA) is a surgical diagnostic procedure to determine if there is free floating fluid (most often blood) in the abdominal cavity. Indications This procedure is performed when ...
(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 Hypovolemia, also known as volume depletion or volume contraction, is a state of abnormally low extracellular fluid in the body. This may be due to either a loss of both salt and water or a decrease in blood volume. Hypovolemia refers to the los ...
or shock is not present. Laboratory diagnostic studies such as a
hematocrit The hematocrit () (Ht or HCT), also known by several other names, is the volume percentage (vol%) of red blood cells (RBCs) in blood, measured as part of a blood test. The measurement depends on the number and size of red blood cells. It is norm ...
,
white blood cell count A complete blood count (CBC), also known as a full blood count (FBC), is a set of medical laboratory tests that provide information about the cells in a person's blood. The CBC indicates the counts of white blood cells, red blood cells and pl ...
and chemical tests such as
liver function tests Liver function tests (LFTs or LFs), also referred to as a hepatic panel, are groups of blood tests that provide information about the state of a patient's liver. These tests include prothrombin time (PT/INR), activated partial thromboplastin ti ...
can also help to determine the efficiency of care.


Surgery

Surgical intervention may be required but it depends on what
organ system An organ system is a biological system consisting of a group of organs that work together to perform one or more functions. Each organ has a specialized role in a plant or animal body, and is made up of distinct tissues. Plants Plants have ...
s are affected by the wound and the extent of the damage. It is important for care providers to thoroughly check the wound site in as much as a
laceration A wound is a rapid onset of injury that involves lacerated or punctured skin (an ''open'' wound), or a contusion (a ''closed'' wound) from blunt force trauma or compression. In pathology, a ''wound'' is an acute injury that damages the epiderm ...
of an
artery An artery (plural arteries) () is a blood vessel in humans and most animals that takes blood away from the heart to one or more parts of the body (tissues, lungs, brain etc.). Most arteries carry oxygenated blood; the two exceptions are the pul ...
often results in delayed complications sometimes leading to
death Death is the irreversible cessation of all biological functions that sustain an organism. For organisms with a brain, death can also be defined as the irreversible cessation of functioning of the whole brain, including brainstem, and brain ...
. In cases where there is no suspicion of bleeding or infection, there is no known benefit of surgery to correct any present injuries. Typically a
surgeon In modern medicine, a surgeon is a medical professional who performs surgery. Although there are different traditions in different times and places, a modern surgeon usually is also a licensed physician or received the same medical training as ...
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 In biology, homeostasis (British English, British also homoeostasis) Help:IPA/English, (/hɒmɪə(ʊ)ˈsteɪsɪs/) is the state of steady internal, physics, physical, and chemistry, chemical conditions maintained by organism, living systems. Thi ...
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. Stab wounds can result from self-infliction, accidental
nail gun A nail gun, nailgun or nailer is a form of hammer used to drive nails into wood or other materials. It is usually driven by compressed air (pneumatic), electromagnetism, highly flammable gases such as butane or propane, or, for powder-actuate ...
injuries, and stingray injuries, however, most stab wounds are caused by intentional
violence Violence is the use of physical force so as to injure, abuse, damage, or destroy. Other definitions are also used, such as the World Health Organization's definition of violence as "the intentional use of physical force or Power (social and p ...
, as the
weapon A weapon, arm or armament is any implement or device that can be used to deter, threaten, inflict physical damage, harm, or kill. Weapons are used to increase the efficacy and efficiency of activities such as hunting, crime, law enforcement, s ...
s used to inflict such wounds are readily available compared to
gun A gun is a ranged weapon designed to use a shooting tube (gun barrel) to launch projectiles. The projectiles are typically solid, but can also be pressurized liquid (e.g. in water guns/cannons, spray guns for painting or pressure washing, p ...
s. Stabbings are a relatively common cause of
homicide Homicide occurs when a person kills another person. A homicide requires only a volitional act or omission that causes the death of another, and thus a homicide may result from accidental, reckless, or negligent acts even if there is no inten ...
in Canada and the United States. Typically death from stab wounds is due to
organ failure Organ dysfunction is a condition where an organ does not perform its expected function. Organ failure is organ dysfunction to such a degree that normal homeostasis cannot be maintained without external clinical intervention. It is not a diagnosi ...
or
blood loss Bleeding, hemorrhage, haemorrhage or blood loss, is blood escaping from the circulatory system from damaged blood vessels. Bleeding can occur internally, or externally either through a natural opening such as the mouth, nose, ear, urethra, vag ...
. They are the mechanism of approximately 2% of
suicide Suicide is the act of intentionally causing one's own death. Mental disorders (including depression, bipolar disorder, schizophrenia, personality disorders, anxiety disorders), physical disorders (such as chronic fatigue syndrome), and s ...
s. In Canada,
homicides Homicide occurs when a person kills another person. A homicide requires only a volitional act or omission that causes the death of another, and thus a homicide may result from accidental, reckless, or negligent acts even if there is no inten ...
by stabbing and gunshot occur relatively equally (1,008 to 980 for the years 2005 to 2009). Homicides by method 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 A gunshot wound (GSW) is a penetrating injury caused by a projectile (e.g. a bullet) from a gun (typically firearm or air gun). Damages may include bleeding, bone fractures, organ damage, wound infection, loss of the ability to move part ...
in the United Kingdom, but the
mortality rate Mortality rate, or death rate, is a measure of the number of deaths (in general, or due to a specific cause) in a particular population, scaled to the size of that population, per unit of time. Mortality rate is typically expressed in units of de ...
associated with stabbing has ranged from 0-4% as 85% of injuries sustained from stab wounds only affect
subcutaneous tissue The subcutaneous tissue (), also called the hypodermis, hypoderm (), subcutis, superficial fascia, is the lowermost layer of the integumentary system in vertebrates. The types of cells found in the layer are fibroblasts, adipose cells, and macr ...
. Most
assault An assault is the act of committing physical harm or unwanted physical contact upon a person or, in some specific legal definitions, a threat or attempt to commit such an action. It is both a crime and a tort and, therefore, may result in crim ...
s resulting in a stab wound occur to and by men and persons of
ethnic minorities The term 'minority group' has different usages depending on the context. According to its common usage, a minority group can simply be understood in terms of demographic sizes within a population: i.e. a group in society with the least number o ...
.


History

Some of the first principles of wound care come from
Hippocrates Hippocrates of Kos (; grc-gre, Ἱπποκράτης ὁ Κῷος, Hippokrátēs ho Kôios; ), also known as Hippocrates II, was a Greek physician of the classical period who is considered one of the most outstanding figures in the history of ...
who promoted keeping wounds dry except for irrigation.
Guy de Chauliac Guy de Chauliac (), also called Guido or Guigo de Cauliaco ( 1300 – 25 July 1368), was a French physician and surgeon who wrote a lengthy and influential treatise on surgery in Latin, titled '' Chirurgia Magna''. It was translated into many othe ...
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 The heart is a muscular organ in most animals. This organ pumps blood through the blood vessels of the circulatory system. The pumped blood carries oxygen and nutrients to the body, while carrying metabolic waste such as carbon dioxide t ...
was performed in 1896 by
Ludwig Rehn Ludwig Wilhelm Carl Rehn (13 April 1849, Bad Sooden-Allendorf – 29 May 1930) was a German surgeon. Rehn was born in 1849, in the village of Allendorf, the youngest of five children. After the visiting the convent school in Bad Hersfeld, he studi ...
, in what is now considered the first case of
heart surgery Cardiac surgery, or cardiovascular surgery, is surgery on the heart or great vessels performed by cardiac surgeons. It is often used to treat complications of ischemic heart disease (for example, with coronary artery bypass grafting); to corr ...
. 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 A laparotomy is a surgical procedure involving a surgical incision through the abdominal wall to gain access into the abdominal cavity. It is also known as a celiotomy. Origins and history The first successful laparotomy was performed without ane ...
, 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 A tourniquet is a device that is used to apply pressure to a limb or extremity in order to stop the flow of blood. It may be used in emergencies, in surgery, or in post-operative rehabilitation. A simple tourniquet can be made from a stick an ...
to initially control bleeding.


See also

*
Ballistic trauma A gunshot wound (GSW) is a penetrating injury caused by a projectile (e.g. a bullet) from a gun (typically firearm or air gun). Damages may include bleeding, bone fractures, organ damage, wound infection, loss of the ability to move part of th ...


References


Bibliography

* *


External links

{{Authority control Injuries Causes of death