A puncture wound is a specific form of penetrating trauma to the skin resulting from a knife or similar pointed object that is "deeper than wide". While puncture wounds are usually considered only caused by knives, they can also occur from ice picks, pens, taps, and broken bottles, to name a few. Most stabbings occur because of intentional violence or self-suffering. This treatment depends on many different variables such as anatomic location and severity of injury. Although stab wounds are at a much greater rate than gunshot wounds, they account for less than 10% of all penetrating traumatic injuries.
Video Stab wound
Management
Stab wounds can cause a variety of internal and external injuries. They are generally caused by low-speed weapons, which means that injury inflicted on a person is usually limited to internally taken pathways, rather than causing damage to surrounding tissue, which is common in gunshot wounds. The abdomen is the area most often injured due to stab wounds. Interventions that may be required depend on the severity of the injury including the airway, intravenous access, and control of the bleeding. The length and size of the blade, as well as the trajectory that followed, may be important in planning management as it may be a predictor of the damaged structure. There are also special considerations to be put into effect as given the nature of the injury, there is a higher likelihood that people with this injury may be under the influence of illicit substances which can make it more difficult to obtain a complete medical history. Special precautions should also be taken to prevent further injury from the offender to the victim at the hospital. Similarly, to treat shock, it is important to maintain systolic pressure above 90mmHg, maintain one's core body temperature, and to transport rapidly to the center of the trauma in severe cases.
To determine whether internal bleeding is present a focused assessment with sonography (FAST) or peritoneal lavage diagnostics (DPL) may be used. Other diagnostic tests such as computed tomography scans or various contrast studies can be used to classify more clearly the injuries in both severity and location. Local wound exploration is also another technique that can be used to determine how far the object is penetrated. Observation may be used at the site of operation as it may replace unnecessary surgery, which makes it a preferable treatment of secondary penetrating injury from stab wounds when hypovolemia or shock are absent. Laboratory diagnostic studies such as hematocrit, white blood cell count and chemical tests such as liver function tests may also help determine treatment efficiency.
Surgery
Surgical intervention may be necessary but depends on what organ system is affected by the injury and the extent of the damage. It is important for care providers to thoroughly examine the location of the wound because lacerations often result in delayed complications occasionally leading to death. In cases where there is no suspicion of bleeding or infection, no surgical benefit is known to correct the existing injury. Usually a surgeon will track the weapon path to determine the damaged anatomical structure and repair the damage they deem necessary. Surgical wound packing is generally not the preferred technique for controlling bleeding as it may be less useful than repairing the affected organ directly. In severe cases when homeostasis can not be maintained, the use of damage control operations can be exploited.
Maps Stab wound
Epidemiology
Stab wounds are one of the most common forms of penetrating trauma in the world, but are responsible for lower mortality than blunt injuries because of their more focused impact on a person. Stab wounds can be caused by self-suffering, accidental nail injury, and stingray injuries; however, most puncture wounds are caused by intentional violence, since weapons used to injure the wound are readily available compared to weapons. Stabbing is a relatively common cause of killing in Canada and the United States. Usually death from stab wounds is caused by organ failure or blood loss. They are a mechanism of about 2% of suicides.
In Canada, murder with stabbing and shooting occurred relatively similarly (1.008 to 980 for 2005 to 2009). In the United States, weapons are the more common method of killing (9484 versus 1,897 for stabbings or withholding in 2008).
Stab wounds occur four times more than a gunshot wound in England, but the mortality rate associated with pricking has ranged from 0-4% because 85% of injuries sustained by stab wounds affect only subcutaneous tissue. Most of the attacks that resulted in stab wounds occurred in men and people from ethnic minorities.
History
Some of the first principles of wound care come from Hippocrates who promote keeping wounds dry except for irrigation. Guy de Chauliac will promote the removal of foreign bodies, recombine with disconnected tissue, maintain tissue continuity, preservation of organ substances, and prevent complications. The first successful surgery on a person who was stabbed at the heart was done in 1896 by Ludwig Rehn, in what is now considered the first case of heart surgery. By the late 1800s it was difficult to treat stab wounds due to poor transport of the victims to health facilities and low ability for surgeons to effectively repair organs. However, the use of laparotomy, which has been developed several years earlier, has yielded better results than ever before. Once initiated, the use of an exploratory laparotomy is highly recommended for "all deep puncture wounds" in which the surgeon should stop active bleeding, repair the damage, and remove the "destroyed tissue". Because laparotomy looks beneficial to patients, they are used on almost everyone with stomach puncture wounds until 1960 when physicians are encouraged to use more selectivity in favor of observation. During the Korean War, a greater emphasis was placed on the use of pressure and tourniquet dressings to control bleeding initially.
References
Bibliography
- Feliciano, David V.; Mattox, Kenneth L.; Moore, Ernest J (2012). Trauma, Seventh Edition (Trauma (Moore)) . McGraw-Hill Professional. ISBN 978-0-07-166351-9.
- Marx, John A. Marx (2014). Rosen emergency medicine: clinical concepts and practice (8th ed.). Philadelphia, PA: Elsevier/Saunders. pp.Ã, Chapter. ISBN: 1455706051.
See also
- Ballistic trauma
Source of the article : Wikipedia
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