Emergency clinicians manage stab wound (SW) injuries now more than ever. This topic review will discuss the evaluation and management of abdominal stab wounds.
A-allergies, M- medication, P- past medical experience, L- last oral intake, E- events surrounding the injury (Penetrating trauma).
Circulation, control of haemorrhage by proximal compression of vessel, by packing of wound, by ligation of the bleeding vessel.
Assessment of DISTAL neurological status and level of consciousness:
A-awake. V- open eyes to voice P- open eyes to painful stimuli U- unarousable
- Patient completely disrobed,
- Visual inspection of the entire patient, Examine the back as well.
- Record entry and exit of stab wound in full dimensions with relation to bony landmarks.
- Splaying of legs to examine the perineum.
- Per-rectal examination.
- Inform the registrar/attending.
- Set up two I/V lines with branula #16 G
- Draw blood samples for blood grouping and cross-matching, Hb%, PT, APTT.
- Send investigations for urinalysis, pregnancy test for women of childbearing age.
- Start I/V Ringer’s or normal saline.
- Pass Foleys catheter #16 in adults with complete aseptic technique.
Classification of Abdominal Stab Wounds
I. Not penetrating the peritoneal cavity.
II. Penetrating but not damaging the organs.
III. Penetrating with significant damage.
Group III: Presents with signs of peritonitis and circulatory shock. They need immediate resuscitation & exploration of abdominal cavity.
Group II, I: Penetrating but occult injuries, need secondary abdominal survey.
Local wound exploration to rule out any peritoneal breach in stable patients.
- No breach – manage as deep laceration.
- Breach – penetration assumed and significant damage ruled out.
Admission, observation, USG, diagnostic peritoneal lavage, or laparoscopy laparotomy.