Emergency clinicians manage stab wound (SW) injuries now more than ever. This topic review will discuss the evaluation and management of abdominal stab wounds.
Primary Survey:
History:
AMPLE
A-allergies, M- medication, P- past medical experience, L- last oral intake, E- events surrounding the injury (Penetrating trauma).
Physical examination:
Airway.
Breathing.
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
Exposure:
- 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.
Resuscitation:
- 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.
Management:
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.
Options:
Admission, observation, USG, diagnostic peritoneal lavage, or laparoscopy laparotomy.
