Stab wound
An 1833 depiction ofJereboam O. Beauchamp stabbingSolomon P. Sharp.
Specialty	Emergency medicine

Astab wound is a specific form ofpenetrating trauma to theskin that results from aknife or a similar pointed object.^[1][2][3][4] 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. Moststabbings occur because of intentionalviolence or throughself-infliction.^[5] 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 thangunshot wounds, they account for less than 10% of all penetrating trauma deaths.^{[citation needed]}

Stab wounds can result in various internal and external injuries. These wounds are typically caused by low-velocity weapons, meaning the damage is usually confined to the weapon's path, unlike gunshot wounds which often affect surrounding tissues.^[6] Theabdomen is the most commonly injured area in cases of stab wounds. Interventions that may be needed depending on severity of the injury includeairway,intravenous access, and control ofhemorrhage.^[5][7] The length and size of the knifeblade, as well as its trajectory, are critical factors in assesssing and predicting which internal structures may have been damaged.^[1][3] 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 drugs which can make it harder to obtain a complete medical history.^[8] Special precautions should also be taken to prevent further injury from a perpetrator to the victim in ahospital setting.^[9] Similarly to treatingshock, it is important to keep the systolic pressure above 90mmHg, maintain the person's core body temperature, and for prompt transport to atrauma center in severe cases.^[10][11]

To determine if internal bleeding is present afocused assessment with sonography (FAST) ordiagnostic peritoneal lavage (DPL) can be used. Other diagnostic tests such as acomputed tomography scan or variouscontrast studies can be used to more definitively classify the injury in both severity and location.^[12] Local wound exploration is also another technique that may be utilized to determine how far the object penetrated.^[13] 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 whenhypovolemia or shock is not present.^[14] Laboratory diagnostic studies such as ahematocrit,white blood cell count and chemical tests such asliver function tests can also help to determine the efficiency of care.^[15]

Surgical intervention may be required, but it depends on whatorgan systems are affected by the wound and the extent of the damage.^[3] It is important for care providers to thoroughly check the wound site in as much as alaceration of anartery often results in delayed complications sometimes leading todeath. In cases where there is no suspicion of bleeding or infection, there is no known benefit of surgery to correct any present injuries.^[16] Typically asurgeon will track the path of the weapon to determine the anatomical structures that were damaged and repair any damage they deem necessary.^[17] 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.^[18] In severe cases whenhomeostasis cannot be maintained the use ofdamage control surgery may be utilized.^[19]

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.^[16] Stab wounds can result from self-infliction, accidentalnail gun injuries,^[20][21] andstingray injuries,^[22] however, most stab wounds are caused by intentionalviolence, as theweapons used to inflict such wounds are readily available compared toguns.^[23] Stabbings are a relatively common cause ofhomicide in Canada^[24] and the United States.^[25] Typically death from stab wounds is due toorgan failure orblood loss. They are the mechanism of approximately 2% ofsuicides.^[26]

In Canada,homicides by stabbing and gunshot occur relatively equally (1,008 to 980 for the years 2005 to 2009).^[24] In the United States guns are a more common method of homicide (9,484 versus 1,897 for stabbing or cutting in 2008).^[25]

Stab wounds occur four times more thangunshot wounds in the United Kingdom, but themortality rate associated with stabbing has ranged from 0–4% as 85% of injuries sustained from stab wounds only affectsubcutaneous tissue.^[7][9][27] In Belgium, mostassaults resulting in a stab wound occur to and by men and persons ofethnic minorities.^[28]

Some of the first principles of wound care come fromHippocrates who promoted keeping wounds dry except for irrigation.^[40]Guy de Chauliac would promote removal of foreign bodies, rejoining of severed tissues, maintenance of tissue continuity, preservation of organ substance, and prevention of complications.^[40] The first successful operation on a person who was stabbed in theheart was performed in 1896 byLudwig Rehn, in what is now considered the first case ofheart surgery.^[41] 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 oflaparotomy, which has been developed a few years earlier, had provided better patient outcomes than had been seen before.^[42] 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".^[43] 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.^[44] During theKorean War, a greater emphasis was put on the use of pressure dressings andtourniquets to initially control bleeding.^[40]

• Ballistic trauma

• 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's emergency medicine : concepts and clinical practice (8th ed.). Philadelphia, PA: Elsevier/Saunders. pp. Chapter.ISBN 978-1455706051.

• Injuries
• Causes of death

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