AN APPROACH TO STAB WOUNDS

DR Y MAHOMED

MOST STABS ARE NOT SERIOUS , BUT MUST BE TAKEN SERIOUSLY

• WE WILL TRY TO COVER A BASIC APPROACH TO STABS

• HOW TO DEAL WITH A STAB WOUND

• WHEN TO BE WORRIED

A STAB IS LIKE ANY WOUND

• WOUNDS MUST BE KEPT CLEAN

• WOUNDS MUST BE DERIDED

• WOUNDS MUST BE FULLY ASSESSED

• WOUNDS MUST BE CLOSED PROPERLY

• A CLOSED, CLEAN WOUND IS A HAPPY WOUND

WHAT STEPS DO WE FOLLOW?

• EXPOSE THE WOUND

• CLEAN THE WOUND AND SURROUNDING AREA

• DRAPE THE WOUND

• STERILE EQUIPMENT IS VERY IMPORTANT

• GIVE LOCAL ANAESTHETIC

• DEBRIDE IF NECESSARY

• CLOSE WITH SUTURES,STAPLES OR TAPE

• DRESS THE WOUND WITH ANTISEPTIC

WE CAN USE THE MNEMONIC LACERATE

• L-LOOK AT THE WOUND

• A-ANAESTHETIC

• C-CLEAN THE WOUND

• E-EQUIPMENT(SET-UP)

• R-REPAIR WOUND

• A-ASSESS THE RESULTS

• T-TETANUS IMMUNIZATION

• E-EDUCATE ABOUT WOUND CARE

CUTE BABY TO MAKE US FORGET THE UGLY WOUND

SUTURES

• WE HAVE ABSORBABLE AND NON-ABSORBABLE

• BOTH CAN BE USED

• NON-ABSORBABLE LEAVES A BETTER SCAR

• ABSORBABLE EASIER FOR CHILDREN, BECAUSE IT DOESN’T HAVE TO BE REMOVED

INTERUPTED SUTURE

CONTINOUS SUTURE

STAPLES

SUBCUTICULAR SUTURE STERI-STRIPS

WOUND GLUE SEPTIC SUTURE WOUND

IF YOU HAVE A WEAK STOMACH PLEASE LOOK AWAY

THE NEXT SLIDE IS A BIT GRAPHIC

SCALP STABS• THEY OFTEN BLEED ALOT • A SKULL XRAY SHOULD BE DONE

IF ITS DEEP • LUCKILY WE HAVE THICK SKULLS

SO IT’S DIFFICULT FOR A BLADE TO PENETRATE, BUT NOT IMPOSSIBLE

NECK STAB WOUNDS

• THERE ARE 3 ZONES

• IF THE PLATYSMA IS VIOLATED THE SURGEONS MUST BE INVOLVED

• THESE PATIENTS CANT BE SUTURED AND SENT HOME

• WHY?

THERES A LOT THAN CAN BE

DAMAGED!!MOST OF THESE STRUCTURES ARE

QUITE CLOSE TO THE SURFACE , DAMAGE TO THEM HAS

SERIOUS ,AND SOMETIMES FATAL ,CONSEQUENCES

CHEST STAB WOUNDS

• POTENTIALLY VERY DANGEROUS

• MAY INJURE HEART, LUNGS, MAJOR VESSELS, LYMPHATICS

• MUST BE X-RAYED EVEN IF THEY SEEM NOT SO SERIOUS

A PNEUMOTHORAXI.E A COLLAPSED LUNG DUE TO A STAB WOUND

ABDOMINAL STABSPOTENTIAL FOR INJURY TO MANY STRUCTURES

IF YOU HAVE A WEAK STOMACH PLEASE LOOK AWAY

THE NEXT SLIDE IS A BIT GRAPHIC

PENETRATING WOUNDS

BOWEL EVISCERATION

BOWEL EVISCERATION

FREE AIRTHIS IS UNDER THE DIAPHRAGM, A SIGN OF BOWEL INJURY

IT IS A MEDICAL EMERGENCY

SOME OTHER AREAS OF

IMPORTANCEANTERIOR ASPECT OF THE BODY

MAJOR VESSELS RUN

IN THESE AREAS

SOMETIMES THERE MAY BE SIGNIFICANT INJURY WITHOUT

MASSIVE BLEEDING

OTHER AREAS OF

IMPORTANCEPOSTERIOR ASPECT

THESE ARE OFTEN MISSED EVEN BY EXPERIENCED DOCTORS!!

• FROM TOP TO BOTTOM

• SPINAL COLUMN

• ABDOMEN, KIDNEYS, AORTA

• MAJOR NERVES AND VESSELS OF THE BUTTOCK

• POPLITEAL ARTERY BEHIND KNEE

• TENDONS OF THE HAND

TAKE HOME MESSAGE• STABS ARE SERIOUS

• SEVERE INJURIES CAN BE MISSED

• ALL OF US CAN BE VIGILANT AND GUIDE ONE ANOTHER

• DONT BE AFRAID TO APPROACH COLLEAGUES IF YOU THINK SOMETHING HAS BEEN MISSED

• KEEP THINGS CLEAN

• TRY NOT TO STAB PEOPLE TOO OFTEN, CASUALTY IS ALREADY BUSY ENOUGH!!

• REMEMBER , LIFE IS BEAUTIFUL, DONT LET SOME OF THE HORRIBLE THINGS WE SEE MAKE YOU FORGET THAT

THANK YOU