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942.e2 Stab Wounds

Stab Wounds Client Education
Sheet
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BASIC INFORMATION
• Animals with a previously unattended
wound may present for signs associated with extent of internal injury suspected from the
initial exam.
Definition infection.
• Low-energy impact, penetrating injuries Differential Diagnosis
inflicted by sharp instruments, such as knives, PHYSICAL EXAM FINDINGS • Ballistics injuries (gunshot wounds, arrows,
tools, and tusks/horns/antlers, resulting in • Exam findings usually reflect the location shrapnel)
localized tissue trauma of injury. • Vehicular or other significant trauma
• This chapter covers nonaccidental (malicious) • Tachycardia, tachypnea, pale mucous mem- • Hemoabdomen
injuries causing incised wounds (cuts) and/or branes, and collapse with major hemorrhage • Uroabdomen
stab wounds and the injuries seen in working (hemorrhagic shock) • Spontaneous pneumothorax
dogs, such as cattle dogs and police dogs. • Dyspnea or respiratory distress with lacera- • Sepsis
tions to the chest, neck, or thorax
Synonym • Abdominal distention and discomfort with Initial Database
Impalement injury penetrating abdominal wounds, which • Point-of-care blood tests: elevations in blood
may also leak a serous or serosanguinous lactate in patients with shock, decreased
Epidemiology peritoneal fluid packed cell volume (PCV) and total plasma
SPECIES, AGE, SEX • Neurologic deficits and/or obtunded men- protein in patients with hemorrhage (if the
Animals sustaining nonaccidental (malicious) tation with central or peripheral nervous hemorrhage is peracute, plasma protein may
physical injuries are significantly more likely system injury (e.g., laceration of brachial be decreased before anemia evident), and
to be male than female and of younger age. plexus, traumatic brain injury) hypoventilation and hypoxemia in patients
• Skin lacerations can result in hemorrhage with respiratory compromise
GENETICS, BREED PREDISPOSITION or subcutaneous emphysema. • CBC, serum biochemistry profile: changes
• Certain breeds (e.g., pit bull) are at markedly • Animals with chronic wounds and infection reflective of organ damage (e.g., azotemia and
greater risk for nonaccidental or malicious may present with elevated rectal temperatures hyperkalemia in patients with uroabdomen),
physical injuries. Conversely, other breeds in or hypothermia. hemorrhage, or pre-existing condition(s)
the pet population (e.g., Labrador retrievers) • Sample and cytologic analysis of any free
are at markedly lower risk. Etiology and Pathophysiology fluid identified in abdomen or thorax
• Military working dogs, police dogs, herding • Injury reflects the shape and length of the (p. 1343)
dogs, and so-called catch dogs used in wild weapon, location of injury, and the direction • Survey radiography, abdominal and thoracic
boar hunting are also at increased risk for and force of impact. focused assessment with sonography for
accidental or malicious stab injuries. • Further injury can result from indiscriminate trauma (abdominal/thoracic focused assess-
removal of the weapon, which may involve ment with sonography for trauma [AFAST/
RISK FACTORS twisting and dragging of the blade on its TFAST] [p. 1102])
• Stabbing wounds inflicted by humans are tract out of the wound.
almost invariably the result of malicious • The locations of penetration into the skin and Advanced or Confirmatory Testing
intention. musculature often do not line up. Careful Based on extent and location of wound(s):
• Working dogs with exposure to potentially surgical dissection or a radiographic study • CT
dangerous encounters or environments are using a contrast agent (e.g., fistulogram) may • MRI (p. 1132)
at greater risk. be necessary to establish the true depth and • Selective angiography
• Outdoor cats and roaming dogs extent of injury. • Fistulography
• Penetrating wounds to the thorax or • Aerobic (and anaerobic if indicated) bacte-
ASSOCIATED DISORDERS neck may cause cardiovascular collapse if riologic culture of wounds
Depending on the variety of implement, force major vascular structures or the heart is • Esophagoscopy
of impact, and location of injury, associated dis- involved.
orders may include head trauma, spinal injury, • Pneumothorax can result from injury to lung TREATMENT
pneumothorax, hemothorax, hemoperitoneum, or major airway structures.
subcutaneous emphysema, or uroabdomen. • Penetrating wounds to the abdomen may Treatment Overview
cause injury to viscera, resulting in hemor- Treatment goals are control of blood loss,
Clinical Presentation rhage, leakage of intestinal contents, leakage maintenance of adequate oxygenation and
HISTORY, CHIEF COMPLAINT of bile, or leakage of urine. ventilation, infection control, and wound
• Usually acute onset of signs • Laceration to the diaphragm can result management.
• Victim may be a working dog recently in herniation of abdominal viscera and
involved in a violent encounter. potentially bowel strangulation that could Acute General Treatment
• Unless an act of violence is evident or clear occur months or years later. • Control of airway and ventilation, poten-
malicious intent is suspected, history may • Penetrating wounds to the head may cause tially including intubation, ventilation
be vague. hemorrhage or infection in the brain, eyes, (p. 1185), thoracocentesis (p. 1164), or chest
• Repeated presentations for treatment of and sinuses. tube placement (p. 1082)
unexplained or poorly explained injuries • Cardiovascular resuscitation (p. 1077) with
should raise the suspicion of malicious DIAGNOSIS IV fluid therapy or blood products (p. 1169)
injury and trigger notification of local law • Surgical exploration by celiotomy, thora-
enforcement (p. 9). Diagnostic Overview cotomy, or other approach indicated by injuries
• Chief complaint (e.g., dyspnea, skin lacera- The diagnosis is based entirely on available • Flush, debride, and close (with a drain) minor
tion, abdominal discomfort) may suggest history and physical identification of compatible stab wounds to the soft tissue.
localization of the wound. wounds. Diagnostic imaging may confirm the • Broad-spectrum antibiotics
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