Tuesday 8 November 2011

Emedinews:Insights on Medicolegal issues:How can a doctor assess the severity of stab wounds by external examination?

The severity is based exclusively on the location and depth of penetration seen in autopsy.
• The important medical considerations include the type of weapon used i.e. knife length, shape, straight or serrated, and manner of assault, whether the stabbing is overhand/underhand.
• The gender of the assailant may have some importance; women tend to stab "overhand." Penetration tends to be deeper with the "underhand" thrust.
• Stab wounds to the chest should always be considered dangerous and likely to cause death until proven otherwise.
• Central stab wounds, below the clavicles and to either side of the breastbone can result in penetration of the heart. Chest wounds can result in puncture and rupture of the lung or marked bleeding within the chest cavity causing hemothorax.
• Stab wounds to the abdomen will often result in an exploratory laparotomy to rule out serious damage. Slow bleeding inside the abdomen is extremely difficult to diagnose, and should be considered a possibility in every case.
• Stab wounds to the upper back can involve the lung or heart.
• Stab wounds to the lower and middle back can involve the kidneys and ureters. Evaluation of stab wounds to the back that may have punctured the kidney will require intravenous pyelography for evaluation. The presence of blood in the urinalysis indicates injury to the kidney, bladder, or ureter.
• An examination for sensation, movement and pulses of the victim should be carefully done and documented in case of stab wounds to the hands/legs that do not lacerate nerves, blood vessels, or tendon structures.

(Contributed by Dr Sudhir Gupta)

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