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skin. The term, stab, usually refers to a puncture with a knife or sharp weapon. There are two common causes of stabbed or punctured wounds, a puncture caused by gunshot or stabbed with a knife or sharp weapon. A gunshot wound can be penetrating, perforating, or grazing. A penetrating gunshot wound is one in which the bullet remains in the body; a penetrating gunshot wound only has an entrance wound. These injuries are often the most lethal; as they indicate that the entirety of the bullet's kinetic energy was transferred to the body. A perforating gunshot wound is one that passes through the body completely; there are both an entrance wound and an exit wound. The energy that remains in carrying the bullet once it has left the body can vary greatly; often, a bullet that has passed through a body can become deformed and tumble, thus making it very dangerous. However, sometimes the bullet has so little energy remaining it can't even break through clothing - in one reported case, a person was shot from the back, and the bullet passed through their back and exited their body from the chest, and the bullet was found in that person's breast pocket, as it had insufficient energy to break through the other side of the person's clothing. Of course, a grazing wound is one in which the bullet grazes the body as it passes, causing a generally milder injury than the other forms of gunshot wound.
When a bullet penetrates the body, it imparts some of its energy into the body. Typically this energy results in temporary cavity formation. This means that as the bullet creates a path through tissue, the path expands for a fraction of a second and then retracts. This expansion can damage tissue in its own right, making a bullet wound and its resulting injuries appear larger than the projectile itself. In flexible areas - such as the abdomen - there might be a higher resistance to the expansion and thus, the temporary cavity doesn't cause as much damage; but, in an inflexible area, such as the tough unyielding skull, the temporary cavity formation can result in severe pressures and devastating injuries. Most handguns aren't powerful enough to cause the skull to explode with a gunshot wound to the head, but weapons like shotguns and high-velocity rifles can cause the head to seemingly explode due to the pressures caused. Ammunition can be designed to contribute to injury secondary to temporary cavity formation. For example, hollowpoint rounds are designed for that purpose. Despite myths, hollow-point rounds do not explode;
they "mushroom" their tips upon impact thus increasing temporary cavity formation and ensuring that their kinetic energy gets transferred to the body. Their injuries can appear as though they were created with larger ammunition.
Point-blank gunshot wounds can also feature injuries caused by the hot gases released from the muzzle of the gun. There may be burns and soot marks at the entrance wound. Pointblank gunshot wounds to the head, as a result of the barrel being firmly held against skin upon tough bone, can have a unique appearance due to gases from the muzzle forcing under the skin, causing it to balloon out and tear, leaving a star-like tearing wound in the skin around the entrance wound. Shotguns fire a wad of small projectiles that spread as they travel, hence why shotguns are rarely lethal beyond a certain range from the muzzle (typically much shorter than that of a rifle). People shot from a distance by a shotgun may have many small penetrating wounds; the distance between the wounds and knowledge of the particular weapon can help to determine distance from the gun. However, at close-range, shotguns produce devastating injuries. Stab wounds are incised wounds where the length of injury on the surface is less than the depth of penetration into the body, and are the result of a thrusting action, where the force is delivered along the long axis of a narrow, pointed object. The force of impact is concentrated at the tip of the implement, and the sharper the tip, the easier it will penetrate the skin. The weapons of choice in the majority of assaults both domestic and on-the-street include lock knives, sheaf knives and kitchen knives. MANIFESTATIONS Symptoms of a stab wound include a puncture wound, as well as pain, swelling, tenderness or numbness of the skin around the wound. A stab wound to an arm or leg may result in poor circulation to the fingers or toes. Symptoms of a severe stab wound may include pale skin, fatigue, faintness, difficulty breathing, excessive sweating, confusion, or fainting.
Clean cut edges One or both ends pointed Non-pointed end may be squared off or split (fish tail or boat shaped defect) Often gape (related to skin elasticity and Langers lines) Cross section of weapon may be illustrated when edges of wounds opposed Underlying bone may be scored by blade Abrasions may be present Frequently shows notching or a change in direction (caused by relative movement of the knife and body)
EMERGENCY MANAGEMENT Potentially deadly and definitely very painful and gory, a stab wound is in need of fast treatment to try and alleviate the bleeding and pain, as well as buying time to get the victim to proper medical treatment. If you're attending to a stab wound, it's a lot of responsibility that requires quick action and a level head, including calling for emergency services, staying calm and providing basic first aid to help reduce the bleeding and hopefully save the victim's life. 1. Assess the situation as a whole before involving yourself A stabbing often occurs within a volatile situation and the attacker or provokers may still be in the vicinity, threatening others. Avoid making yourself another potential victim by going near such people until it's clear that they've left the scene. While this loses precious time for the person stabbed, having more people stabbed is hardly conducive to rescuing anybody.
2. If at all possible, put on disposable gloves. This is vital in reducing the risk of infection to yourself or the victim. If available, nitrile or other non-latex gloves are preferable as they minimize the possibility of an allergic reaction to latex which may complicate treatment. They are most commonly blue or purple in color and are rapidly replacing the white latex gloves that were previously the standard. Other alternatives include plastic bags over your hands, or having extremely clean hands if there is no other choice than to touch bare-handed. Remember, you absolutely do NOT have to touch the person if you believe that you are in danger of contracting a pathogen they may be infected with or are otherwise uncomfortable. Wait for emergency assistance if you are in doubt, YOUR SAFETY MUST COME BEFORE THAT OF THE PATIENT. If you choose to treat them, do your absolute best to minimize contact with the victim's blood.
3. Check the victim's airway before all else If there is blood present, this will be an obstruction to their breathing and needs to be cleared out. It is more likely to be an issue if the stab wound is close to the chest.
4. Remove the victim's clothing with care This will enable you identify the precise location of the stab wound. It can be obscured by both clothing and by blood or other fluids and even dirt or mud, depending on where the victim is found.
5. Leave the stabbing object in the wound if it's still there Pulling it out will increase blood loss, and pushing it in may cause further injury. You'll just need to dress the wound around the knife the best that you can.
6. Stop the bleeding through use of a dressing Apply pressure on the wound with a clean and absorbent material (like a shirt or towel), or preferably, a clean dressing. If the object is still in the wound, press firmly around it. The application of pressure to the wound will help to slow down the rate of bleeding. Some first aid training suggests using the edge of a credit card to "seal" the wound, an item that's handy because so many people have one on them. Not only does this stem blood flow, but it may also prevent lung collapse (by keeping air out of the wound) if the wound is in the chest.
7. If the wound is bleeding profusely, apply pressure to the major artery leading to the area with the pads of your fingers, pushing down to the bone, while your other hand continues to apply pressure on the wound To slow bleeding in the arm, press on the inside of the arm just above the elbow or just below the armpit. If the wound is on the leg, press just behind the knee or in the groin.[2] If bleeding persists, apply a tourniquet.
8. Cover the dressing Hold the dressing in place using a bandage or tape. Do not lift or remove the dressing as this will disrupt clot formation and re-start the bleeding. If the dressing becomes soaked with blood, add more cloth material on top of it. In the case of a chest wound, be extremely careful. Cover the wound with something like kitchen foil a plastic bag or cling-film and only cover three sides of the wound and leave one untaped or bandaged down. The reason for this is that air must be able to escape from one side of the bandage, to prevent it from entering the pleural cavity. If air enters the pleural cavity in this manner, the lungs can collapse. Never use a tourniquet except as the last resort to save a life. Know how and when to use a tourniquet. If it is done incorrectly, it may lead to an unnecessary serious injury to or loss of the leg or arm.
9. If possible, reposition the person so that the wound is above the level of the heart. This will help reduce blood loss. If the victim can sit, get them to move themselves into an upright position; if not, then help them if possible. Talk to them reassuringly all the
time. If you haven't already called for emergency services, do so now. Hopefully others have been able to help with this earlier on.
10. Continue applying pressure until help arrives While waiting for emergency help, continue to monitor the ABCs, Airway, Breathing and Circulation. Keep the victim warm. Both shock and loss of blood can cause the victim to suffer from lowered body temperature. Throw a blanket, coat or some other warm item over the victim to try and keep the person warm. Keep the victim as still as possible. Whether lying or sitting down, the patient should be kept still and calm. It is important that someone remains with the person constantly, to both reassure them and to monitor their condition.
11. Should the victim fall unconscious, you'll need to act quickly Place the victim in the recovery position and either: Continue to monitor breathing; or If the unconscious victim ceases breathing, perform CPR.
Gunshot wounds are one of the most traumatic injuries you can suffer. It's difficult to assess the extent of damage done by a gunshot wound, and most of them far exceed what you can reasonably treat with first aid. For this reason, the best option for most bullet wounds is to get the victim to a hospital as soon as possible. However, this article will provide some guidance on what you can do to stabilize the victim in the meantime.
2. Make sure you are safe. If the victim was shot unintentionally (e.g., while hunting), make sure that everyone's firearm is pointed away from any other person(s), cleared of ammo, safe and secured. If the victim was shot in a crime, try to make sure that the shooter is no longer on the scene and that both you and the victim are safe from further injury. Wear personal protective equipment if available.
3. Do not move the victim unless you must do so to keep him safe or to access care
4. Act quickly Time is your enemy in treating the victim. Victims who reach medical facilities during the "Golden Hour" have a much better likelihood of surviving. Try to keep your movements swift without making them frenzied.
5. Check the A, B, C, D, E's Assess these five critical factors A (Airway) If the person is talking, their airway is probably clear. If the person is unconscious, check to make sure that his airway is not obstructed. Turn the victim's head to the side to facilitate better breathing and get the tongue out of the way. If the victim's mouth is filled with blood, try to help them remove it by coughing or quickly sop it up with a rag or piece of clothing. B (Breathing) Is the victim taking regular breaths? Can you see his or her chest rising and falling? If the victim is not breathing, sweep his or her mouth for obstructions and start rescue breathing immediately. C (Circulation) Apply pressure to any bleeding, then check the victim's pulse at the wrist or throat. Does the victim have a discernible pulse? If not, begin CPR. Control any major bleeding. D (Disability/Deformity) Disability refers to damage to the spinal cord or neck. Check to see if the victim can move hands and feet. If not, there may be an injury to the spinal cord. Deformity refers to things such as compound or obvious fractures, dislocations, or anything that looks out of place or unnatural. These injuries can be worsened by moving the victim. E (Exposure) Always look for an exit wound. Check the victim as thoroughly as possible for other wounds that you may be unaware of. Pay special attention to the armpit, buttocks or other difficult-to-see areas. Avoid completely undressing the victim before emergency help arrives as this may advance shock.
6. Control bleeding Controlling bleeding is most important thing you can do to save a gunshot victim's life Applying direct pressure is the best way to control most wounds. Use a pad over the wound and apply pressure directly to the wound. If you have nothing available, even your hand or fingers can be used to control bleeding. Add new bandages over the old; do not remove bandages when they become soaked. Use pressure points in the arm (between the elbow and armpit), groin (along the bikini line), or behind the knee to control bleeding in the arm, thigh, or lower leg, respectively. There is little that can be done with conventional methods if the wound involves the torso, but chemical hemostats (QuickClot, Celox, etc.) have been proven to be very effective on all major bleeds. Ensure that you follow the instructions on the package for application, though it is usually as simple as holding the wound open, pouring in the powder or inserting the powder packet/sponge/applicator, and applying strong pressure for five minutes.
7. Be prepared to treat the victim for shock Gunshot wounds frequently lead to shock, a condition caused by trauma or loss of blood that leads to reduced blood flow throughout the body[1]. Expect that a gunshot victim will show signs of shock and treat it accordingly by making sure the victim's body temperature is as normal as possible cover him up if his skin feels cold, or remove clothing and fan him if he's burning up. However, do not elevate the legs if the gunshot wound is to the torso, as this will increase bleeding and make it more difficult for the victim to breathe.