Injuries — spear and knife (stab) wounds

May be damage inside and a long way from where knife or spear went into body (eg heart, lungs, spine, bowel)

Do not

  • Do not remove any deeply embedded object (eg knife, spear) from wound
  • Do not probe (poke or feel around in) stab wounds
    • Above elbow, above knee, trunk, face, neck or head
    • With arterial bleeding
  • Do not suture

Do first

  • If evidence of shock — low BP and/or high pulse AND suspicion of uncontrolled (internal) haemorrhage AND less than 3 hours from time of injury — medical consult for tranexamic acid
    • Adult — tranexamic acid IV — 1g (in 100mL compatible fluid) over 10 minutes THEN 1g (in 1,000mL of a compatible fluid) IV over 8 hours — doses
    • Child — tranexamic acid IV — 15mg/kg up to 1g over 10 minutes THEN  2mg/kg/h for 8 hours, dilution 500mg in 500mL of compatible fluid and infuse at 2mL/kg/h (maximum dose 125mg per hour) — doses

Check

  • Calculate age-appropriate REWS
    • Adult — AVPU, RR, O2 sats, pulse, BP, Temp
    • Child (less than 13 years) — AVPU, respiratory distress, RR, O2 sats, pulse, central capillary refill time, Temp
  • Weight, BGL
  • Head-to-toe exam — with attention to wounds
  • Immunisation status — tetanus

Do

  • Stop the bleeding
    • Apply firm direct pressure using gloved hands or pad
    • If something still in wound — apply pressure to pads above and below or around the object
    • Pack wound with gauze soaked in normal saline OR alginate dressing
  • If bleeding not settling
    • Infiltrate with lidocaine (lignocaine) 1% + adrenaline (epinephrine) 1:100,000 up to 50mL
  • If significant blood loss, deterioration or wound in high risk area — put in 2 large bore IV cannula
  • Medical consult
    • Boluses of normal saline or Hartmann's solution — adult 250–500mL, child 20mL/kg
    • Target systolic BP — 80–90mmHg (adult)
  • Always send to hospital if any 
    • Wound in high risk area — head, neck, chest, abdomen, buttocks, thighs
    • Injury to arteries, nerves, tendons
    • Object (eg knife, spear) still in wound
    • Observations or general condition getting worse
  • Clean wound thoroughly
  • Bandage

Give antibiotics — major wounds

    • Cefazolin IV — adult 2g, child 50mg/kg/dose up to 2g — doses — every 8 hours (tds)
    • AND metronidazole IV — adult 500mg, child 12.5mg/kg/dose up to 500mg — doses — every 12 hours (bd)
    • If allergy to penicillin — medical consult for clindamycin IV — adult 450mg, child 10mg/kg/dose up to 450mg — doses — every 8 hours (tds)

Give antibiotics — minor wounds — see Injuries — soft tissue