What are the considerations for a stab wound from a knife?

From the Guidelines

For a puncture wound from a knife, immediate medical attention is crucial, especially if the wound is deep, bleeding heavily, or in a critical area, to minimize the risk of infection and damage to underlying structures, as emphasized by the most recent guidelines 1. When dealing with a puncture wound from a knife, it's essential to prioritize immediate medical attention, particularly if the wound exhibits signs of being deep, bleeding heavily, or is located in a critical area such as the chest, abdomen, or neck. The primary concern is to control bleeding by applying direct pressure with a clean cloth. For superficial wounds, cleaning with soap and water followed by the application of an antiseptic like povidone-iodine is recommended. Covering the wound with a sterile bandage and changing it daily is also advised. It's critical to monitor for signs of infection, including increasing pain, redness, swelling, warmth, pus, or fever, which necessitate prompt medical care.

Key considerations for managing puncture wounds include:

• Thorough cleaning of the wound, as suggested by guidelines for acute care of severe limb trauma patients 1.
• Wrapping the wound in a sterile wet dressing to maintain a clean environment.
• Immobilization of fractures, if applicable, to prevent further injury.
• Antibiotic prophylaxis may be considered, especially in cases of deep wounds or wounds in critical areas, with recommendations for antibiotics like amoxicillin-clavulanate (875/125 mg twice daily for 5-7 days) to prevent infection, as noted in various studies 1.
• Tetanus prophylaxis should be considered if the patient's immunization is not current.
• Never removing an embedded object, as it may be preventing severe bleeding.

The risk of infection is high with knife wounds, as they can introduce bacteria deep into tissues where oxygen levels are low, creating an ideal environment for bacterial growth. These wounds may also damage underlying structures like blood vessels, nerves, or organs. Therefore, professional cleaning, possible exploration for damage assessment, and sometimes antibiotics are necessary to prevent infection and promote healing, as supported by recent guidelines for first aid 1.

From the Research

Considerations for Puncture Wound from Knife

• Puncture wounds can be classified into two distinct types, with one type commonly occurring on the foot and the other among hospital employees 2.
• The fundamental trends of treatment of puncture wounds include:
  • Cleansing the wound
  • Debridement of any necrotic or devitalized tissue
  • Appropriate immunoprophylaxis 2
• Irrigation and cleaning of the wound are crucial to prevent infection, and there is no evidence that antiseptic irrigation is superior to sterile saline or tap water 3.
• Occlusion of the wound is key to preventing contamination, and suturing can be completed up to 24 hours after the trauma occurs, depending on the wound site 3.
• Tetanus toxoid should be administered as soon as possible to patients who have not received a booster in the past 10 years 3, 4, 5.
• Patients with high-risk conditions, such as diabetes mellitus, are at increased risk for tetanus exposure and should be evaluated for tetanus prophylaxis 5.
• Guidelines for tetanus prophylaxis should be followed, and physicians should take a detailed tetanus immunization history and vaccinate patients if the tetanus history is unclear 5.