What is Penetrating Chest Trauma (Stab Wounds in the Chest)?
Injuries to the chest have rapidly become the second most frequent type of accidental trauma. Interestingly, chest injuries have the highest rate of death associated with them, with some research showing a fatality rate of up to 60%, depending on how the injury happened. Though wounds from sharp objects penetrating the chest are not as prevalent as blunt force injuries, they can be more life-threatening. Prompt action and early treatment are crucial to assessing, managing and surviving these injuries.
What Causes Penetrating Chest Trauma (Stab Wounds in the Chest)?
Chest injuries can occur from either a sharp object piercing the skin, known as penetrating trauma, or a heavy impact, called blunt trauma. Blunt trauma is more common, but penetrating trauma can pose serious, immediate danger to life. Understanding how the injury happened is crucial as it can affect the way it is managed. Also, the approach of the penetrating object influences the course of investigation and treatment.
In cases of penetrating chest injuries, quick diagnosis and immediate medical operation may be needed to save the patient’s life. The type of penetrating injury, like a knife versus a bullet wound, can lead to different kinds of injuries. Out of all penetrating chest injuries, gunshot and stab wounds are the most common, accounting for 10% and 9.5%, respectively.
Risk Factors and Frequency for Penetrating Chest Trauma (Stab Wounds in the Chest)
Chest trauma can occur in individuals of all ages and is the third most common injury after head and extremity trauma. In fact, it’s increasing in frequency and is nearly the second most common.
- Gunshot and stabbing incidents cause 10% and 9.5% of penetrating chest injuries in the United States, respectively.
- However, these statistics differ around the world. In war-torn countries, for example, chest injuries can account for up to 95% of total injuries.
Testing for Penetrating Chest Trauma (Stab Wounds in the Chest)
Identifying chest trauma quickly is important for treatment. The first three steps of trauma evaluation involve checking and responding to potential injuries in the chest area, known as “the box.” Following standard trauma procedure helps avoid overlooking injuries. Damage to the heart and lungs is usually severe and diagnosing these early is essential as these injuries can be fatal if missed. The ribs, collarbone, windpipe, bronchi, food pipe, and large blood vessels including the aorta and veins also need checking.
Checking thoroughly is important since the route a penetrating injury can take, varies. The main review identifies injuries that are immediately life-threatening and these should be treated straight away. These injuries could include a large build-up of blood or air in the chest, fluid around the heart with or without heart compression (tamponade), and a large amount of blood in the abdominal cavity.
When the first exam and additional imaging is complete, a secondary test may find things like rib fractures, small amounts of blood or air in the chest, and bruising on the lungs or chest wall. Physical signs can point to chest trauma. Open wounds could be from where something entered or exited the chest. When caused by something like a bullet, it’s crucial not to record wounds as entry or exit points since it’s a legal matter and wrongly recording it can have legal consequences.
In terms of diagnosis, while chest X-rays are the most common, they can miss small to medium amounts of air or blood in the chest because they’re taken lying down. The enhanced (extended) Focused Assessment with Sonography in Trauma (eFAST) can be done at the same time as the main test for unstable patients. It quickly spots abnormal amounts of air or blood in the chest and helps determine treatment.
The traditional FAST test checks four areas, the heart, right upper abdomen, left upper abdomen, and the lower abdomen. If there’s a noticeable black area outside an organ or the heart sac, this suggests a positive FAST result. The eFAST includes checking the lungs and can detect air or blood in the chest. It should start in the area where an injury is most likely. If there’s a concern about the chest, start here. This includes checking the front chest wall for air and reviewing the spinal cord in the right and left upper abdomen to check for blood. Any fluid found in trauma patients is assumed to be blood.
A CT scan is more accurate but the patient needs to be stable for the test. Other supplementary tests like endoscopy, bronchoscopy, and electrocardiography can also be done as needed.
Treatment Options for Penetrating Chest Trauma (Stab Wounds in the Chest)
If someone is injured, the first steps usually involve ensuring that they can breathe properly and that their heart is pumping blood effectively. After that, specific treatments for their injuries can be started.
Certain critical injuries need immediate attention. For instance, if someone has a large air pocket or significant bleeding in their chest, an emergency procedure might be required to drain the area. This is important to prevent complications, like an infection that could require further surgery.
Most chest injuries can be managed without surgery. However, around 15% of patients will need an operation. Early surgery is crucial in these cases. For instance, if a chest drain removes a large amount of blood at once or consistently over several hours, this could indicate the need for surgery. Or if a person is persistently getting worse despite receiving a blood transfusion and there’s no other clear reason why, this, too, might signal that surgery is required.
In critical situations, where a cardiac arrest seems imminent, a specific procedure called an emergency department thoracotomy might be performed to help resuscitate the patient. This procedure is particularly beneficial for patients who have been stabbed in the chest and still show signs of life upon arrival at the hospital.
If a patient comes in with a penetrating chest wound but appears to be otherwise fine, they’ll often be kept under observation in case a delayed air or blood pocket develops. If nothing problematic shows up on repeated examinations and tests after around 6 hours, they can usually go home. However, they’ll be given clear instructions to come back immediately if they start to struggle with breathing, have chest pain, or find swallowing painful.
Simple injuries can often be managed with careful monitoring and adequate pain control. Pain control is particularly important in chest injuries, as pain can prevent proper healing and lead to complications like pneumonia. Therefore, early pain relief, such as short-acting opioids, should be provided as soon as possible. Other treatments that can help manage pain include nerve blocks, pain-relieving patches, patient-controlled pain relief systems, and epidurals.
Pain-relieving patches that don’t contain opioids can be a safe option for managing chest pain, especially for patients with persistent discomfort despite not having any confirmed rib fractures. These patches can also be beneficial for patients being discharged, or for those admitted to the hospital who need additional pain control options.
For procedures involving a chest tube for blunt chest trauma, it’s generally not necessary to give preventative antibiotics as long as the procedure is done using a clean technique. However, antibiotics might be considered if the wound is heavily contaminated or if sterile techniques were disrupted at any point. Also, everyone with a penetrating injury should make sure their tetanus shots are up to date.
What else can Penetrating Chest Trauma (Stab Wounds in the Chest) be?
In order to avoid overlooking or misinterpreting injuries, it’s essential to conduct a thorough examination. This includes an initial assessment, a more detailed secondary review, and then a final third stage of checks.
The direction of an injury is crucial when identifying its effects. For example, a wound in the right chest area could be linked to a liver injury or an intentional harm due to its trajectory, or the path it took to cause the harm.
If you’re dealing with injuries caused by objects like bullets or shards from an explosion, remember the simple rule: the total of wounds and remaining objects in the body should always be even. This might help in anticipating all potential injuries.