Stab wounds

[Smokin Joe]

Okay I don't post in this AO b/c I only know enough to be a first responder (cert expired like 3 years ago). So here is the deal, the FEDS booked some guys into my jail this afternoon. 1 individual had multiple stab wounds. He had been treated at the hospital and released. No big deal right? Well he starts knocking on his door for help. I look in and he is bleeding profusely out of his chest (the area in which 3 wounds were). What I and our nurse did worked to stop the bleeding but what should be done from start to finish? Here are pics of the wounds after the bleeding had stopped and he had been cleaned up.

[ccrn]

From the pictures the wounds look to be superficial although its difficult to tell.

Tx for you guys would depend on what you want to achieve.

If bleeding lay him flat with feet slightly elevated, pack the wounds with gauze, apply a pressure dressing and call EMS. Internal bleeding with tamponade or pneumo among other things would be of concern. Your facility must have protocols for situations like this?

If the wounds are just superficial and arent to be sutured they need to be irrigated, covered for a period of time, and tx with a course of abx. I would guess the lump is a hematoma or localized inflammation?

Wound care could be an irrigation with dressing change one to three times daily.

Your RN should know all of this.

I suggest an EMT-B course. Your emplyoyer might even pay for it-

[Smokin Joe]

ccrn,

Here is what we did.

1. My first question when I saw all the blood (about a half a pint) was should we call EMS? Our nurse said not yet.
2. I applied direct pressure for about 10 minutes
3. Nurse continued to monitor and clean patient
4. Bleeding dropped off substainally onces I applied direct pressure.
5. After about 20 mins the pictures were taken.

Here are my observations of the left wound:

The left wound (our left as you look at the patient) was the real bleeder in which I applied the direct pressure to. I could not tell how deep it was but when I initially assessed his wound the blood was coming from deep with in the cut it was not coming from the dermis or epidermis layer of tissue. The blood was also flowing out of the wound not a trickle.

We do have protocols when dealing with this but I asked you guys just to make sure we are good to go.

[24601]

I'm kinda suprised they didn't suture that one. For now, you guys seem GTG. If it starts bleeding again, I'd call EMS. He might need more fluids, it further treatment. I had many calls to the jail for pts. that were worst off than they looked. You have good judgment, so trust it. You've done good, don't doubt yourself.

Keep an eye on color, breathing, alertness, etc. I take it there weren't any bubbles coming from it? A little off from the lung, I know, but it's hard to tell how deep it is.

[ccrn]

Originally Posted by Smokin Joe

We do have protocols when dealing with this but I asked you guys just to make sure we are good to go.

I hope I didnt give you the impression I didnt think you were aware of these. I was more curious what they were p/t this situation. Also I am wondering if you guys have an MD on staff that writes these for you regarding medical issues and emergencies.

From your description it seems like you guys did ok. My fear would be internal bleeding that might not manifest itself until later. Liability also comes to mind especialy in todays litigious climate.

Do you guys have a form of liability insurance that you carry aside from employer protection? Quite a few nurses carry private malpractice now. Sometimes the employer will defend RN's in a lawsuite only to turn around and sue them as individuals-

[Smokin Joe]

Originally Posted by ccrn

I hope I didnt give you the impression I didnt think you were aware of these. I was more curious what they were p/t this situation. Also I am wondering if you guys have an MD on staff that writes these for you regarding medical issues and emergencies.

From your description it seems like you guys did ok. My fear would be internal bleeding that might not manifest itself until later. Liability also comes to mind especialy in todays litigious climate.

Do you guys have a form of liability insurance that you carry aside from employer protection? Quite a few nurses carry private malpractice now. Sometimes the employer will defend RN's in a lawsuite only to turn around and sue them as individuals-

Yes I'm in a Cop Club that protects us from civil litigation.

Our Protocol's were written by a PA. Because my cheap ass county can't afford an MD on staff.

Normally I would have applied direct pressure and called medics but our nurse (who is almost a PA) said not yet so I waited.

[ccrn]

Originally Posted by Smokin Joe

Normally I would have applied direct pressure and called medics but our nurse (who is almost a PA) said not yet so I waited.

Like I said it seems like you guys did ok. Saved you the risk and hassle of transport back to ER in anycase.

How did your guy do anyway?

BTW, BP q hour x 4 might be appropriate in your situation given the circumstances. A lowering systolic pressure, narrowing pulse gap, and tachcardia would be symptoms of concern among others (ie pallor, decreaseed mentation, decreased heart tones, tachnypea etc etc).

Of course nothing is a replacement for higher care (qualifyer)-