[swatsurgeon]

Unfortunately no pictures to go with this......
Had a 20 year old stabbed 3 times by a knife that had about a 3 1/2 inch blade. First wound to his back, right side just over the 10th rib, second wound antero-lateral abdomen on the anterior axillary line just under the lowest rib and the third one more medial on the abdomen in the right upper quadrant under the nipple line.
I'm called 3 hrs after the incident by another hospital that states: "he had no breath sounds so we put in a right chest tube". What they didn't say was they has a CXR that was NORMAL before they decided to put in the tube. Anyway, they transfer for these wounds.
He arrives with a heart rate of 85, normal BP, minimal complaits about 5 hours post incident.
History from other hosp.: gave 4 liters IVF, 1 IV site, 32 F chest tube with confirmation CXR after tube that it is in the right chest, No airleak but 160mL of blood in tube (pleurovac).....ROCK STABLE. Anyone worried yet?

So I decide to send him to CT to evaluate abdomen. Retake CXR and their chest tube was placed really low but in the tube does end in the chest.
CT shows A LOT of blood and active hemorrhage RUQ....HR still in the 80's and SBP 130, no distress.
Go to OR and find 1200-1500mL blood in abd and active bleeding from the right lobe of liver, a small hole in the diaphragm....everything dealt with, pt doing fine.

ISSUES: some people think "it's just a flesh wound" vitals are stable, no worries. Now if you took the same patient and made it a GSW, everyone worries......so why not as much anxiety for a stab wound?
This guy was compensating very well for a long time...that won't last forever.
Knife length makes a difference. if you can determine if it was > 2-2 1/2 inches in the average size person without a thick layer of fat, it can get inside and cause significant bleeding.
Based on anatomy and experience, a blade that is 3 1/2 inches or greater typically causes internal injuries, that is not to say smaller blades can't but if you are using the odds for your defensive weapon, go with > 4 inches.
Nothing to really treat these can be done in the field. Stuffing a hemostatic agent into the wound would not have helped, the wound was not bleeding (skin, fat, muscle, fascia), the liver was. A tourniquet would help nothing, so you are left with supportive measures only and getting them to a trauma surgeon.
In general, stable vitals give a false sense of security for stab wounds, not GSW's....time to increase that paranoia for stab wounds also, especially for longer length blades. The old saying of "stabbed with a kitchen knife", well if true, be worried (if a carving knife with a 6 inch blade vs 2 inch paring knife).
Note, this was all about abdominal stab wounds, not chest, neck groin, etc.

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