Ministry of Health

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 Published: 28/11/2011

Evaluation of Stab Wounds to the Chest

Penetrating wounds to the chest represent are uncommon presentations to Auckland Hospital. Many will cause pneumothorax or haemothorax and require chest drain. Occasionally mediastinal or cardiac injuries occur. Penetrating cardiac injuries have a high mortality and only 25% (2 or 3 each year) survive to reach our hospital. Diagnosis before tamponade is associated with better outcomes than waiting for cardiac arrest.

Any patient who is haemodynamically unstable after a stab wound to the chest needs the cause established as soon as possible. Needle decompression or chest drains will identify tension pneumothorax or massive haemothorax. FAST scan or 'DPL and pericardiocentesis' assess bleeding into the abdomen or pericardium.

In stable patients, clinical examination combined with chest x-ray can be used to evaluate the lungs and pleural cavities but these modalities are insensitive for cardiac injury. When patients have been stabbed in "the box" the possibility of cardiac injury exists. ("The box" is that part of the anterior chest and abdomen bounded by the clavicles superiorly, the mid-clavicular lines laterally, and the costal margin in the mid-clavicular line.)

Cardiac injury can be identified by: FAST scan, echocardiography, pericardiocentesis, pericardial window or thoracotomy. All of these are operator and skill dependent. Get consultant input immediately for suspected cardiac injury.

Last updated on 28/11/2011