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WEST Guidelines – Stab Wounds, Avoid Pitfalls

December 13, 2018

Written by Clay Smith

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It is important to see how trauma surgery has evolved regarding abdominal stab wounds. Know their algorithm, especially the caveats and when not send patients home.

Why does this matter?
We need to understand how Trauma manages abdominal stab wounds. Unlike when I started in EM, patients sometimes stay in the ED, and we are left to send them home. Who should not go home?

It’s just a flesh wound
The main goal of this post is to make you aware of this algorithm. It is good and helpful. More importantly, I want to point out the areas where you might get in trouble. First, here is the algorithm.

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From cited article and publicly available as a PDF here.

From cited article and publicly available as a PDF here.

Here are the pitfalls I see.

It’s easier when trauma just admits these patients. But from their perspective, they had up to a 50% negative exploratory laparotomy rate prior to selective surgery. So, they are more circumspect in assessing abdominal stab wounds. Just be sure you know the caveats of this algorithm.

Another Spoonful
See what the Trauma Pro had to say about this.

Source
Evaluation and management of abdominal stab wounds: A Western Trauma Association critical decisions algorithm. J Trauma Acute Care Surg. 2018 Nov;85(5):1007-1015. doi: 10.1097/TA.0000000000001930.

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What are your thoughts?