Stab Wounds

and Firearm
Injuries
dr. Andreas S M Lumbantobing
Orthopaedi & traumatology
Stase Thorax (Bedah Dasar)
 PENETRATING TRAUMA

Refers to injury produced by foreign objects that penetrate tissue. Weapons are
usually classified based on the amount of energy produced by the projectiles
they launch:
• Low energy—knife or hand-energized missiles
• Medium energy—handguns
• High energy—military or hunting rifles

Brunicardi F, Andersen D, Billiar T, Dunn D, Hunter J, Matthews J, Pollock R. Schwartz's principles of

surgery, 10e. McGraw-hill; 2014.
ATLS Subcommittee; American College of Surgeons’ Committee on Trauma; International ATLS working group. Advanced trauma life
support (ATLS®): the tenth edition. 2018
 a) Stab wounds of the chest: 4 penetrated the thorax, 4 were limited to subcutaneous tissue, and 4 were
hesitation marks;
b) b) stab wounds of the abdomen: 10 penetrated the cavity, 4 were small hesitation marks. 

Di Vella G, Grattagliano I, Curti S, Catanesi R, Sullivan MK, Tattoli L. Multiple stab wounds: understanding the manner of death through the psychological autopsy. La Clinica Terapeutica. 2017
Jul 13;168(4):e233-9.
 Gunshot wounds are
subdivided further into
high- and low-velocity High-velocity gunshot
injuries, because the wounds (bullet speed
speed of the bullet is >2000 ft/s) are
much more important infrequent in the civilian
than its weight in setting.
determining kinetic
energy.

Brunicardi F, Andersen D, Billiar T, Dunn D, Hunter J, Matthews J, Pollock R. Schwartz's principles of

surgery, 10e. McGraw-hill; 2014.
 Shotgun injuries are divided into close-range (<20 feet) and long-range

• Close-range shotgun wounds are same to high-velocity wounds because the

entire energy of the load is delivered to a small area, often with devastating
results.
• Long-range shotgun blasts result in a diffuse pellet pattern in which many pellets
miss the victim, and those that do strike are dispersed and of comparatively low
energy.

Brunicardi F, Andersen D, Billiar T, Dunn D, Hunter J, Matthews J, Pollock R. Schwartz's principles of

surgery, 10e. McGraw-hill; 2014.
ATLS Subcommittee; American College of Surgeons’ Committee on Trauma; International ATLS working group. Advanced trauma life
support (ATLS®): the tenth edition. 2018
ATLS Subcommittee; American College of Surgeons’ Committee on Trauma; International ATLS working group. Advanced trauma life
support (ATLS®): the tenth edition. 2018
 1 2 3 4
Stab wounds differ from Knife wounds are limited Gunshot wounds, In addition to injury
gunshot wounds in their to the direct tract of the however, impart kinetic along the direct wound
potential depth of blade and impart only energy to the path, radial injury is
penetration and degree the kinetic energy surrounding tissue produced by the kinetic
of damage to transfer to surrounding produced by the mass energy transferred to
surrounding organs. tissue that is manually and velocity of the bullet the surrounding tissue.
produced. (Kinetic energy = 12 ×
Mass × Velocity).

Sabiston, David C.,Townsend, Courtney M.,eds. Sabiston Textbook Of Surgery: The Biological Basis Of
Modern Surgical Practice. Philadelphia, PA : Elsevier Saunders, 2012.
Diagnosis
 FOR PENETRATING THORACIC TRAUMA
• Physical examination
• Plain posteroanterior and lateral chest
radiographs with metallic markings of wounds
• Pericardial ultrasound
• CVP measurement

Brunicardi F, Andersen D, Billiar T, Dunn D, Hunter J, Matthews J, Pollock R. Schwartz's principles of

surgery, 10e. McGraw-hill; 2014.
 If there is a suspicion of a
Hemodynamically stable
subclavian artery injury
patients with
 brachial-brachial CTA should be
transmediastinal gunshot
indices should be performed based on
wounds should undergo
measured, but >60% of injury proximity to
CT scanning to
patients with an injury intrathoracic vasculature.
determine the path of
may not have a pulse
the bullet
deficit.

Brunicardi F, Andersen D, Billiar T, Dunn D, Hunter J, Matthews J, Pollock R. Schwartz's principles of

surgery, 10e. McGraw-hill; 2014.
Management
 PRIMARY SURVEY (ABCDE’s)

RESUSCITATION

ATLS SECONDARY SURVEY

DATA/INFORMATION/RESPONSE TO
THERAPY

DEFINITIVE CARE
ATLS Subcommittee; American College of Surgeons’ Committee on Trauma; International ATLS
working group. Advanced trauma life support (ATLS®): the tenth edition. 2018
 The primary survey : Life-
The secondary survey
threatening injury
• Management of airway obstruction • Identification using adjunctive
• Laryngeal injury studies such as x-rays, laboratory
• Upper chest injury tests, and ECG
• Tracheobronchial tree injury • Initial treatment of the following
• Tension pneumothorax potentially life-threatening injuries
• Open pneumothorax
• Massive hemothorax
• Cardiac tamponade
• And traumatic circulatory arrest

ATLS Subcommittee; American College of Surgeons’ Committee on Trauma; International ATLS working group. Advanced trauma life
support (ATLS®): the tenth edition. 2018
 Complicatio
n

Sabiston, David C.,Townsend, Courtney M.,eds. Sabiston Textbook Of Surgery: The Biological Basis Of Modern Surgical Practice. Philadelphia, PA : Elsevier Saunders, 2012.
THANK YOU