Stabbing #1: Machete
Responded as a solo to a ground floor flat in a city suburb. 16 year old ‘stabbed in the head’. Police already on scene, wounds dressed. A v p u. Worried about where his phone is, which is always a good sign. Police have removed most clothing. Legends.
Clearly this kid has been the target of either gang-related voilence or a mugging. My questioning is not about what happened – the history will often be deliberately vague or complete bullshit. Neither ‘Where does it hurt?’ as the adrenaline will mask pain. I just reassure the patient, ask their name and look for any major haemorrhage that’s occurring. On potentially extremely time critical jobs like this I tend to assertively state what I need to do rather than ask in a mealy-mouthed way. Pateints rarely object.
No blood is dripping onto the floor, none seeping quickly through bandages and so I grab some obs to get a baseline (HR97 / RR20 / SP02_100 / BP126/74. All fairly stable so I move onto a complete top-to-toe. Back, axilla and groin are the places oft missed at this juncture. A pack of wipes come in handy wiping away the blood to spot missed wounds and given a more adherent surface for any dressings placed later on. A really good listen to the chest here is vital. I also remove the police bandages to inspect the wounds underneath and then replace them as they were.
Stabbed in head rarely means actually stabbed through the skull into the brain. More often it means the head a sliced open with the skull visible if you look hard enough. Which was the case here. Normally with a slashing instrument like a machete.
2 x 2-3 inch lacerations to the skull. No obvious bone trauma underneath. Obvious is the key word here. One similar wound to the right hip. Smaller defensive wounds to this fingers.
I update control and the helicopter trauma team. I aim to get all of this done in under 3 minutes, which is a long time if you’re sitting at the trauma desk waiting to find out if you need to dispatch the team.
The police tend not to be the best at dressing wounds but they can be redressed en route. A decent blood pressure (126/74) tells me that this person can walk, and therefore shave a good few minutes walking them out to the ambulance. Therefore two decisions have already been made.
Unfortunately the ambulance crew arrives and insist on getting the bed to the front door. The skill here is to pick your battles. He’s stable at present so in the few minutes spare I get the patient details, history and most notably what kind of weapon it was. I prep the TXA and off we go.
Turns out he was attacked nearby and ran to a random flat and banged on the door asking for help. Your standard middle class nuclear family were just sitting there watching TV and a minute later you have a gang member sitting in your living room, bleeding over your carpets. I wonder if they moved out of the city after this.
