The hands and arms should be inspected for the presence of defensive wounds. If the patient presents with the weapon, care should be taken to handle the weapon as little as possible; gloves should be worn. The weapon should be placed in a protective covering or commercial storage device and turned over to law enforcement.

The treating physician should never guess the directionality of the wound tract and the degree or depth of penetration. The weapon could have entered directly perpendicular to the body or at upward or downward angles, drastically changing the possibility of structures injured. The depth of penetration can be shorter than, equal to, or longer than the weapon’s length. The physician should rely on computed tomography or direct surgical exploration to determine wound tract direction, penetration depth, and injury.

Case Resolution

Based on the wound angle characteristics, it is suspected the weapon was a double-edge knife. A suspect is apprehended carrying a military knife that has the victim’s blood on it. At autopsy, it is determined that the blade entered at a downward angle and severed his proximal subclavian artery.

Dr. Riviello is professor of emergency medicine at Drexel Emergency Medicine in Philadelphia.

Dr. Rozzi is an emergency physician, director of the Forensic Examiner Team at WellSpan York Hospital in York, Pennsylvania, and chair of the Forensic Section of ACEP.