New Innovations in Approach and Management

As trauma patients’ care evolves, so does the diagnostic and therapeutic approach to patients who suffer stab wounds. For patients who develop hemodynamic instability or cardiac arrest due to abdominal stab wound, resuscitative endovascular balloon occlusion (REBOA) can be placed to aid resuscitation and stabilize to bridge to further diagnostic and therapeutic interventions.^12,13,14 In lieu of a resuscitative thoracotomy and supradiaphragmatic aortic clamp, REBOA can obtain control above the level of the diaphragm to control hemorrhage. Studies have shown a survival benefit over resuscitative thoracotomy, especially in patients who have not arrested, although further studies are needed for this recommendation to be more definitive.¹²

Another developing approach for immediate diagnosis and intervention is mobile digital subtraction angiography. This technique utilizes angiography for dynamic real time diagnosis and provides the ability for therapies such as AE, endovascular aortic repairs, and stenting.⁵ Subtraction angiography and endovascular therapies for trauma depend on multiple factors such as location and equipment, skill and availability of proceduralist, potentially transferring the patient, and capacity for hybrid approaches in trauma.

Conclusion

In conclusion, patients with abdominal stab wounds must be assessed in a methodical manner utilizing appropriate exposure, physical exam, imaging modalities to best determine appropriate management. Management has evolved to focus on stabilizing the patient, minimally invasive interventions, and holistic evaluations. As the field of emergency medicine and traumatology grows, so will diagnostic and therapeutic interventions.

Dr. Doko is an emergency physician currently pursuing an anesthesia critical care fellowship at Emory School of Medicine.

Dr. Dave is a dual-boarded emergency and surgical critical care physician who is an intensivist at Emory School of Medicine and emergency medicine attending at Grady Memorial Hospital.

References

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