Clinical scenario week 2: · Learn Emergency Medicine

Clinical scenario week 2:

An ambulance is dispatched on a high-priority response following a report of domestic violence. A neighbor has contacted dispatch stating that a 23-year-old female has been stabbed. Law enforcement has been notified and is en route.

Upon arrival, the patient is found sitting semi-upright on the kitchen floor of an apartment. She is awake, anxious, and in visible pain. A smaller kitchen knife remains impaled in the left upper quadrant of the abdomen. There is minimal external bleeding, though blood is visible on a towel she is holding against the wound.

The patient has a patent airway and is speaking in full sentences. Respiratory effort is slightly increased but unremarkable. She appears pale and mildly diaphoretic. Her heart rate is 110 beats per minute, blood pressure is 105/65 mmHg, and oxygen saturation is 98% on room air. She is fully alert and oriented with a Glasgow Coma Scale score of 15.

She reports severe abdominal pain. She has no known allergies, takes no regular medications, and has no significant medical history. Her last oral intake was approximately one hour prior to the incident. She states that she was stabbed with a knife during an argument with her partner.

The nearest urgent care facility is 15 minutes away, while a trauma center is approximately 35 minutes away. The patient is prepared for transport with the knife left in place.

Questions:

What medical and tactical considerations support leaving the impaled knife in place during prehospital care?
Which interventions should be prioritized during transport to reduce the risk of patient deterioration?

This case is fictional and used as a reflection case.

A proposed solution will be published on Friday, January 9.

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