Within 48 hours from admission, all 54 patients underwent a complete psychiatric evaluation. Contextual factors associated with their self-inflicted stab wounds as endorsed by patients are reported in Table 3.
Table 4 describes the specific psychiatric diagnoses of our patient population. In this subgroup, patient injuries included the neck 1 , chest 2 , and abdomen 5. In patient with the neck injury, superficial bilateral neck lacerations were encountered that the patient stated was related to a chain saw accident.
The patient denied that his lacerations were self-inflicted, however, the patient had a history of prior suicidality and the wounds were not reflective of a chainsaw related injury.
Of the chest traumas, one individual reported that a band saw blade dislodged into his chest, however, the patient could not explain how he sustained a wrist laceration at the same time thus indicating the high likelihood for suicidality. Another patient reported that he accidentally stabbed himself in his chest. Additional information obtained from the patient's family confirmed the accident was in fact a suicide attempt. Of the abdominal traumas, five patients reported accidental abdominal injuries including: Hitting the wrong button on a switchblade knife 1 , tripping while putting a knife away 2 , or falling on a knife 2.
Such mechanisms were only fully understood and acknowledged following serial interviews conducted by the consulting psychiatric service. In the remaining two patients in which non-intentional circumstances were questioned, the first individual was intoxicated and presented with penetrating trauma to the neck.
Police later confirmed that an arrest was made in connection with the patient's injuries. The other patient was non-intoxicated and presented with a stab to the abdomen. The patient reported fixing the screw on his glasses at which time the knife slipped, puncturing his abdomen. Despite the suspicious wound and circumstances, information obtained later on supported that the injury may have been accidental.
Five patients were transferred voluntarily to a diversion residential program. Two were referred for partial hospitalization. Three were deemed safe to be discharged home without psychiatric treatment. One patient with a Cluster B Personality Disorder was able to leave against medical advice following a protracted surgical hospital stay.
One patient went to jail. Another patient eventually died not of the self-inflicted stab wound, but as a result of a Selective Serotonin Reuptake Inhibitor overdose. Nationally, suicide represents the 11 th leading cause of death in the United States.
In general, men complete suicide more frequently than women. Sher et al. Compared to previous reports of stab wounds among trauma patients, patients with self-inflicted stab wounds may have a higher incidence of operative interventions and significant injuries depending on the location of the stab wound. Biffl et al. The patient's desire to induce significant self-harm may explain the higher incidence of significant injuries compared to the general population when the site of stab is in the neck or chest.
In terms of those with abdominal stab wounds, it has been well established that those who undergo laparotomy for an anterior stab wound may not receive a therapeutic benefit. As mentioned previously, our method of deciding operative intervention for stable anterior abdominal stab wounds is that of serial abdominal exams. Given that this population maintains several risk factors including psychiatric illness and poly-substance abuse, potentially unreliable subjective and objective findings elicited at the bedside may have contributed to the higher incidence of non-therapeutic operations.
This forces the practitioner to depend on a variety of indirect indicators that may falsely lead to an operation. Ninety-eight percent of our patients met criteria for a formal psychiatric diagnosis. My vision went black for a second and my nose was bleeding. Cut the line! I was sitting on the ground completely dazed. The captain cut the line, and he and the crew gathered around me. I looked down and saw about half of the 5in blade embedded in my chest, close to my heart. I felt around under the sweater I had on and was relieved to realise that the blade seemed to be in my pectoral muscle and not my heart.
So, with the knife still sticking out of my chest, we went down to the galley and a deckhand brought me ice to put around the knife blade. Then he made lunch as usual. This article has been cited by other articles in PMC. Abstract We would like to present a case report of a very unusual suicide attempt.
Keywords: suicide, neck and mediastinum injuries. Case report A year-old female patient was admitted to the emergency department due to a stab wound of the neck region Fig. Open in a separate window.
Disclosure Authors report no conflict of interest. References 1. Non-fatal suicide attempt by intentional stab wound: clinical management, psychiatric assessment, and multidisciplinary considerations. J Emerg Trauma Shock. Penetrating neck injuries: analysis of experience from a Canadian trauma centre.
Can J Surg. Smith GA. Knife-related injuries treated in United States emergency departments, J Emerg Med. Management of the retained knife blade. World J Surg. Penetrating neck trauma: lack of universal reporting guidelines. Am Surg. Penetrating neck injuries. The role of angiography in penetrating neck trauma.
J Trauma. Physical examination alone is safe and accurate for evaluation of vascular injuries in penetrating Zone II neck trauma. Always follow your healthcare professional's instructions.
Patient Education. Stab Wound A stab wound usually causes a small opening at the skin, but may go very deep. Home care These guidelines will help you care for your wound at home: Keep the wound clean and dry. If the wound was left open or if stitches were used, clean the wound daily: After removing the bandage, wash the area with soap and water.
Follow-up care Most skin wounds heal within 10 days. When to seek medical advice Call your healthcare provider right away if any of these occur: Bleeding not controlled by direct pressure Wound bleeding for longer than 24 hours Signs of infection: Increasing pain in the wound Fever of Call For neck, chest, back, or abdomen wounds, call if you have: Shortness of breath Painful breathing Back or abdomen pain that gets worse Blood in the stool or urine Vomiting blood Weakness, dizziness, or fainting.
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