The question of whether an individual is capable of physical activity, i.e., able to walk or run away from the assailant after receiving a fatal stab wound, depends on the organ(s) injured, the extent of the injury, the amount of blood lost, and the rapidity with which the blood is lost. With profuse bleeding, physical activity is limited or lost rapidly; with slow bleeding, the victim is capable of walking away from the assailant. Not infrequently, a trail of blood will mark the path of escape. A stab wound that will disable one victim will not necessarily affect the physical activity
of another. The authors have seen prolonged survival (several hours) following stab wounds of major vessels.
Karger et al. evaluated 12 cases of suicide from sharp pointed weapons in order to estimate the potential for physical activity following injury.9 In all cases, the suicidal action and the subsequent behavior were witnessed. Seven of the victims had stab wounds of the heart. These latter deaths fell into three categories, based on time of survival and physical activity: immediate incapacitation (one case); short-term survival (two cases) and long-term survival (four cases). The short-term group collapsed in approximately 10 seconds; the long-term 2-10 minutes.
The individual who collapsed immediately had a 15 mm wound of the heart and a 450 ml tamponade. In the short-term group, both individuals collapsed in 10 seconds; both had tamponade, one 250 ml with the other not specified. The stab wounds of the heart were 14 and 20 mm long, compared with 7-10 mm for the long-term group. In two of the long-term group, cardiac tamponade of 300 and 400 ml were found. No mention of tamponade is made in the other two cases. The individual with the 400 ml tamponade lived the longest — 10 min. An eighth case involved a stab wound of the heart with a cannula. This individual survived 2 h and was found to have a 600 ml tamponade.
In the eight cases with stab or puncture wounds of the heart, the right ventricle was punctured three times; the left five. All injuries to the heart perforated only the anterior wall. The case with the longest time of physical activity (2 h) and three of the four individuals in the long-term physical activity group had wounds of the left ventricle, while both cases in the short-term group had wounds of the right ventricle. In another case, an individual stabbed himself in the right chest, injuring his lung and liver. He survived 2 h and was found to have a 2200 right hemothorax and a 700 ml hemoperitoneum.
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