Don't pull out knife, says doctor
Sat, May 08, 2010
The New Paper

WHAT should you do if you have a knife sticking out of your abdomen?

Should you remove it as Mr Tan Meng Tee did immediately after he was stabbed? Or should you leave it where it is, until you get emergency help?

Dr Malcolm Mahadevan, head and senior consultant at the National University Hospital's emergency medicine department, said that Mr Tan's reaction is not recommended.

Removing the object, like a knife from the abdomen, could potentially double the damage, Dr Mahadevan told The New Paper.

"Damage is caused once when the person is stabbed. Damage is caused a second time when the object is removed," he said.

So, it is better to leave the object alone.

This is because the object can potentially act to stem and stop the flow of blood by exerting pressure on the injured surface, Dr Mahadevan explained.

He said: "The reflex response for most of us is to pull the knife out, but (when one is stabbed), the blade cuts through tissues, which bleed.

"And because the blade is hard, it provides substance so that the tissue doesn't bleed continuously."

For instance, if the tip of the knife had punctured the heart when a person is stabbed in the chest, the blade would stop the hole from being exposed, resulting in potentially less bleeding, he said.

"There's a higher chance that doctors can save him when he comes into the emergency room.

"Once you pull out the knife, it's like the proverbial guy who has his finger stuck in the wall to stop the water from coming through. The minute you pull out the finger, or in this case, the knife, that's it," he said.

Cases of patients removing sharp objects from their stab wounds before arriving at the hospital are not unheard of, he said.

He has come across patients who have stepped on long nails while walking barefoot.

"But because they removed the nails, we didn't know how deep the nails went and what tissues could have potentially been damaged," he said.

Seek professional help

Similar cases involve workers from construction sites who accidentally puncture their limbs when using industrial nail guns. In such situations, it is best to let the professionals remove the object.

Said Dr Mahadevan: "When doctors take the object out in the emergency or operating room, it's in a controlled environment, so when bleeding starts, we can take measures to stop the bleeding.

"If it's in a construction site, blood may start spurting out, and the person can actually bleed to death."

Indeed, removing the object would not be the first thing doctors would do even in emergency rooms, Dr Mahadevan added.

"We would first resuscitate the patient and check the direction and track of the object before deciding when or where to remove it," he said.

This article was first published in The New Paper.

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