When the Secondary Survey is Primary: Knife Blade in the Spine.

A 42-year-old male was assisted from a car in front of our inner city stand-alone emergency department (ED) with a stab wound to the right chest. He was confused and bleeding; his past medical history was unknown. The patient was diaphoretic, pale and confused with a large vertical stab wound over his right chest with no other obvious injuries. On initial exam in the outlying ED, his back was obscured by blood. He was transferred to the trauma center where during a full secondary survey a 2cm wound was located over the patient’s lumbar spine. The patient was stabilized and taken for imaging. No focused assessment with sonography for trauma (FAST) was done at either site; however, the Lehigh Valley Health Network, Department of Emergency Medicine, Allentown, Pennsylvania Lehigh Valley Health Network, Department of Surgery, Allentown, Pennsylvania University of South Florida Morsani College of Medicine, Tampa, Florida *