**Question:** A 26-year-old man is brought to the emergency department with a stab wound to the right side of the back just medial to the posterior axillary line. His blood pressure is 120/80 mm Hg, pulse rate is 98 bpm, and respiration rate is 22 breaths per minute. Physical examination reveals no abdominal tenderness, guarding, or neurologic changes. Local exploration of the stab wound is performed using local anesthesia. The track to the wound ends in the paraspinal muscles. What would be the next step in management?

A. Perform a complete abdominal examination
B. Perform a chest X-ray
C. Instruct the patient to apply ice to the wound
D. Remove the foreign body and suture the wound

**Correct Answer:** D. Remove the foreign body and suture the wound

**Core Concept:**

The core concept being tested in this question is related to the management of a stab wound to the back. A stab wound to the back, particularly in the area of the posterior axillary line, can potentially involve organs like the liver, spleen, or kidney, leading to life-threatening complications like hemorrhage, peritonitis, or rupture of viscera. Therefore, the initial management involves identifying and addressing the immediate risks associated with the wound.

**Why the Correct Answer is Right:**

Given the patient's clinical presentation and the findings from local exploration, the next step in management should focus on addressing the potential complications related to the stab wound. Since the wound is in the back and exploration reveals it ends in the paraspinal muscles, it is unlikely to involve major organs. However, it is essential to remove the foreign body (e.g., knife) and suture the wound to prevent infection and promote healing.

**Why Other Options Are Incorrect:**

A. Performing a complete abdominal examination is not necessary at this stage as the wound is not in the abdominal area, and there is no clinical evidence of abdominal organ involvement.
B. A chest X-ray is not essential as the stab wound is not in the chest area and there is no indication of chest-related complications.
C. Applying ice to the wound is not a suitable management strategy for a stab wound and may even cause tissue damage and delay healing.

**Clinical Pearl:**

In managing a stab wound, it is crucial to focus on addressing immediate risks like removing the foreign body and suturing the wound promptly to prevent infection and promote healing. This approach helps ensure that students understand the priority of appropriate wound management based on the location of the injury and the lack of clinical evidence of organ involvement. Ignoring potential complications and focusing on unrelated examinations (like a chest X-ray or abdominal examination) or using an inappropriate intervention (applying ice) can lead to delayed treatment and potentially worsened outcomes.