Impalement Question

[ncmedic309]

If it's not causing airway compromise, it's staying in place...

[SingleLovingLife]

First rule of test taking: Don't read into the question! Good response Medic429.

If I'm not mistaken, I had almost that exact question on my basic registry - so make sure you understand the rationale behind the question - and why that answer is the best.

My 2¢ worth - every impalement gets stabilized unless it could compromise their airway or interfere with CPR. I'm not a surgeon and I don't have x-ray vision! LOL

[Ridryder 911]

It is based upon what is described as "impaled" and being stuck into the skin. I was in an instructors class when they were discussing, "one should never remove the stinger of a bee", since it is an impaled object... do what ? First, I would not consider this an impaled object, second we are going to allow secretion to continue from the stinger as well how is one going to "immobilize the object ?".

I had a scenario on one of my trauma assessment stations of a mannequin that was stabbed in the neck with a syringe/needle. After making fumbling attempts to secure, (which incidentally caused the needle to move around) my instructor asked me if I ever seen ABG's, or biopsies performed? I answered yes, then he proceeded act like he talked to medical control then went to the mannequin and removed it with direct pressure. As he directed "just like any other needle stick" and applied direct pressure. Teaching common sense and looking at the "whole picture".

Yes, immobilization of an object that can produce trauma to underlying tissue, nerve, blood vessels, etc.. but use common sense as well. As far as impending the airway, yes one can remove it, and from the cheek as well since both sides can be observed.

R/r 911

[FormerEMSLT297]

:!: This question or a similar question has been around for AT LEAST 22 years... it was on the New York EMT test in 1984... I too knew the answer before reading the multiple guess questions... it is part of the National Standard curriculum as well.

the reasons for it are as stated... 1. you can get to both sides of the wound,,, 2 in could impede breathing or occlude the airway....

not a stupid question,,,,, but they should have taught you this in your Soft tissue Injury portion of the course....

[EMSm0nster]

It makes sense, airway is one of the priorities. This was drilled into our heads in our program and I saw it again in the National Registry. =)

[speedygodzilla]

As I understand this, an impaled object in the cheek is an airway compromise. The patient will be likely bleeding inside the mouth (as well as the outside), and this will block the airway. They may not be able to swallow the blood as they can't shut their mouth.

I know that is the test answer.

It doesn't give you the choice to call medical control or we all would.

[Ridryder 911]

Okay, let's see if we can make this as simple as it is. The reason we do not remove impaled objects is because we are not aware of injuries the object might be into or against. Thus, the cheek one can see where the object is.. therefore we know exactly where and what the object is. The second reason, is pretty obvious one can control the bleeding simply by applying pressure outside and inside the cheek wall, as well it is pretty damn hard to ventilate a patient with a pencil or impaled object in their cheek and mouth!

R/r 911

[AnthonyM83]

We were taught that's actually a pretty valid legal defense. Standard of care is defined by many things, DOT Guidelines, Local Protocols, Classroom Instruction, and your EMT Text, too. So, you do have the "according to my training" defense... which probably wouldn't work if it were a ridiculous guideline like tourniquet the neck for uncontrolled head hemmorhage....but I'd imagine something like removing impaled objects from the cheek would okay.

[NREMT-Basic]

Okay, let's see if we can make this as simple as it is. The reason we do not remove impaled objects is because we are not aware of injuries the object might be into or against. Thus, the cheek one can see where the object is.. therefore we know exactly where and what the object is. The second reason, is pretty obvious one can control the bleeding simply by applying pressure outside and inside the cheek wall, as well it is pretty damn hard to ventilate a patient with a pencil or impaled object in their cheek and mouth!

R/r 911

Here's an example of reading into the question, which after all is what this thread is all about. The question does not mention the need to ventilate the patient. That being said, in the absence of any airway occlusion, there is absolutely no reason to remove the pencil. If it isnt causing respiratory difficulty or impeding CPR, there is absolutely no reason to remove an "impaled" object in the pre-hospital (scene or rig) setting. Why would you want to remove something non life-threatening that is going to bleed like a stuck pig when the object itself is controlling the bleeding to a certain extent and the ER has capabilities to removed the object, control bleeding and repair the puncture, virtually at the same time.

[JakeEMTP]

One would remove it because it may become life threatening. If the object ( pencil for instance) was to break, then there could be some airway compromise. We in the pre-hospital setting can control the bleeding to a certain extent.

I imagine my patient may feel a whole lot better with it removed also.