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10.16 Minor Impalement Injuries


Presentation

A sharp metal object such as a needle, heavy wire, nail or fork is driven into or through a patient's extremity. In some instances, the patient may arrive with a large object attached; for instance, a child who has stepped on a nail going through a board may be brought in with the entire board attached. As minor as most of these injuries are, they tend to create a spectacle and draw a crowd.

What to do:

What not to do:

Discussion:

Simple impalement injuries of the extremities should not be confused with major impalement injuries of the neck and trunk in which the foreign object usually should not be precipitously removed. With major impalement injuries careful localization with x rays is required, and full exposure and vascular control in the operating room is also a necessity to prevent rapid exsanguination when the impaled object is removed from the heart or a great vessel. Large impalement injuries of the extremities also require immediate surgical consultation and thorough consideration of potential neurovascular and musculoskeletal injuries.

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from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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Craig Feied, MD
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