Management of a massive thoracoabdominal impalement: a case report

Abstract

A 26 year old male was impaled through his chest and upper abdomen with an iron angle, one and half meter long and five centimeters thick. The iron angle entered the chest, through the epigastrium and exited posteriorly just inferior to the angle of left scapula. The patient was transported to hospital with the iron angle in situ. Positioning the patient for intubation proved a major challenge. An unconventional position for intubation allowed a successful airway management. Paucity of time prevented us from gauging the nature and extent of injury. The challenges posed by massive impalement could be successfully managed due to rapid pre-hospital transfer and co-ordinated team effort.

A Case of Severe Thoracoabdominal Impalement by a Steel Bar

“…Thoracoabdominal impalement is one of the most severe types of penetrating trauma injuries [1]. These injuries usually involve vital organs such as the heart, lung, or the great vessels.…”

“…Fatal conditions such as hypoxemia, airway obstruction, hemorrhage, cardiac tamponade, and aspiration can lead to death within 30 minutes to 3 hours. However, it is reported that patients with these conditions who are immediately transferred alive to a hospital have a high probability of survival [1,2]. Therefore, cautious extrication from the scene and rapid transportation to a trauma center are crucial factors for a survival outcome.…”

Management of Severe Thoracic Impalement Trauma Against Two-Wheeled Horse Carriage: A Case Report and Literature Review

“…Therefore, these should be avoided or administered in titrated doses in haemodynamically unstable patients or in patients with suspected cardiovascular compromise. Ketamine is considered useful to induce anaesthesia in patients with cardiac tamponade, which produces stimulation of the sympathetic nervous system [7]. Also, use of lidocaine on anaesthetic inductions may be useful once cardiovascular compromise is present.…”

“…The prehospital phase of care is even more crucial. The main goals in thoracic trauma resuscitation include optimizing tissues oxygen delivery, bleeding control and replacement of intravascular volume [7].…”

“…The mechanism and severity of trauma must be evaluated immediately to determine appropriate resuscitation and management [4]. Reported protocols for managing impalement injuries are entirely anecdotal, with no uniformity on impaled patient's approach and management, although general principles of trauma care apply in these specific infrequent cases [7,8]. Attention to airway, breathing and circulation is paramount.…”