Thoracic impalement injury: A survivor with large metallic object in-situ

Abstract

Impalement injuries, is a severe form of trauma, which are not common in civilian life. These injuries rarely occurs in major accidents. Abdomen, chest, limbs and perineum are often involved due to their large surface area. Thoracic impalement injury is usually a fatal injury, due to location of major vessels and heart in the thoracic cavity. These injuries are horrifying to site, but the patients who are lucky enough to make it to hospital, usually survive. Chances of survival are larger in right sided impalement injuries while central injuries are always died at the scene.Our patient, 25 years old male, was brought to the emergency room (ER) with large impaled metallic bar (about 2.5 feet long) in situ, in right sided chest. The patient was immediately shifted to operation room (OR) and was operated, his recovery was uneventful without any sequelae.Such patients should be treated and resuscitated according to advanced trauma life support (ATLS) protocols and operated without any delay for further investigations. Such operations are carried out by the most experienced surgeon team available. The impaled objects should not be processed if not necessary to avoid major hemorrhage and damage to vital structures, until the patient is in operation room. Large size and unusual position of impaled objects, makes the job difficult for surgeons/anesthetists.Although horrifying at scene, patients with thoracic impalement injuries are mostly young and healthy, and those who survive the pre-hospital phase are potentially manageable with proper resuscitation. Usually these patients make recovery without any further complications.

Management of Thoracic Impalement Injury in Ghana: A Five-Year Experience at the Komfo Anokye Teaching Hospital

“…This observation correlates with our cases in which we had a young age group with the youngest being 12 years and the oldest being 42 years and therefore may have contributed to the zero mortality observed in our study. Impalement injuries commonly occur in road traffic accidents, airplane crashes and occupational injuries occurring at building sites according to Muhammad et al[1]. However, we found physical attack with knife as the leading cause of the impalement injuries.…”

“…Impalement injuries consist of injuries in which large foreign objects pierce through a body cavity or any extremity and remain in place [1]. This definition were overt types making the presentation easier to appreciate and also motivat-ing the patients to be brought early to the hospital for management.…”

Thoracic impalement injury by the barrel of a locally fabricated gun in 2 patients: case report

“…As with the general principles of managing impalement injuries, patients should be transported to the hospital with the foreign body insitu, and attempts at removal outside the controlled setting of an operating theater is strongly discouraged, especially when the chest is involved [ 1 , 6 ]. Although the scenarios are often horrifying and distracting spectacular with the first instinct to rush to the operating room, patient initial evaluation should still be structured and based on the Advanced Trauma Life Support (ATLS) algorithm of the American college of surgeons [ 2 , 6 , 7 ]. This ensures that immediately life-threatening conditions such as a tension pneumothorax are addressed immediately, especially in a resource-limited setting where the time interval between arrival at the trauma center and getting into the operating theater is often not immediate as was the scenario in the first patient and other reported cases [ 2 ].…”

“…Impalement injuries are defined as when large objects or foreign bodies, commonly steel bars or wooden objects, pierce through a body cavity or extremity and remain in place [ 1 ]. Thoracic Impalement injuries are uncommon among civilian populations and quite dramatic in presentation [ 2 ]. The commonly encountered mechanisms of injury include a fall from a height onto a fixed elongated object, ejection from a car unto a fixed pole during road traffic accidents, and spear/arrow injuries to the chest.…”

Cardiac impalement injury by a steel rebar: A case report

“…The removal of foreign objects may eliminate the tamponading effect on the main vessel or body cavities, which may result in massive or fatal bleeding. The foreign objects can also damage the surrounding tissues and aggravate injuries [4,11].…”