Impalement Question

[dropdeded]

Brady EMT-Basic Self-Assessment Exam Prep book.

Question is:

Which of the following impaled objects may be removed in the prehospital setting?

Choices are:

A) screwdriver embedded in the chest

pitchfork impaled through the foot

C) pencil impaled through the cheek

D) knife embedded in the upper leg

Correct answer is C, says "removing impaled objects from areas other than the cheek can lead to further injury, even death".

Full answer is:- "You should never remove an impaled object unless it is impaled through the cheek or it is impaled in the chest and interferes with chest compressions while performing CPR. Removing impaled objects from areas other than the cheek can lead to further injury or even death. Impaled objects should be stabilized in place using bulky dressings and tape."

Pull it, stuff the cheek with sterile gauze (inside) and dress outside??

Stupid post?? Just seemed like an odd answer to me :?

thoughts??

ed

[Ace844]

Seems to me they left out the fact that 'a cheek' impalement, bleeds like no tomorrow, due to the vascularity of the area.....Absent of course this object causing 'airway compromise issues'!!!!

Good luck with that whole removing impaled objects thing, and repeat after me....

You see your honor, it's like this.....

BUT, BUT, my EMT book SAYS I can... So it MUST BE OK!!

ACE844

[dropdeded]

Really seems to be a half-assed answer to me. Unless it was a choking hazard, I thought it would (should?) be left in place??

ed

[AnatomyChick]

Brady Books (and nearly all EMT-B books that I know of).... stipulate that you can remove an impaled object that is in the cheek, due to the reduced risk of injuring underlying organs, tissues, muscles, etc....

I believe that BTLS teaches that you should only remove the object in the cheek if it's impeding the airway though...

Here's the deal with testing... a lot of times you won't find what you feel is the "right" answer... you'll find the best answer.. go with your gut... most of the time you'll be safe with that.

[paramedicmike]

Not a stupid post or a stupid question.

I think a better way to look at this would be why you think it's an odd answer. I knew the answer before I finished reading the post. And I knew why it was correct even before reading the rationale you provided.

So why do you think it's an odd answer? Maybe we can start there and then see how we can help you.

But it's not a stupid post or question.

-be safe.

[Ace844]

This link will also help you..

www.naemsp.org/documents/ClinicalGuidelinesfor.pdf

HTH,

ACE844

[Arachne]

I've never heard of a cheek impalement as an exception to "never-never-never remove an impaled object unless it prevents transport or prevents chest compressions". Sure it's in a textbook, but textbooks generally also say that we must adhere to local protocol - I'd double check with that.

As someone mentioned above, removing something from the cheek could cause a lot bleeding (messy) and I've never been a fan of a lot of bleeding in or near the mouth due to risk of airway compromise.

This seems like an odd answer to me because I'm not sure how it could be beneficial to remove the pencil. Are they worried that leaving it in will cause further injury? Is it somehow impractical to stabilize a pencil in the cheek? I'd be concerned about how deeply the pencil was embedded, at what angle, and what else inside the mouth it may have impaled. The patient should be seen by a doctor regardless (to close the wound, etc), so I don't see how the patient is better off if we remove it prior to ER arrival.

[dropdeded]

So why do you think it's an odd answer? Maybe we can start there and then see how we can help you.

The scenario that came to mind was that if it was a non-life threatening injury "as is", I would definately leave it in place. I guess it struck me as odd because I honestly dont recall this "situation" in my books or class.

Definately interesting stuff though. I dig coming across these chances to think and learn. A lot of the big stuff can be a little stressful so every once in awhile a "pencil in the cheek" comes along and makes me go hmmmm :wink:

Thanks

ed

[paramedicmike]

I guess it struck me as odd because I honestly dont recall this "situation" in my books or class.

I hope you realize this, but I think it's safe to say that more than half of everything you run into on the street won't have been covered in your book. That's one of the inherent problems and biggest dangers in basic EMT training. If you want to hear more on that idea then search the forums. You'll find tons of info there.

As to the idea of the pencil in the cheek, you've got half the pencil outside the body. The other half inside the mouth...potentially between the teeth...which can still bite down...and sever a pencil...creating what?

Think about potential here, not about the specific injury itself. Sure, bleeding out is bad. But what comes before that in your assessment?

-be safe.

[medic429]

also...

don't forget....it's usually the BEST answer, not the RIGHT answer they are looking for

and

don't read into the question that is posed!

good luck