Impalement Question

[brentoli]

How would you control the bleeding from inside the mouth. I am just trying to think here on a conscious vs. unconscious patient. With a conscious one I know I could give the patient a roll of Kerlex and let him hold pressure himself with out worrying about airway compromise. How would you get sufficient pressure on the inside of the cheek on an unresponsive? A roll of Kerlex wouldn't be secure, a few 4x4's would be loose and potentially slide back in to the throat. Any other solutions?

[FormerEMSLT297]

Grab corner of mouth with a gloved hand,, pull out away from cheek, place kerlex in between cheek a gums,, and hold with gloved hand,,, and place direct pressure.

[FormerEMSLT297]

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.

If they are bleeding into their mouth SUCTION.... ohh and WHY would you call medical control ????? for what ????

An who is "WE ALL WOULD"... I certainly would not call medical control for an impaled object in the cheek..... no more so than i would call medical control for an obviously angulated and deformed tib fib fracture. just my 2 cents

[brentoli]

Grab corner of mouth with a gloved hand,, pull out away from cheek, place kerlex in between cheek a gums,, and hold with gloved hand,,, and place direct pressure.

And control the airway with... My 3rd hand? The dentist doohicky? Yeah thanks for the demeaning tone. If I wanted that I would have called up a nurse. Better try next time.

[FormerEMSLT297]

its really no tthat hard ,,, one hand for bleeding control, one hand for suctioning...... if its too difficult your partner can help you..... or your patinet can help you.

I still dont understand the calling thing .. ???

[Ridryder 911]

Wow! All this debate over a little thing such as an impaled object in the cheek! Geez.. Do they not teach anything in EMT schools anymore, like using common sense? What is a Doc going to tell you except do your job, and apply pressure and suction PRN?

Okay, if it is bothering their airway pull it out, simple. Why leave it in there? You are not going to strike any more dangerous organs, lacerate any more vessels, etc.. Again this is the reason WHY you don't remove impaled objects. Apparently, not many people have seen very many lacerations or especially puncture wounds to the mouth and cheek areas. They don't hardly bleed, especially after a few minutes of pressure. Like EMSLT described, place a glove finger and "squeeze" with a 4X4 between the outside and inside cheek wall. Probably, within 2-5 minutes (if they have normal clotting time), the bleeding will have stopped, and yes, you can do more than one thing at a time; like suctioning the patient or if the patient is conscious, alert' allow the patient to suction themselves. This procedures is not hard to teach, we teach EMT's this all the time. Heck, I might even lay the patient on the side to "drool" out, remembering you can package for cervical injuries on the side as well.

Personally, I do not see how an impaled object could be in the oral cavity and not be in the gum line, or bony areas, otherwise it would probably fall out on its own.

Silly debate, this has been in EMT textbooks (remember the stupid moulaged picture) for at least 35 years, with the same answer.

R/r 911

[ERDoc]

I agree with you Rid. This is one of those questions that comes right from the textbook, almost word for word. It is a classic question that has been taught for years and years. The only impaled object you remove in the field is one in the cheek. There is not much to debate here. Any EMT book will tell you the same thing. Like you said, take it out and put some pressure on it.

[speedygodzilla]

If they are bleeding into their mouth SUCTION.... ohh and WHY would you call medical control ????? for what ????

An who is "WE ALL WOULD"... I certainly would not call medical control for an impaled object in the cheek..... no more so than i would call medical control for an obviously angulated and deformed tib fib fracture. just my 2 cents

Suctioning is great if you get the concept like many of us do. It doesn't look to me that everyone gets that it is an airway compromise.

And I didn't realy mean let just all call medical control for a simple thing as an implaed object in the cheek, but if your one of those who said never remove any impaled object "those all need to call Medical Control"

As for me I would let them know what I have done or am going to do about the impaled object in the cheek in my report to the ER.

[FormerEMSLT297]

No, I think that those who aren't clear on why to remove it, need to go back to EMT-Basic school for a little refresher training.

[epellatt]

Heck, I might even lay the patient on the side to "drool" out, remembering you can package for cervical injuries on the side as well.

how is that done? just tilting the backboard, or is there a different technique?