An impaled object is a foreign body that remains embedded in soft tissue, creating a puncture wound. The object often tamponades bleeding by blocking the wound from within; removing it can precipitate severe hemorrhage and further tissue damage.
Common Types of Impaled Objects
| Object Type | Typical Scenarios | Risk Factors |
|---|---|---|
| Sharp Tools | Knives, scissors, screwdrivers | High risk of vascular and nerve injury |
| Glass Fragments | Car accidents, window falls | Jagged edges increase tissue damage |
| Metal Rods/Pipes | Construction, industrial accidents | Deep penetration, risk of organ damage |
| Wooden Stakes/Splinters | Falls, outdoor injuries | Infection risk due to organic material |
| Nails/Screws | DIY accidents, falls onto hardware | May puncture bone or joint structures |
| Pens/Pencils | School or workplace injuries | Often superficial but painful |
| Rebar/Fence Posts | High-impact trauma, impalement from falls | Complex extrication and transport |
| Vehicle Debris | Motor vehicle collisions | Multi-site trauma, high contamination |
| Animal Horns/Teeth | Farm or wildlife injuries | Risk of infection and irregular wounds |
| Needles/Syringes | Accidental or intentional punctures | Infection, bloodborne pathogen risk |
Anatomical Considerations
- Extremities: Risk of nerve, vessel, or bone injury; often easier to stabilize.
- Thorax: Potential damage to lungs, heart, or major vessels—life-threatening.
- Abdomen: May involve liver, intestines, or kidneys; internal bleeding risk.
- Head/Neck: High risk due to proximity to airway, brain, and spinal cord.
- Eye: Requires extreme caution—avoid pressure and stabilize both eyes.
Immediate First Aid Steps
- Call EMS without delay (e.g., 911) and describe “impalement injury” so specialized care can be dispatched promptly.
- Do not remove the impaled object unless it obstructs the airway or must come out for CPR.
- Stabilize the object to prevent movement:
- Surround it with bulky dressings or gauze rolls
- Secure the dressings with bandages, ensuring the object cannot shift
- Control bleeding around the object by applying firm, direct pressure to the wound edges—not on the object itself.
- Keep the person still and calm; encourage them to minimize movement of the injured area.
- Monitor vital signs (consciousness, breathing, pulse) and prepare to begin CPR if the patient becomes unresponsive.
Do’s and Don’ts
| Do | Don’t |
|---|---|
| Call emergency services immediately | Pull out the impaled object (unless airway or CPR requires it) |
| Stabilize the object with bulky dressings | Apply pressure directly to the embedded object |
| Control bleeding around the wound by pressing wound margins | Probe or dig around the object to clear debris |
| Keep the patient immobilized and reassured | Move the person unnecessarily or transport without support |
| Monitor for shock and begin CPR if breathing or pulse ceases | Delay calling for professional help |
Prevention Tips
- Wear appropriate protective gear (gloves, face shields) when handling sharp or heavy objects.
- Secure work areas to prevent falls or collisions with protruding items.
- Keep pathways clear and well-lit to reduce tripping hazards.
REFERENCES
- Melkamu H, Bekele S, Hailemariam B, Yerdaw W, Shiferaw E, Shiferaw Y. A non-lethal left sided thoracic impalement injury: A case report. Int J Surg Case Rep. 2023;113:109074.
- Palmer L. Hemorrhage control-Proper application of direct pressure, pressure dressings, and tourniquets for controlling acute life-threatening hemorrhage. J Vet Emerg Crit Care (San Antonio). 2022;32(S1):32-47. doi:10.1111/vec.13116
- Govindaraju RC, Munavalli J. Difficulties in the management of impalement injuries sustained in rural India. J Emerg Trauma Shock. 2020;13(3):227-230. doi:10.4103/JETS.JETS_163_19
- Salomone JP. More than skin deep: use caution when treating impalement injuries. JEMS. 2011;36(6):40, 43.
- Cristiano Antonino, First aid, impaled object: Whatever You Do, Don’t Take It Out Unless You Have To, On Jul 4, 2022.
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