# impailed object



## Joe (Aug 21, 2011)

So without starting another civil war about a tv show that was canceled and now appears on netflix i have a legit question on how to handle this call. 

long story short:

Pt falls back off some stairs and is impailed through his abdomen by i verticle piece of rebar. according to medic no arteries are hit and there isnt major bleeding. pt is stable and they are preparing for transport. the rebar is laid out in a flat grid with the verticle rebar anchoring into the ground. my real question is how do you get this guy out if the is stuck in the rebar and you cant cut out from beneath him? even if you cut out the grid he is still stuck in the ground. do you lift him off? 

just something i dont remember covered much in depth in school

unrelated: they lifted him and nicked an artery and the medic had to do field surgery and suture the arteries closed while on the radio with a doc in the copter. magically it worked and he lived.


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## abckidsmom (Aug 21, 2011)

The only person I've ever seen that was trapped on vertical rebar was impaled through the thigh.  When we got there, his friends were all holding him up, basically parallel with the ground.  We built a table out of a backboard and some cribbing, and cut the rebar with a torch they were using on the construction site.  It was very much a team effort and the construction guys were so completely helpful and part of the team.

We flowed a very small stream of water over the metal to try to cool it, but it was a pretty quick cut and it didn't burn the patient at all, thought the rebar did heat up some.

We transported with the 3-4 foot section of rebar stabilized as best we could.  If it had been through the abdomen or chest, I would have done the same thing if possible, and immobilized the guy on his side, with the ends of the rebar trimmed if possible to fit in the medic unit.


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## DesertMedic66 (Aug 21, 2011)

abckidsmom said:


> We transported with the 3-4 foot section of rebar stabilized as best we could.  If it had been through the abdomen or chest, I would have done the same thing if possible, and immobilized the guy on his side, with the ends of the rebar trimmed if possible to fit in the medic unit.



Exactly like that. You are going to have to end up cutting the rebar.


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## sir.shocksalot (Aug 21, 2011)

Joe said:


> unrelated: they lifted him and nicked an artery and the medic had to do field surgery and suture the arteries closed while on the radio with a doc in the copter. magically it worked and he lived.





Joe said:


> the medic had to do field surgery and suture the arteries closed while on the radio with a doc in the copter





Joe said:


> the medic had to do field surgery



Did no one else notice this? Or am I the only one that read this and laughed?

Anyway, carry on.


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## Tigger (Aug 21, 2011)

http://stevespak.com/spak/ems/impaled.html

An excellent photo essay on how deal with a wrought iron fence through the mouth and neck. Pictures a bit graphic, but not gory by any means. 

They used an oxy/acetylene torch for this rescue, which would be best in my limited metal working opinion. I know a lot of fire/rescue departments that don't do a lot of metal work carry exothermic torches like the Slice Pack, but those create a huge amount of sparks and heat compared to the oxy torch, which is a bit easier to control. 

One way or another, great care needs to be taken to ensure that the metal is immobilized to the patient so that metal cannot move around in the patient and do more damage.


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## Joe (Aug 21, 2011)

abckidsmom said:


> The only person I've ever seen that was trapped on vertical rebar was impaled through the thigh.  When we got there, his friends were all holding him up, basically parallel with the ground.  We built a table out of a backboard and some cribbing, and cut the rebar with a torch they were using on the construction site.  It was very much a team effort and the construction guys were so completely helpful and part of the team.
> 
> We flowed a very small stream of water over the metal to try to cool it, but it was a pretty quick cut and it didn't burn the patient at all, thought the rebar did heat up some.
> 
> We transported with the 3-4 foot section of rebar stabilized as best we could.  If it had been through the abdomen or chest, I would have done the same thing if possible, and immobilized the guy on his side, with the ends of the rebar trimmed if possible to fit in the medic unit.



thats something i didnt think about. i always forget about oxy acet torches. rebar is only 3/8ths so it should cut quickly. i was thinking cutoff saws but the vibrations would be horrible and probably cause more damage.  so if you do lift him and he starts bleeding out is it kinda go for broke time? i would imagine a major bleed in the abdomen needs to be controlled pretty fast. 



sir.shocksalot said:


> Did no one else notice this? Or am I the only one that read this and laughed?
> 
> Anyway, carry on.



yea its from the tv show trauma. its super cheesy but its on netflix. if you really want a good laugh check out the first 5 or so episodes. theres an MCI in every episode with explosions. this particular scenerio is from episode 4


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## Joe (Aug 21, 2011)

Tigger said:


> http://stevespak.com/spak/ems/impaled.html
> 
> An excellent photo essay on how deal with a wrought iron fence through the mouth and neck. Pictures a bit graphic, but not gory by any means.
> 
> ...



thanks for the share. this is awesome work by all. i could not even imagine the pain that guy was in


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## abckidsmom (Aug 21, 2011)

Joe said:


> thats something i didnt think about. i always forget about oxy acet torches. rebar is only 3/8ths so it should cut quickly. i was thinking cutoff saws but the vibrations would be horrible and probably cause more damage.  so if you do lift him and he starts bleeding out is it kinda go for broke time? i would imagine a major bleed in the abdomen needs to be controlled pretty fast.



If they are alive and stable with the item impaled, absolutely, definitely positively do not remove the object, especially from the abdomen or other organ compartment.

Removing the object in the OR is a way better option, and cutting it as small as possible to get the patient there is the best bet.


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## Tigger (Aug 21, 2011)

Joe said:


> thats something i didnt think about. i always forget about oxy acet torches. rebar is only 3/8ths so it should cut quickly. i was thinking cutoff saws but the vibrations would be horrible and probably cause more damage.  so if you do lift him and he starts bleeding out is it kinda go for broke time? i would imagine a major bleed in the abdomen needs to be controlled pretty fast.
> 
> 
> 
> yea its from the tv show trauma. its super cheesy but its on netflix. if you really want a good laugh check out the first 5 or so episodes. theres an MCI in every episode with explosions. this particular scenerio is from episode 4



Correct, cut off saws are not going to be a good option. An air powered whizzer saw might work though, it'll create a lot less vibrations and should be able to make it through 3/8" rebar fairly easily. Hydraulic tools aren't much of an option either, the force created by the pressure on the metal would result in a lot of movement when the cut is finally made.


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## Joe (Aug 21, 2011)

abckidsmom said:


> If they are alive and stable with the item impaled, absolutely, definitely positively do not remove the object, especially from the abdomen or other organ compartment.
> 
> Removing the object in the OR is a way better option, and cutting it as small as possible to get the patient there is the best bet.



yea i remember thats what i was taught but of course you wouldnt pull the pt off the whole piece. they way he was impaled gravity caused there to be no room below to cut from. hence why they picked him up a little to get some room



Tigger said:


> Correct, cut off saws are not going to be a good option. An air powered whizzer saw might work though, it'll create a lot less vibrations and should be able to make it through 3/8" rebar fairly easily. Hydraulic tools aren't much of an option either, the force created by the pressure on the metal would result in a lot of movement when the cut is finally made.



yea its kinda what i was thinking. they ended up using the jaws on the rebar (it was lying there, they didnt show them using it but i assume). i would have expected alot of bending and movement from the jaws since they dont cut they just compress and break it off so to speak. whizzer say eh? googleing it as we speak.


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## dixie_flatline (Aug 21, 2011)

I would mobilize the GO Team.  The Shock Trauma GO-TEAM is composed of an attending physician (anesthesiologist, surgeon, critical care medicine specialist) and a certified registered nurse anesthetist.  

It typically takes awhile to get them on scene, but in a situation like you described I want that insurance.  No reason for us to try something foolish like pulling them off the rebar if they're CAOx3 and present as hemodynamically stable.

Capabilities include:


> Perform surgical procedures to achieve hemostasis.
> Administer advanced fluid resuscitation, including blood transfusion.
> Administer sedative, analgesic and paralytic medications.


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## usalsfyre (Aug 21, 2011)

Small diameter rebar can often be cut with a decent sized pair of bolt cutters, meaning no heat/vibration. The material does need to be stabilized prior to cutting if there's any tension on it though. 

The last impalement I dealt with was an E-brake pedal through and through a patients calf. We cut it with a recip saw. Talked to the surgeon later that day, apparently the pedal managed to go BETWEEN the tibia and fibula.


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## Joe (Aug 22, 2011)

dixie_flatline said:


> I would mobilize the GO Team.  The Shock Trauma GO-TEAM is composed of an attending physician (anesthesiologist, surgeon, critical care medicine specialist) and a certified registered nurse anesthetist.
> 
> It typically takes awhile to get them on scene, but in a situation like you described I want that insurance.  No reason for us to try something foolish like pulling them off the rebar if they're CAOx3 and present as hemodynamically stable.
> 
> Capabilities include:



i like this idea. i know in my area we have nothing like that. is sounds BA tho!!



usalsfyre said:


> Small diameter rebar can often be cut with a decent sized pair of bolt cutters, meaning no heat/vibration. The material does need to be stabilized prior to cutting if there's any tension on it though.
> 
> The last impalement I dealt with was an E-brake pedal through and through a patients calf. We cut it with a recip saw. Talked to the surgeon later that day, apparently the pedal managed to go BETWEEN the tibia and fibula.



dude! thats a cool call. recip saw? like a sawzall? thats the way to do it. yea the only prob with bolt cutters is the movement while cutting. it will bend and stuff. but if its pretty stable and it snaps fast it would be ok.


Thanks everyone for the replys its pretty incitefull (sp?)


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