# Hand through window with glass sticking out of hand.



## exodus (Dec 30, 2009)

Okay, I was just wondering this, Arrive on scene to find your pt has punched has hand through a window
There's several lacerations on the hand several cm's long, and there are a few pieces of glass sticking out. Blood loss is moderate, PT is ETOH, denies light headneness, no major trauma. HR 128, BP 108/72, RR 20.  


Okay, here's the big thing. The hand is still bleeding, oozing, there a few deep gashes, you can see there are small pieces of glass inside of the hand, and one larger piece sticking out of another laceration. Do you remove the glass so you can apply a pressure bandage? Or do you leave the glass in and let the ER deal with it?

On scene time will be about 10 minutes, you're 15-20 out.


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## DrParasite (Dec 30, 2009)

remove as much glass as you can.  esp the big pieces (since they are easily removable), but the more glass you remove, the better off he will feel when you apply the pressure bandage.

if it's that bad, removed as much glass as you can, then two 4x4s, with pressure bandage with cling, and transport to the ER for further treatment and cleaning.


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## lightsandsirens5 (Dec 31, 2009)

No no no! Never remove an impaled object. (Unless it is pinning the pt to something else. Or it falls out when you touch it.) Stabilize it as best you can and punt, errrrr.....let the hosp. deal with it.

Just my $0.02. I'll double check with my SEI.


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## exodus (Dec 31, 2009)

In my opinion. If even if the bleeding is dripping, and it is not severe enough. Just leave it a lone and monitor the patient, if it appears to get worse, then I'd go ahead and pressure bandage. But, to me, pushing glass harder into the skin will not only cause more pain, but can very easily cut nerves.


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## usalsfyre (Dec 31, 2009)

Use common sense. If it's deeply impaled, leave it. Otherwise brush as much of the glass as you can off and properly dress the wound.

Lightsandsirens5, are you advocating removing something like a rebar impalement through th abdomen if it's "pinning" them to a wall? If sou you might want to review impaled objects.


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## exodus (Dec 31, 2009)

usalsfyre said:


> Use common sense. If it's deeply impaled, leave it. Otherwise brush as much of the glass as you can off and properly dress the wound.
> 
> Lightsandsirens5, are you advocating removing something like a rebar impalement through th abdomen if it's "pinning" them to a wall? If sou you might want to review impaled objects.



Aren't there A LOT of nerves in the hand? I wouldn't want to remove the glass and risk severing one unless not removing it and controlling that bleeding is a threat to the pt's life.


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## usalsfyre (Dec 31, 2009)

Lots of nerves, tendons, vessels, ect in the hand. However, if it didn't get it going in, chances are it's not going to sever it going straight back out the same way. If it can't be easily removed (please don't rock the thing back and forth) then leave it, but if it's superficial, get it out, irrigate and dress. Again use common sense. Have you ever tried to stabilize something like that? It's more likely to do damage if you leave it in and let it move around during transport than pulling it out of the same path it went in.


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## lightsandsirens5 (Jan 1, 2010)

usalsfyre said:


> Lightsandsirens5, are you advocating removing something like a rebar impalement through th abdomen if it's "pinning" them to a wall? If sou you might want to review impaled objects.


 
Not in that case, no. Extrication can cut the re-bar and or wall and you take all that stuff with you. I mean like a call a friend of mine had years ago, a guy was crushed and pinned by a dump-truck bed while working on a hydraulic ram. Part of the ram impaled his upper abdomen and (for lack of better terms) went all the way through him. But because he was under the bed, nobody could get to him and extrication could not stabilize and cut the object so they drugged him up and craned the bed off him (taking the ram with it). He made it by the way.

If there is any way to cut and stabilize the impaled object then, by all means, do it. My service had a call at the lumber mill in town where a planer hit a peice of metal in the wood and the board exploded, pinning a guy to the wall with a two inch by two inch by maybe four foot long peice of wood. Apparently they could not get between him and the wall to cut it so they cut a part of the wall out and that went with the pt to the hospital too.


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## DV_EMT (Jan 1, 2010)

ok... so i've go the answer to this one (from what i understand). If the object is "impaled" DO NOT remove it. if and object is impaled and pinning a person... cut the object and transport the PT with the object still intact. its it small surface lacerations with tiny bits of glass in the wounds that you can easilly get out that will not cause the patients vitals to decline... you can _try _ to remove them. however, doing this in that back of a rig may be difficult and therefore... you should leave it for ER staff


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## So. IL Medic (Jan 2, 2010)

exodus said:


> Do you remove the glass so you can apply a pressure bandage? Or do you leave the glass in and let the ER deal with it?



IMHO - gently flush the hand with NS and lightly dress the hand w/ 4x4's and roller gauze. Anything that didn't flush out stays.


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## exodus (Jan 2, 2010)

DV_EMT said:


> ok... so i've go the answer to this one (from what i understand). If the object is "impaled" DO NOT remove it. if and object is impaled and pinning a person... cut the object and transport the PT with the object still intact. its it small surface lacerations with tiny bits of glass in the wounds that you can easilly get out that will not cause the patients vitals to decline... you can _try _ to remove them. however, doing this in that back of a rig may be difficult and therefore... you should leave it for ER staff



Exactly, not to mention painful. When you get to the ER, the doc can squirt the numbing solution straight into the wound and numb it right up. (They did that when I cut my foot in half  ) Then there would be no problems with the pain.



So. IL Medic said:


> IMHO - gently flush the hand with NS and lightly dress the hand w/ 4x4's and roller gauze. Anything that didn't flush out stays.


I would flush, but again, not wrap. Light dressings won't do anything except soak up blood. I guess it'd be alright to keep it clean... But that's about it.


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## Seaglass (Jan 2, 2010)

I'd also flush it gently, and leave anything that stays put. It gets wrapped in place and we go to the hospital. If it starts bleeding dangerously, direct pressure on an artery is a possibility, but I wouldn't do it unless it was pretty bad. 

If the glass all falls out easily with gentle washing, it's not likely to leave tiny shards everywhere*, the bleeding is mild, the patient is adamant about not being transported and competent to refuse (which many of my alcohol calls are), and the wounds are located in places that make it possible, my protocols allow me to butterfly stitch and release with directions to urgent care. I'd flush the wound further and give the tetanus lecture before doing this. I'd really rather just take them to the ER, but it would be possible and allowed, and I don't always get to make the final decision. 

*-I'd be able to take a good guess from the type of glass, the way it broke, and MOI. It's not perfect, which is why I'd rather just go, but I'd consider it. There are some types of glass, which probably wouldn't be an issue unless he punched through an old church window or something, where I'd argue long and hard for the ER.


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## Jeffrey_169 (Jan 9, 2010)

I think lightsandsirens5 put it best..."no no no no". The only time you remove a foreign object is if it impedes the airway or it must be performed to remove a patient from impending fire, drowning, building collapse etc. Never remove an object because you don't know what damage will result. Lets say it is blocking an artery, and now it is removed...corks out of the bottle now, and there can be real problems.


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