Check Your Spot (pretty graphic)

[AngelsSix]

This isn't SF related, but I wanted to know how you would treat such a traumatic injury (obviously he is still alive in this picture??)

Since I cannot post pictures to this web site for some reason, I have provided a link to a site that hosts photos.

Thanks to Sacameulas (I think I spelled it wrong, sorry) for helping to try and see if it was a size issue (it was not).

Here is the link to the photo

[Surgicalcric]

Are you sure he is still alive?

[NousDefionsDoc]

I doubt it.

[Sacamuelas]

Here it is "ma'am"... (**edited to avoid sexual harassment lawsuit by RL)

[Sacamuelas]

Alright.. you guys get over your automatic denial about this situation because of the "WOW...that is to painful to think about" this accident stuff. "

Lets do this as if you find a teammate impaled onto an object (fence posts, tree limb). What to do on scene to at least stabilize him for evac. Obviously, this type of impalement may be a little extreme to expect recovery, but a similar situation (less severe) could be important to review. For instance a NIGHT Halo jump into a densely populated or wooded area by mistake.
Anyone want to work out the basics?

HaHa, look at me. I am" Mr. peacemaker and his friend excuse maker" all in one!! LOL
Sir Sacamuelas the honorable

[Surgicalcric]

There would be no stabiliation of the post necessary. It is being stabilized by the patient's pelvis. Also unless one of the guys has a really good hand saw he will bleed out before getting that post/tree cut.

I am probably going to draw fire for this but;

My treatment for this guy would be an IV and MS to kill the pain and knock out his respiratory drive so he could die without suffereing anymore than he is already. I have seem MANY impaled objects thought the torso. I have yet to see one live to get to the OR. It would be better for him to go as painlessly as possible than to suffer while we screw with an injury not likely to be survivable.

Just my .02

[CSB]

It certainly is a gruesome photograph, what was the cause?

I know the topic subject implies a parachute landing, but I can't see 10-20 fps having the ability to do that much tissue damage, even for such a grossly obese subject. The post is protruding from the back of the victim.

Angels, do you have a time/place/circumstance?

[Eagle5US]

at your defeatest attitude there cric...I expected more. Maybe none of yours lived to get to the OR for just that reason...you never gave them a chance to begin with...
Now...back up, regroup, and try again...your narc box was unsecure during the jump and fluttered away in the darkness at about 18000 feet.

Let's go with Sacamuelas' suggestion and push a 4in diameter fencepost a bit inferio/lateral to where this gentleman was impaled. Use the photo to distinguish what the R leg looks like. The fence is still attached to its uprights and his MC-4 is fluttering in the breeze...

So...lets try this again shall we

Eagle

[Surgicalcric]

Defeatest attitude has nothing to do with it Sir. I have just seen quite a few patients with guard rails run thru them. BTW, I have never used my ability to induce respiratory failure to put them out of their misery, but it has crossed my mind on a few instances.

Back to the scenario at hand...

Call for immediate EVAC.

Remove/cut harness and all other gear. Support patient manually with 3 or 4 other team members holding him up; cut 6" x 5' strips from MC-4, pack around entrance and exit with trauma dressings; pad around post with clothing and left over canopy. Use the strips of canopy to secure the impaled object to both torso and lower extremities to prevent movement during extrication and evac. Cut the post at about knee level and lie patient supine on SKEDCO, stretcher, LSB, etc... and secure. (2) IV's and fluid titrated to mentation. MS for pain.

Evac to bright lights and cold steel.

[Eagle5US]

Originally posted by Surgicalcric
Defeatest attitude has nothing to do with it Sir. I have just seen quite a few patients with guard rails run thru them. BTW, I have never used my ability to induce respiratory failure to put them out of their misery, but it has crossed my mind on a few instances.

touchy touchy...just trying to give you a bit of perspective...not get your tailfeathers all outt whack...

[Surgicalcric]

I did not take it that way Sir. I was just trying to clarify my position. I think I need some block leave from EMS. lol

[Sacamuelas]

Assuming it is a fence post of average height of five feet or so.

I'm obviously out of my league here men. Take this with an understanding that this is not my field. I post to stir debate/correction from knowledgeable members/and learning for myself and others who have no particular expertise in this area.

What I would do:
1. First things first. Detach harness to his chute to prevent it from manipulating his position or causing any more tearing of his tissues from lateral or rotational movement.

2. Have someone radio for immediate and urgent Evac at highest priority

3. Get another soldier to help stabilize his upper body to prevent as much movement as possible.

4. Assuming no active bleeders to clamp (probably not since object is in place), I would get two IV locks started for future pain meds/volume replacement prn.

5. Do not remove soldier from the impaled object. I would actually use ace wraps, any other material available or 100mph tape(if that’s all I had), etc to stabilize and immobilize his lower extremities to prevent movement.

6. With assistance from your teammates, have some soldier begin to cut the base of the post free from the ground. This is when you hope Reaper is with you. He can whip out one of the 1000 gucci gadgets/knives that he owns to perform the cutting quickly and without to much effort. LOL

7. With help of at least four men, lower the soldier and the post together as one unit onto the ground in a position that places as little pressure to cause movement of the object. His side on a prepositioned stretcher may be the ideal position to facilitate future loading onto a helicopter.

8. Treat for shock and manage pain based on BP/symptoms/breathing. IV Ab woudl be indicated to get the drop on the coming infections after he is stabilized. Reassure patient that James didn't make this jump and he will be fine!! LOL

alright James, your turn to blast me for my treatment recs! haha

***edited, I seem to type to slow. James beat me to it.

[Smokin Joe]

Originally posted by Surgicalcric
There would be no stabiliation of the post necessary. It is being stabilized by the patient's pelvis. Also unless one of the guys has a really good hand saw he will bleed out before getting that post/tree cut.

I am probably going to draw fire for this but;

My treatment for this guy would be an IV and MS to kill the pain and knock out his respiratory drive so he could die without suffereing anymore than he is already. I have seem MANY impaled objects thought the torso. I have yet to see one live to get to the OR. It would be better for him to go as painlessly as possible than to suffer while we screw with an injury not likely to be survivable.

Just my .02

If you find me impaled that bad please do me the favor and provide the above stated treatment.

I know it goes against your morale and ethical code but help a brother out.

Sorry its off Topic Eagle.

[NousDefionsDoc]

I agree with Sacamuela's TX. I would also try to think of any other supporting measures I could.

In the UWOA, I don't know. You can't leave it indefinitely.

[18C/GS 0602]

No ABC’s? I can’t tell from the picture but he looks like me might be intubated.

One of the things that was stressed to me during my trauma months was that no matter how spectacular the injury is (i.e. arterial injury with blood spraying everywhere or a knife sticking out of someone’s head) you always start at what will kill the patients first. No one specifically said what the injury mechanism was but if it was powerful enough to do that it seem like there is a good change there are other injuries that might compromise airway and breathing.