Stable Penetrating Chest Trauma
Annotation for Point Q
Impalement injuries are generally approached by stabilizing the object and positioning the patient in a manner that will not dislodge the object. If the physical findings, often in conjunction with CXR, suggest that the object does not penetrate the chest, then it may be removed, although larger objects (fence posts, steel bars) may require anesthesia and surgical debridement. Injuries that are anterior, in the region of the heart or great vessels, may be evaluated by CXR, FAST, or occasionally CT to determine the depth and tract of the object. If the patient is entirely stable, the object can be removed in the operating suite. The impaled object can be removed under thoracoscopic guidance to determine if there are injuries that require repair. Any findings that suggest the object may involve a cardiac or great vessel injury (pulsating, CT suggests injury, etc.) mandates that the object should be removed at the time of the operative exposure.