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Impaled chest object — DipIMC MCQ

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ModeratePre-Hospital Trauma ManagementImpaled chest objectDipIMC

A 30-year-old construction worker has a nail embedded in his chest from a nail gun. He is stable, with equal breath sounds and no major external bleeding. What is the most appropriate management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Stabilise the object in situ and transfer to a major trauma service

Impaled objects should usually be stabilised in situ because removal may release tamponade and worsen bleeding. Field removal is considered if the object prevents safe extrication or resuscitation, not simply for inspection. Chest drain placement is not indicated in a stable patient without tension physiology. The pearl is that controlled removal belongs in an environment prepared for haemorrhage and organ injury.

Reference: JRCALC Guidelines 2025; ATACC