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Impaled object — DipIMC MCQ

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HardTraumaImpaled objectDipIMC

A 35-year-old has a metal fence spike through the right upper abdomen after a fall. He is alert, tachycardic and bleeding around the entry point is controlled by pressure around the object. What is the most appropriate immediate action?

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

Reveal the answer and explanation

Correct answer: E — Stabilise the object in situ and control bleeding around it

Explanation lettering: D = shown as A · A = shown as B · E = shown as C · C = shown as D · B = shown as E

B is correct: Impaled objects are normally left in place pre-hospital because removal can precipitate severe haemorrhage. A is less suitable because it does not address the discriminator in the vignette; C is less suitable because a detailed survey is inappropriate before correcting an immediate threat; D is less suitable because it does not address the discriminator in the vignette; E is less suitable because it delays the immediate life-saving step in the cABCDE sequence. The most tempting alternative is therefore suboptimal because it either delays the time-critical pre-hospital intervention or sends the patient to the wrong level of care. The key DipIMC principle is focused cABCDE decision-making with early pre-alert, triage or retrieval escalation when the scene physiology demands it.

Reference: JRCALC Guidelines; NICE Major Trauma NG39; ATACC