Multiple impalement injury—a remarkable survival

Abstract

A 42-year-old construction worker fell 30 feet (9.23 m) from a supporting harness and became impaled upon some reinforcing steel bars. Following the arrival of the Immediate Care medical team, he was given oxygen via a face-mask and intravenous fluid resuscitation was begun with colloid. Subsequently the bars were cut and he was promptly transferred to the Casualty department. On admission (43 min after the emergency call) he was conscious but distressed with a pulse of lZO/min, BP 90/60, tachypnoea and bilaterally diminished breath sounds. There was no abdominal injury and neurological examination was normal. One rod transfixed his neck whilst a second had entered his left upper arm (F@re 7). A third rod entered the right chest wall via the seventh intercostal space and was pulsating (Figure 2). The chest wound was covered and sealed and bilateral 30 FG chest drains inserted. Fluid resuscitation was continued with colloid initially then cross-matched blood. He then underwent endotracheal intubation and ventilation. Cervical spine immobilization was provided by the presence of the steel rod. There were no bony injuries but a chest X-ray confirmed the presence of a right pneumothorax and a left haemopneumothorax. Although the chest rod had crossed the pericardial shadow, it was not enlarged and the mediastinum was not widened. Following transfer to Harefield Hospital he was taken to a theatre with cardiopulmonary bypass facilities available. Both pleural cavities and the pericardial cavity were examined through a median sternotomy and the rod removed via the entry wound. The rod had entered both pleural cavities and passed between the pericardium and the vertebral bodies. The tip was lying 5 mm in front of the descending aorta and was covered in shirt fabric. The ‘neck rod was carefully removed and digital examination of the wound was performed through an oblique incision. This revealed only a small pharyngeal tear which was subsequently repaired. The rod was removed from the left arm and the wound left open. Postoperatively a period of respiratory distress syndrome necessitated ventilation for 20 days.