A 15-year-old male client arrives at the emergency department. He is conscious, coherent, and ambulatory, but his shirt and pants are covered with blood. He and his hysterical friends are yelling and trying to explain that they were goofing around and he got poked in the abdomen with a stick. Which of the following comments should be given first consideration?
A. “The stick was really dirty and covered with mud.”
B. “He pulled the stick out, just now, because it was hurting him.”
C. “He’s a diabetic, so he needs attention right away.”
D. “There was a lot of blood and we used three bandages.”
Correct Answer: B. “He pulled the stick out, just now, because it was hurting him.”
An impaled object may be providing a tamponade effect, and removal can precipitate sudden hemodynamic decompensation. Additional history including a more definitive description of the blood loss, depth of penetration, and medical history should be obtained. Surgery is often required; impaled objects are secured in place so that they do not move and they should only be removed in an operating room.
Option A: Penetrating trauma often causes damage to internal organs resulting in shock and infection. The severity depends on the body organs involved, the characteristics of the object, and the amount of energy transmitted.
Option C: Other information, such as a history of diabetes, is important in the overall treatment plan, but can be addressed later. The indications for surgical intervention include a patient with hemodynamic instability, development of peritoneal findings such as involuntary guarding, point tenderness or rebound tenderness, and diffuse abdominal pain that does not resolve.
Option D: These injuries may be life-threatening because abdominal organs bleed profusely. If the pancreas is injured, further injury occurs from autodigestion. Injuries of the liver often present in shock because the liver tissue has a large blood supply.
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