How to Treat a Wound Created by an Impaled Object

Do not remove objects that are impaled in the body unless the object is obstructing the airway. Removing the object may cause severe bleeding. The wound from an impaled object can still be treated with special care to immobilize the object.

Instructions

Difficulty: Easy

Preparation

1. Scrub hands thoroughly with soap and disinfected water.
2. Wear latex gloves to prevent the spread of infectious disease.
3. Evaluate and treat the injured person for shock. See "How to Evaluate for Shock" and "How to Treat for Shock."
4. Prepare a disinfectant solution of 1 oz. povidone-iodine and 1 liter of disinfected water. See "How to Disinfect Water." Set the disinfectant solution aside for about five minutes.

Irrigation

5. Do not remove an object impaled in the wound unless it is obstructing the airway.
6. If the object is large or unstable, hold the object steadily in place with one hand, or ask another person or the injured person to hold it for you.
7. Draw the disinfectant solution into an irrigation syringe.
8. Hold the syringe perpendicular to the wound, about 2 to 3 inches above it. Angle the syringe and tilt the wound so that the solution will flood the wound and drain away from the opening.
9. Press down on the plunger to emit a forceful stream of solution.
10. Repeat the irrigation process, rinsing the wound for at least 3 to 5 minutes. Puncture wounds are very difficult to disinfect, so repeat the irrigation process as often as possible to give the wound a thorough cleaning.
11. Rinse the wound liberally with disinfected water, as the disinfectant solution may cause irritation to the skin if left on.
12. Check the clothing and area around the injured person to make sure his or her skin won't be exposed to disinfectant solution for a prolonged period of time, as this may cause burning.

Stabilization and Bandaging

13. Apply antibiotic ointment to small wads of sterile gauze.
14. Pack the sterile gauze into the opening of the wound between the edges of the wound and the impaled object. This will keep it open.
15. Dress and bandage the wound. See "How to Bandage a Wound."
16. Use tape and rolled gauze to stabilize the object as much as possible against and within the bandage, adhering the tape to both the object and the area around the wound. This may take some creativity, depending on the size and width of the object and wound. Don't hesitate to use lots of gauze for padding and create a bulky dressing.

Aftercare

17. Evacuate and seek medical help immediately.

Tips & Warnings

• You will need to have at least 1 liter of disinfectant solution on hand for this procedure.
• Use a clear plastic bottle with measurements on the side, such as a Nalgene bottle, for easy measurement when mixing the disinfectant solution. These bottles include measurements in milliliters and ounces.
• If povidone-iodine is not available, use disinfected water to cleanse the wound.
• Infectious diseases such as AIDS and hepatitis are transmitted via the exchange of bodily fluids. Protect yourself by wearing latex gloves. Wear goggles or glasses to protect against spurting blood or fluids. Wear a surgical mask to prevent the spread of other diseases. If you don't have gloves, a surgical mask and goggles, improvise by placing your hand in a plastic bag, wearing sunglasses and covering your mouth with a bandanna.
• "Irrigation syringes" are also called "pressure irrigators." If an irrigation syringe is not available, improvise by puncturing a plastic bag with a small hole, drilling or burning a hole into the top of a water bottle, or using a sports bottle with a squirting top. The idea here is to create a high-pressure flow of water that will remove debris without damaging the tissue.
• Do not use alcohol, iodine or mercurial solutions to cleanse a wound, as these can damage the tissue.
• Begin antibiotic therapy immediately if in a remote area where medical help is more than 24 hours away. High doses of antibiotics should be given for at least five days. If you anticipate visiting a remote area, consult a physician before you leave about bringing a broad-spectrum antibiotic with you. Make sure you bring all the instructions for usage of the antibiotic and information about complications with you into the backcountry.
• Tetanus is a serious complication of puncture wounds. Tetanus boosters should be given every 10 years, and shots should be up-to-date before heading into a remote area. If the injured person has not received a tetanus booster, evacuate.
• This information is not intended as a substitute for professional medical advice or treatment.