Penetrating Trauma

I'm pretty sure I haven't covered this topic. I think I was about to go into impalements in my foreign objects blog, but realized it deserved it's own sections. Alas, here it is! A recent patient reminded me of this topic, as she was impaled in the eye with a pole that extended into the brain. At my trauma center, blunt trauma is far more common than penetrating trauma, so these cases are always of interest to me.

Although we do see gunshot wounds (GSW) to the head, which seem to come from Mexico with a bad story behind it, I have to say a nail gun to the head is far less frequent. But apparently it happens. In one such case, the nail hit a cerebral vessel that I don't remember anymore, but I found the case very interesting. In order to remove the nail, the patient had undergone a balloon study to determine if the patient could survive without blood flow through that vessel. The patient passed the test, so went on to have the vessel coiled, which essentially blocks blood flow permanently (which is why they had to make sure the patient could tolerate such a procedure). THEN, the nail could be removed. Quite interesting.

Speaking of GSW to the head though, sometimes they are self inflicted. A memorable example of that was a patient that shot himself in the temple, realized he was "unsuccessful" for suicide, and shot himself in the other temple. Unfortunately, this resulted in severing the optic nerve and rendering the patient blind (but the brain was completely unharmed).

In other case, a girl fell several stories onto a iron fence, impaling her vagina. I didn't see this patient, so not sure the extent of the injuries, but the mechanism was certainly enough for me to remember.


This photo avove isn't from our center, but this sort of neck trauma isn't all that rare. I've had several cases of severe neck lacerations, including injury to major vessels. Sometimes, although much less, there can be tracheal injury as well. This isn't impalement, but certainly penetrating trauma. If you get them soon enough, they actually do pretty well. It's really all about the clock-stop the bleeding in time.

Most common to our trauma center are stab wounds. I know I've seen on TV-trauma telephone poles go through torsos, but I've never had a case with that. Nonetheless, we have so many car crashes, falls, and assaults that even stab wounds are different and interesting. And anything more is just plain exotic!