The St.Emlyn’s Podcast

Ep 220 - Penetrating Injuries with John O’Neil at the PREMIER Conference

Jun 19, 2023

Expert John O'Neil discusses penetrating injuries, emphasizing early diagnosis and management. Highlighting the impact on trauma patients, challenges in assessing teenage boys, and unique physiological responses. Stressing the importance of timely recognition and urgent interventions, including thoracotomies for unstable patients. Exploring the readiness of emergency departments for treating penetrating injuries and the psychological impact on staff during resuscitative thoracotomies.

14:49

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Episode guests

John O'Neil

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Quick takeaways

Early and accurate diagnosis is crucial for managing penetrating injuries, with varying mechanisms such as violence, impalement, and self-harm.

Understanding the unique physiological responses in trauma patients, especially children, is essential for timely intervention and avoiding false reassurance.

Deep dives

Penetrating Trauma Presentation

John O'Neill discusses penetrating trauma, including impalement and self-harm. Impalement incidents, often involving adventurous teenagers climbing over fences, bring dramatic cases to hospitals. Self-harm cases, focusing on abdominal injuries and foreign body insertions, are emerging. Statistically, penetrating injuries have high mortality, with 20% fatality rate, emphasizing the critical nature of these cases. Accurate early diagnosis is key for successful treatment.

Introduction

6min

Navigating the Complexity of Treating Penetrating Injuries

2min

Managing Penetrating Injuries: Importance of Timely Recognition and Urgent Interventions

2min

Preparedness for Penetrating Injuries in Emergency Departments

5min

This episode of the podcast is a live recording from the PREMIER Conference of John O Neil discussing penetrating injuries with learning points that are useful for clinicians who look after both adult and paediatric patients.

There are three main mechanisms – violence, impalement and self harm, although the first is by far the most common.

Penetrating injuries are rare but have significant morbidity and mortality. The key is early and accurate diagnosis, and many can be managed conservatively. The distribution of penetrating injuries across the UK differs widely, with most in the London area, although as seen in the news recently can happen anywhere.

Remember how traumatic it is to be a trauma patient. We put you on a bed, cut off your clothes, stick needles in you and take your family away. Some will also just not engage with you (teenage boys particularly) making assessment difficult. Be kind. Don’t get frustrated.

Physiologically there may be a strong vagal response that can hide some of the signs we’d expect. Also, bear in mind the events prior to the injury – the child may have been running a considerable distance (before and after the incident) raising their lactate (but don’t assume this is the cause). Children tend to ‘fall off a cliff’ – they appear well, but can suddenly decompensate – keep the momentum to definitive management going and do not be falsely reassured.

John mentioned a great friend of St Emlyn’s Vic Brazil and we would heartily endorse you have a look at her work.

You can find more information about the Reducing Knife Crime initiative here

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The St.Emlyn’s Podcast

Ep 220 - Penetrating Injuries with John O’Neil at the PREMIER Conference

Episode guests

Podcast summary created with Snipd AI

Quick takeaways

Deep dives

Penetrating Trauma Presentation

Geographical and Demographic Incidences

Preparation and Treatment Procedures

Remember Everything You Learn from Podcasts