title: Thoraco- abdominal impalement injury: a case report.
abstract: BACKGROUND
  Impalement injury is an uncommon presentation in the emergency department (ED), and penetrating thoraco-abdominal injuries demand immediate life-saving measures and prompt care. Massive penetrating trauma by impalement in a pediatric case represents a particularly challenging presentation for emergency providers in non-trauma center settings.
  
  
  METHODS
  We report a case of 10 year old male who presented in our ED with an alleged history of fall from an approximately 15 foot tall coconut tree, landing over an upright bamboo stake approximately 50 centimeter long, resulting in a trans-abdomino, trans-thoracic injury. In addition to prompt resuscitation and hospital transfer, assessment of damage to vital structures in conjunction with surgical specialty consultation was an immediate goal.
  
  
  CONCLUSIONS
  This article describes a case study of an impalement injury, relevant review of the available literature, and highlights the peculiar strategies required in the setting of a resource limited ED.
authors.forename: Gyanendra
authors.initials: G
authors.lastname: Malla
authors.affiliation: Department of General practice and Emergency Medicine, B, P, Koirala Institute of Health Sciences, Dharan, Nepal. bibhusan117@hotmail.com.
authors.forename: Bibhusan
authors.initials: B
authors.lastname: Basnet
authors.forename: Rais
authors.initials: R
authors.lastname: Vohra
authors.forename: Casey
authors.initials: C
authors.lastname: Herrforth
authors.forename: Shailesh
authors.initials: S
authors.lastname: Adhikari
authors.forename: Amit
authors.initials: A
authors.lastname: Bhandari
mesh_terms: D000007:Abdominal Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D000058:Accidental Falls; D002648:Child; D005440:Fluid Therapy; D006801:Humans; D008297:Male; D010102:Oxygen Inhalation Therapy; D011859:Radiography; D013898:Thoracic Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D014950:Wounds, Penetrating / Q000000981:diagnostic imaging / Q000601:surgery*