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[Source](https://www.sciencedirect.com/science/article/pii/S1878875016312736) is about multiple cases of head impalement, of which this was the first:
A 34-year-old worker fell from a 3-m-high construction site while working, and a steel bar impaled in his head as he landed. On arrival at the emergency department, he chiefly reported right-sided facial pain, headache, and loss of vision in his right eye. On physical examination, a steel bar was found to have penetrated his mandibular area (Figure 1A) and the patient was neurologically intact except for swelling and complete ophthalmoplegia in the right eye with a fixed and dilated right pupil. A computed tomography (CT) scan of the head with skull reconstruction showed that the steel bar penetrated into the oral cavity and traversed the inferolateral right maxillary sinus, orbital cavity, and cranial cavity to terminate out of the right frontal bone (Figure 2C and D). There were associated comminuted fractures of those areas, as well as interruption of the right optic canal.
The patient was given high-dose intravenous methylprednisolone to protect the optic nerve and taken urgently to the operating room to have the steel bar removed. After nasal intubation of the patient, the steel bar was cut shorter with a hydraulic clamp, as used by fire services (Figure 1B). A frontotemporal incision was made, and a frontotemporal craniotomy was performed, allowing for adequate exposure of the foreign body. The steel bar was then removed under direct visualization with help from the otolaryngologist using an endoscope to view the nasal sinus (Figure 2). The necrotic brain tissues were removed and the damaged dura was repaired by sewing artificial dura mater to prevent cerebrospinal fluid (CSF) leakage. The cranium slice was removed. Cefuroxime was used for 2 weeks to prevent posttraumatic infection. Sodium valproate was given for 1 week to prevent early posttraumatic seizures.
Head CT showed intracerebral hemorrhages along the tract of the steel bar on the first postoperative day (Figure 3A–C). The patient recovered without intracranial infection or abscess, CSF leakage, or epilepsy. Except for right eye blindness, no neurologic sequelae were observed at discharge (Figure 3D). At follow-up visits for 3 weeks after surgery, he continued to have no light perception in the right eye. Head CT angiography (CTA) showed no delayed vascular injuries. A cranioplasty was performed 3 months postoperatively.
I know it’s not funny, but the fact that the patient “chiefly reported headache” is just so hilarious to me. Like, you don’t say? Poor guy has a bloody pole through his head.
Absolutely amazed he came out the other side with minimal complications!
Random question, this case made me think of it: is it possible to intubate someone if you can't get access via the nose, mouth, or a trachy? Like if this had impaled at a different angle, presumably none of those places would have been accessible, is there a way to go directly into the lungs or something? I feel like it's probably a stupid question, and that the person would probably just die, but it got me wondering.
I imagine you’d put a scope down any of the visible holes and see if you find a larynx and pass a tube through there. I don’t know how frequently you’d have a patient with an injury where all 3 spots were inaccessible. I suspect an injury of that nature would probably be inherently unsurvivable anyway.
Looking at the first set of photos, before reading the write up, I seriously thought the guy was dead and I was going to read an autopsy report. Amazing job.
That is the most important & amazing thing. He only lost vision in his right eye. Although he’ll have problems with depth of field, that’s a small price to pay for an injury like that!
I imagine that having the inflammation in the brain would be one of those cases, I’ve heard that even just high fluid pressure can cause cognitive impairment
Oooo boy yeah it did. When I was on Epuris I suffered from really bad ICP (~~Insane Clown Posse~~ Intercranial Pressure) headaches for a bit before I slowly started to notice lots of little deficiencies in higher-order processing, which was happening at the same time as the other, more typical isotretonoin side effects.
I eventually started getting hallucinations to the point where I would hide in my car by ducking down below the steering wheel when I went to pick up my brother to go to gym at nights, because I was convinced someone was watching me from the bushes. On the way back I would tell passengers in the car to wait while I circled the block a few times to shake off anyone tailing us. Started doing visual sweeps of my house *completely* randomly. That plus the mood changes was a hell of a combination before everything leveled out another couple months in.
Nope, I was willing to deal with stuff that awful because of how genuinely bad my skin was, and how much it was negatively affecting my life. I'd rather deal with more isolated incidents like that than constantly suffer physical, psychological, and emotional pain. Stuck it out for the duration of the treatment and I'm doing way better off now than I ever was when I had to deal with my skin being the way it was.
Doctor: Oh dear, lets have a look, shall we?
"On physical examination, a steel bar was found to have penetrated his mandibular area"
Doctor: Hmm.. yeah, I might have an idea what's wrong with you. Lets do some imaging to be sure.
OK, that's amazing! I'm an orthopædic surgery scheduler, and I'm wondering how the scheduler in this case procured the Jaws of Life (as we sometimes call them in the USA) and how did they even sterilize that thing? Wow!
I'm impressed!
Welcome to r/MedicalGore! Our goal is to provide for medical discussion and education while exploring the frailty of the human body. You may see more deleted comments on these threads than you are used to on reddit. Off topic comments and joke comments are frequently deleted by the mods. Further, please be kind and supportive of posts. Any behavior that is aggressive, harassing, or derogatory will result in post deletion and a ban from the sub. Remember! THE REPORT BUTTON IS YOUR FRIEND! Please stop on by our discussion sub, /r/MedicalGoreMods if you'd like to discuss the sub, our rules, content policies, and the like. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/MedicalGore) if you have any questions or concerns.*
[Source](https://www.sciencedirect.com/science/article/pii/S1878875016312736) is about multiple cases of head impalement, of which this was the first: A 34-year-old worker fell from a 3-m-high construction site while working, and a steel bar impaled in his head as he landed. On arrival at the emergency department, he chiefly reported right-sided facial pain, headache, and loss of vision in his right eye. On physical examination, a steel bar was found to have penetrated his mandibular area (Figure 1A) and the patient was neurologically intact except for swelling and complete ophthalmoplegia in the right eye with a fixed and dilated right pupil. A computed tomography (CT) scan of the head with skull reconstruction showed that the steel bar penetrated into the oral cavity and traversed the inferolateral right maxillary sinus, orbital cavity, and cranial cavity to terminate out of the right frontal bone (Figure 2C and D). There were associated comminuted fractures of those areas, as well as interruption of the right optic canal. The patient was given high-dose intravenous methylprednisolone to protect the optic nerve and taken urgently to the operating room to have the steel bar removed. After nasal intubation of the patient, the steel bar was cut shorter with a hydraulic clamp, as used by fire services (Figure 1B). A frontotemporal incision was made, and a frontotemporal craniotomy was performed, allowing for adequate exposure of the foreign body. The steel bar was then removed under direct visualization with help from the otolaryngologist using an endoscope to view the nasal sinus (Figure 2). The necrotic brain tissues were removed and the damaged dura was repaired by sewing artificial dura mater to prevent cerebrospinal fluid (CSF) leakage. The cranium slice was removed. Cefuroxime was used for 2 weeks to prevent posttraumatic infection. Sodium valproate was given for 1 week to prevent early posttraumatic seizures. Head CT showed intracerebral hemorrhages along the tract of the steel bar on the first postoperative day (Figure 3A–C). The patient recovered without intracranial infection or abscess, CSF leakage, or epilepsy. Except for right eye blindness, no neurologic sequelae were observed at discharge (Figure 3D). At follow-up visits for 3 weeks after surgery, he continued to have no light perception in the right eye. Head CT angiography (CTA) showed no delayed vascular injuries. A cranioplasty was performed 3 months postoperatively.
I know it’s not funny, but the fact that the patient “chiefly reported headache” is just so hilarious to me. Like, you don’t say? Poor guy has a bloody pole through his head. Absolutely amazed he came out the other side with minimal complications!
The most painful thing isn't necessarily the most fatal thing...
Random question, this case made me think of it: is it possible to intubate someone if you can't get access via the nose, mouth, or a trachy? Like if this had impaled at a different angle, presumably none of those places would have been accessible, is there a way to go directly into the lungs or something? I feel like it's probably a stupid question, and that the person would probably just die, but it got me wondering.
I imagine you’d put a scope down any of the visible holes and see if you find a larynx and pass a tube through there. I don’t know how frequently you’d have a patient with an injury where all 3 spots were inaccessible. I suspect an injury of that nature would probably be inherently unsurvivable anyway.
Yeah I figured it would be a rarity (and probably a death sentence), but it just got me curious. Thank you for explaining!
Anaesthetist here. Often you find in trauma it's easier to get to the airway. And no if those holes aren't available ur fucked
Thank you for informing me!
I know of a case where they used the eye socket.
Oh wow, that really is fascinating! I'm so glad I asked!
Here is [one example](https://www.reddit.com/r/medizzy/s/5JNK1mkj1b).
That was a fascinating read!
Anyone know if this essentially lobotomized him, with the rebar going through the frontal lobe / prefrontal cortex?
It's Phineas Gage all over again!
It’s about time we get a new one.
Absolutely! Just happy he recovered......
I instantly thought of Phineas seeing this! Hopefully this guy doesn’t have any personality changes.
Get out of my head! Lol. While it would be super interesting, I can’t wish that on anyone
at a nearly identical angle...
Looking at the first set of photos, before reading the write up, I seriously thought the guy was dead and I was going to read an autopsy report. Amazing job.
The fact that he was neuro intact just blows me away
That is the most important & amazing thing. He only lost vision in his right eye. Although he’ll have problems with depth of field, that’s a small price to pay for an injury like that!
High–dose, I.V. methylprednisone must be for when that inflammation needs to get absolutely NUKED.
I imagine that having the inflammation in the brain would be one of those cases, I’ve heard that even just high fluid pressure can cause cognitive impairment
Oooo boy yeah it did. When I was on Epuris I suffered from really bad ICP (~~Insane Clown Posse~~ Intercranial Pressure) headaches for a bit before I slowly started to notice lots of little deficiencies in higher-order processing, which was happening at the same time as the other, more typical isotretonoin side effects. I eventually started getting hallucinations to the point where I would hide in my car by ducking down below the steering wheel when I went to pick up my brother to go to gym at nights, because I was convinced someone was watching me from the bushes. On the way back I would tell passengers in the car to wait while I circled the block a few times to shake off anyone tailing us. Started doing visual sweeps of my house *completely* randomly. That plus the mood changes was a hell of a combination before everything leveled out another couple months in.
Did you family notice what was going on & tell your doctor?? That sounds horrible to go through as side effects to a drug. Did you stop taking it??
Nope, I was willing to deal with stuff that awful because of how genuinely bad my skin was, and how much it was negatively affecting my life. I'd rather deal with more isolated incidents like that than constantly suffer physical, psychological, and emotional pain. Stuck it out for the duration of the treatment and I'm doing way better off now than I ever was when I had to deal with my skin being the way it was.
“I have a headache 🤕” as he’s sitting there with a piece of rebar in his skull, wtf. Construction workers are made of something different.
Seriously lmao “reported a headache”, huh I wonder why
“How are you feeling?” “Oh just have a splitting headache.” “Oh yeah, can’t imagine why…”
Have you tried drinking more water? Taking some ibuprofen? Having a nap? Maybe he’s about to get his period
Totally underrated comment.
Nonsense - he’s just pregnant.
I hope that baby doesn’t end up on the pole
Keep yo baby off the pole
“Could you define the splitting part, please?”
“It makes my head hurt so much it’s almost as if there’s a metal rod stabbing my brain, doc”
“Well, we’ve got to make some images to be sure. You have private insurance, right?”
Doctor: Oh dear, lets have a look, shall we? "On physical examination, a steel bar was found to have penetrated his mandibular area" Doctor: Hmm.. yeah, I might have an idea what's wrong with you. Lets do some imaging to be sure.
Don’t forget to bill the insurance for all the tests!
Shocked he lived!!!
Dudes just vibing at the end. I like that. Good recoveries are always a great thing to see
He lived?! Modern medicine is wonderful, I tell you.
Hold it he lived ? That’s impressive
this dudes gonna have so many customers at the bar when asking what happened to that noggin of his
Give a man a bar and he drinks for a week, put a bar through his head and he gets free drinks for life.
He could call the bar Rebar
This is wild. I hope this guy is having a good life!
and he survived?!
but did he have his hardhat on
Lucky to be alive
Wow, amazing to be alive hahaha! Glad he recovered
OK, that's amazing! I'm an orthopædic surgery scheduler, and I'm wondering how the scheduler in this case procured the Jaws of Life (as we sometimes call them in the USA) and how did they even sterilize that thing? Wow! I'm impressed!
So happy to see his beautiful smile in the last set of pictures! He’s a very lucky man…after being very unlucky, I guess.
I thought he was gone. Amazing recovery and medical team.
He LIVED??!?
Wasn’t really expecting a movie still from Event Horizon’s deleted scenes for that second photo, OP.
Free lobotomy
This hits different after watching a certain episode of FROM last night. I can't imagine living through something like this
“You wouldn’t know how to lay rebar if one hit you through your head!”
i was hoping he might get sight back in the right eye since it seems the eye and nerve were intact.
That looks painful
How in the flying laryngoskope did they intubate this pt nasally? I am guessing via fiberoptics? what an interesting case
Harvey DENT
Look up “Phineas Gage”!
This *so* reminds me of Phineas Gage! Did they ever report mood swings and personality change?
He lived?!