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Case of a 30 year old male who had been cutting down a tree branch, when he fell 20 feet and became impaled by a large piece of wood.

General principles of trauma care apply in the management of thoracic impalement injuries. Attention to the airway, breathing and circulation are paramount. The pre-hospital phase of care is even more crucial. With rare exception, the impaling object should be left in-situ during transport. Efforts at removal are best carried out under direct vision in a controlled environment as obtains in an operating theatre. Premature removal may result in exsanguinating haemorrhage. The operative approach may be a thoracotomy or a sternotomy based on the suspicion of involved organs. Additionally tetanus and antibiotic prophylaxis should be administered as the impaling objects often have high infective potential.