A 22-year-old man is pulseless and apneic after a chest stab with an impaled knife. What should be done?

• A. Stabilizing the knife, starting CPR, and providing rapid transport.
• B. Removing the knife, starting CPR, and providing rapid transport.
• C. Removing the knife, applying an occlusive dressing, and providing rapid transport.
• D. Stabilizing the knife, applying an occlusive dressing, and providing rapid transport.

Answer: (B)

In penetrating chest trauma with a patient in cardiac arrest, restoring circulation takes precedence. An impaled object can prevent effective chest compressions and ventilation, so removing the object may be necessary to enable high‑quality CPR. Once the object is removed, begin CPR immediately and transport rapidly to definitive care. While you can still apply bulky dressings around the wound to control external bleeding, the quickest path to perfusion is to remove the object, then deliver CPR without delay.

Stabilizing the knife would keep the object in place and can hinder chest compressions, delaying resuscitation. Simply applying an occlusive dressing around the wound doesn’t address the need for immediate chest compressions and airway management in a pulseless patient. Removing the object first aligns with delivering rapid life support and getting the patient to the hospital for definitive care.