A 42-year-old man has a large knife impaled in the center of his chest. He is unresponsive, pulseless, and not breathing. You should:

• A. Secure the knife in place with bulky dressings and transport immediately.
• B. Carefully remove the knife, control the bleeding, and begin CPR.
• C. Stabilize the knife with bulky dressings, begin CPR, and transport at once.
• D. Carefully remove the knife, control the bleeding, and apply the AED.

Answer: (B)

The main idea is that in a patient in cardiac arrest from penetrating chest trauma, you need to restore circulation and ventilation as quickly as possible, and the impaled object can hinder resuscitation. A large knife through the chest can obstruct chest compressions and effective ventilation, so removing it, done carefully to minimize further injury, allows chest compressions and rescue breaths to be delivered more effectively. After the knife is removed, focus on controlling bleeding with direct pressure and bulky dressings, then begin CPR immediately and continue rapid transport for definitive care.