A 21-year-old male was injured in an explosion at a metals factory. He has a 6-inch piece of metal protruding from the RUQ of his abdomen with evisceration to the left lower abdomen. What is the correct immediate management?

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When a penetrating abdominal injury includes a protruding object and evisceration, the immediate priority is to prevent further injury by stabilizing what’s impaling the body and protecting the exposed tissues. Stabilizing the metal piece with bulky dressings keeps it from moving, which reduces additional damage to internal structures during transport and helps control bleeding around the wound. Do not attempt to remove the object in the field, because extraction can unleash more bleeding and tissue injury. Also avoid applying direct pressure on the abdomen over the wound, as that can compress or damage exposed tissues. If feasible, cover any exposed organs with sterile, moist dressings to reduce contamination and heat loss, and transport promptly for definitive care.