Check out the "Hard 2 Kill" tattoo
Particularly enjoyable is that at least three people are taking pics of this guy: The cop, presumably a nurse, and the one who actually took this picture. There are so many times throughout my day that I simply want to do the same thing! One has to be professional and then there is HIPPA to consider.
Now how would I treat this guy?
My first consideration is securing that airway. I would consider intubation. Fortunately for this guy, it apparently wasn't completely necessary to intubate him at the time this photo was taken.
Secondary to securing the airway is bleeding control. Securing the airway and bleeding control would happen in quick order. Facial injuries appear to bleed a lot but are usually not as bad as they appear. I wouldn't be able to completely staunch the flow of blood for this guy because of the nature of the injury. The knife is going to help control the bleeding too. I would potentially have to be Johnny on the spot with the suctioning to help support the airway unless I completely secured it by means of intubation. It's always helpful to have a conscious patient as he can help you with this. I'd get a line started and monitor his vitals and treat accordingly.
A tertiary measure would be to secure the impaled object in place. Looks like that knife is plenty secure to me already. I don't want that knife moving at all if it can be helped. I could secure it in place by wrapping gauze around it but given the location of the knife I'd have to be careful about it. For one thing, I don't want seal off his airway in the process. They really get mad at you if you start pulling impaled objects out of your patient.
