**2.1. Primary evaluation: emergency department**

All NMPSCI patients should be treated like other trauma victims according to the ATLS (Advanced Trauma Life Support) principles [20]. When the retained weapon is clearly prominent from the patient's body, the attention of the treating personnel tends to focus on it and distract them from acting according to the ATLS protocol. These injuries are sometimes less visible than it might be seen at first and may harbor other damages such as large vessels, heart, tracheal, or lung injuries that can affect hemodynamics, airway, and breathing and may be fatal. This is why any suspected patient should obtain an appropriate initial assessment and resuscitation before taking the next step. The initial assessment should not delay instance evacuation with minimal movements to the nearest hospital.

Extracting the penetrating object must not be done on site, not even at the emergency room, before obtaining proper imaging studies. These should include radiographs, sonography, and computerized tomography, according to the involved area. In case the patient is hemodynamically unstable and does not respond to initial resuscitation, an immediate transfer to the operating room with no further delay must take place.

NMPSCI always entails the risk of a retained foreign body material. It is well described in the literature [12, 21]. Patients presenting with delayed wound infections following stab wounds that were irrigated and primarily sutured without further evaluation were documented [22–24]. This is why many authors recommend routine imaging of any penetrating injury, even if only a skin or fascia discontinuity is observed, with no obvious damage.
