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J Emerg Med. 2018 Oct 30. pii: S0736-4679(18)30955-7. doi: 10.1016/j.jemermed.2018.09.036. [Epub ahead of print]

Bedside Ultrasonography in the Management of Penetrating Cardiac Injury Caused by a Nail Gun.

Author information

1
Department of Emergency Medicine, Christiana Care Health System, Newark, Delaware.
2
Department of Trauma Surgery, Christiana Care Health System, Newark, Delaware.
3
Department of Cardiovascular Surgery, Christiana Care Health System, Newark, Delaware.

Abstract

BACKGROUND:

Injuries from nail guns are a unique type of penetrating trauma seen in emergency departments (EDs), rising in prevalence in the United States. These devices can lead to life-threatening injuries that require rapid diagnosis to help guide management.

CASE REPORT:

An elderly man was brought to the ED having sustained a nail gun injury to the chest. After loss of pulses, brief closed chest compressions and rapid blood product administration led to a return of spontaneous circulation. Using bedside ultrasound, a metallic foreign body was identified tracking through the right ventricle with associated pericardial fluid and pericardial clot. This rapid diagnosis with bedside ultrasound helped facilitate timely transport to the operating room for median sternotomy, foreign body removal, and pledgeted cardiac repair. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: With continued developments in image quality and acquisition, and improvements of physician operator performance, ultrasonography has continued to make significant impacts in traumatically injured patients in new ways. We present this case report to highlight precordial nail gun injuries and to emphasize the diagnostic capabilities of bedside ultrasound for these patients.

KEYWORDS:

cardiac tamponade; emergency medicine; heart; nail gun; pericardial effusion; thoracotomy; trauma; ultrasonography

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