Owee

Nailgun accident. And, this patient had the best excuse for not getting a visual acuity with an eye injury: the nail literally had his lid ‘nailed shut’. Off to the OR.

owee AP owee lat

CT views below the break.

Here’s the CT views:

nail in brainnail transits eye

also posted at Lingual Nerve


Comments

  1. A muscle lamp or small bright penlight can be placed very near the closed lid to ask whether the patient has any sensation of light from the injured eye (i.e., penlight on or penlight off). Also, even with a non-responsive patient, a consensual pupillary reflex can be seen in the uninjured eye with a light source placed near the skin of the closed eyelid, provided there is not too much edema. This reflex can be graded in comparison to the degree of constriction seen in the open eye when the light is placed directly in front of the uninjured eye.

  2. GruntDoc says:

    Both good tips. Thanks!

  3. How did this accident happen? Was the victim looking down the ‘barrel’ of the nail gun to see if it was clear?

    It reminds me of the classic handgun accident where the victim looks down the barrel to see if it’s empty. Those victims usually don’t get to go to OR.

  4. Not another!

    Can’t they design a nail gun that only allows actuation when the head of device is in contact with a surface?

    Presumably, that might have prevented this injury – unless of course the man in question was pushing it into his eyeball.

    Have you got a claw-ended hammer in the OR?

  5. Tony,
    there are at least two safeties. One is the trigger, the other is a ‘shoe’ that must be depressed to enable firing.

    My understanding is that there was a trip and fall involved.

  6. A few other CT/X-ray images of nail gun to head:

    http://www.boston.com/news/daily/02/carpenter.htm

    http://content.nejm.org/cgi/content/short/328/9/620

    “A Man from Cali survives after 6 nails get shot into his head…
    Scroll down for pictures”
    http://www.jokaroo.com/news/nail-head.htm

  7. GruntDoc says:
  8. You got me!

    I just haven’t had the time to dig through your archives the way I’d like to.