Sunday, April 22, 2007

You'll Shoot Your Knee Out

Nail guns. It's construction season and in the last three weeks I've seen three nail-gun injuries. This guy above had to be taken to the operating room to remove this nail from his lower thigh. Luckily it didn't hit anything important. The reason I couldn't get it out in ED was that the head of the nail had disappeared deep into the muscle and objects like this are notoriously hard to find without the aid of Xray and the ability to open the wound. In this case it also had to be opened for wash-out as the nail had carried part of this guy's jeans deep into his thigh.

I didn't get a picture of the nail-gun injury that was more impressive than this, but I did take care of a guy who came in with a 2X4 nailed into his index and middle fingers. He was a great patient and sat in the bed without even asking for any pain medicine. I was able, in his case, to digitally block his fingers and remove the nail and the board. He too had escaped permanent injury.

Nail guns = job security.


  1. I don't personally remove high velocity foreign bodies like that. Maybe I should.

    I'll dig around for a toothpick or a sewing needle for quite a while, but for some reason I'm gunshy about nailgun injuries. No reason, really.

  2. I had a blog entry about a guy that tried suicide with one, a total failure but did end up causing a raging case of meningitis. That is one set of films that went in to the ED docs hall of fame

  3. I routinely use bedside U/S for removal of FB. At night, since I am buddy with the xray techs, they'll bring the C-arm down for me to look for FB's under fluoro. That is if we're not too busy.

  4. wish we had a c-arm that we could use in the ed. in this case i was worried enough about the posteior neurovascular bundle that i involved vascular and ortho. the ortho doc said there was no way i would have retrieved it as it had punctured the vastus and disappeared into the muscle belly. the guy did fine. thanks for your comment. hey, come work with us!

  5. OUCH! Stoic guy - being nailed to the board like that and not needing pain meds.

    When I think of spring seasonal injuries in the ED, I think of imbedded fishing hooks,tics and then poison Ivy a little later in the season.

    However, my husband did get poison ivy in his groin area in the winter. He had been splitting wood that was covered in what he thought was dead poison ivy vines. :)

  6. Ack, these are the times I'm far happier to write about such things rather than experiencing them firsthand. Something about a nail in anything but wood just gives me the squeegies.

  7. Dear Ms. Price. Forgive me for asking, but isn't a squeegie something you use to clean a window or push water off a tennis court?