Delayed presentation of a pneumatic nail gun injury to the right ventricle without circulatory compromise

Christopher G Bargoud; Eimon Lee; Alexander Toppo; Devesh Patel; Evan Berger; Christian McDonough; Christopher Fjotland; Vincent Reformato; Manabu Takebe; Joseph S Hanna

doi:10.1016/j.tcr.2021.100597

Delayed presentation of a pneumatic nail gun injury to the right ventricle without circulatory compromise

Trauma Case Rep. 2021 Dec 23:37:100597. doi: 10.1016/j.tcr.2021.100597. eCollection 2022 Feb.

Authors

Christopher G Bargoud^{1

2}, Eimon Lee^{1

2}, Alexander Toppo^{1

2}, Devesh Patel^{1

3}, Evan Berger^{1

3}, Christian McDonough^{1

3}, Christopher Fjotland^{1

3}, Vincent Reformato^{1

3}, Manabu Takebe^{1

4}, Joseph S Hanna^{1

2}

Affiliations

¹ Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
² Division of Acute Care Surgery, Department of Surgery, Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
³ Department of Anesthesiology and Perioperative Medicine, Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
⁴ Division of Cardiac Surgery, Department of Surgery, Robert Wood Johnson Medical School, New Brunswick, NJ, USA.

Abstract

Delayed presentation of penetrating cardiac injuries is exceedingly rare due to the observed near 100% pre-hospital mortality. We describe a case of a patient who presented for evaluation nearly 24 h after sustaining a self-inflicted pneumatic nail gun injury to the right ventricular outflow tract. Remarkably, the patient had no evidence of hemodynamic compromise. This case highlights the importance of maintaining a high index of suspicion for cardiac injury with penetrating trauma to the cardiac box regardless of presenting signs and symptoms, and the value of adhering to advanced trauma life support principles.

Keywords: Cardiac injury; Critical care; Nail gun; Trauma.

Publication types

Case Reports