Airway strategies for lung isolation in a patient with high-velocity nail gun injuries to the right cardiac ventricle and floor of the mouth: a case report

Abstract

IntroductionWe report a case of deliberate self-harm in which three three-inch nails were fired from a nail gun resulting in mandibular fixation and two penetrating injuries to the right cardiac ventricle. This combination of high-velocity penetrating injury has not been previously described.Case presentationA 69-year-old Caucasian man with a medical history of chronic depression was brought to hospital after a failed suicide attempt. The attempt consisted of self-asphyxiation with car exhaust fumes and shooting himself thrice with a three-inch nail gun. He sustained a penetrating nail injury to the floor of his mouth, effectively pinning his mouth closed, and penetrating injuries to the right ventricular free wall and at the junction of the right atrioventricular septum. The patient required emergency surgery with requirements for thoracotomy and sternotomy, lung isolation and cardiopulmonary bypass.ConclusionsThis is the first reported case of a combination high-velocity penetrating nail gun injury to the face and the right cardiac ventricle. This rare case offers airway strategies to accommodate the surgical requirement for lung separation for penetrating chest trauma in a patient with iatrogenically limited mouth opening.

Low-Velocity Nail-Gun Injuries to the Interventricular Septum: Report of Two Cases, One in a Child

“…1 Since then, only 3 American cases involving the IVS have been published. [2][3][4] In 1964, Zverev 8 reported (in Russian) one case of nail-gun injury to the heart of a child.…”

“…To the best of our knowledge, there have been only 5 reported cases of penetration of the cardiac interventricular septum (IVS), and none of those has involved a child. [1][2][3][4][5] We describe 2 additional cases of nail-gun injuries through the IVS. One case involved an accidental self-inflicted wounding of a child, who needed removal of the nail during cardiopulmonary bypass (CPB).…”

Lung Isolation in a Patient with Sub Mucosal Fibrosis: Anaesthesiologist Perspective

“…Though nasal univent has been reported in the literature, we avoided it in view of nasal mucosal trauma and bleeding [12], and the outer diameter of 6.5 mm ID univent tube is 10.5 and 11.5 mm in sagittal and transverse planes respectively [13]. This outer diameter corresponds to 8.0 mm ID (outer diameter 11 mm) tube or more.…”

“…Single lumen tube and bronchial blocker [14] Endobronchial tube [12] Univent tube [ Patient consent and cooperation is required for successful awake fibreoptic intubation. Absence of which is a contraindication for awake intubation [10,11] .…”

Penetrating cardiac trauma caused by a nail-gun: A case report and narrative review

“…He was discharged to a mental health facility on postoperative day 7. A narrative review of case reports pertaining to nail-gun related cardiac injury was performed [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] ( Supplementary Table 1 ). Medical illustrations and case reports of paediatric patients (under 16) were excluded.…”