Nail embolization to the femoral artery

Abstract

Modern air-nailing tools are known to cause penetrating trauma. We report the unusual case of a pneumatically fired carpenter's nail that penetrated the chest of a 30-year-old man and subsequently embolized from the heart to the left femoral artery without clinical evidence of having entered the heart. The nail was surgically removed, and the patient was discharged from hospital without sequelae after 10 days. This case and the relevant literature are discussed from the perspective of the emergency department investigation and care of such patients. RÉSUMÉLes cloueuses pneumatiques modernes peuvent causer des traumatismes pénétrants. Nous présen-tons un cas inhabituel de pénétration d'un clou de charpentier à déclenchement pneumatique dans le thorax d'un homme de 30 ans. Le clou s'est par la suite embolisé à partir du coeur vers l'artère fémorale gauche sans signe clinique de pénétration du coeur. Le clou fut retiré chirurgicalement et le patient reçut son congé de l'hôpital après dix jours, sans séquelle. Le présent cas et la littérature pertinente sont discutés du point de vue de l'investigation au département d'urgence et des soins à donner à un tel patient. CASE REPORT • OBSERVATIONS DE CAS Nail embolization to the femoral artery Case reportA 30-year-old man presented to our emergency department (ED) by private vehicle after being unintentionally shot with a pneumatic nail gun at his workplace. Thirty minutes prior to arrival the patient was standing underneath a wooden board when a colleague, who was sitting above him, fired a nail through the board and into the patient's chest. On arrival the patient was diaphoretic and anxious. His blood pressure was 68/52 mm Hg, heart rate 133 beats/min, respiratory rate 18 breaths/min, room air oxygen saturation 96%, and he had a Glasgow Coma Scale score of 14. There was a round entry wound 5 mm in diameter over the mid-sternum (Fig. 1). No exit wound was identified. Chest auscultation revealed normal air entry and lung sounds bilaterally, and normal heart sounds. There was no jugular venous distension, and the abdomen was soft and non-tender. A detailed examination of the extremities was not initially performed. The patient was immediately placed on 100% oxygen by a non-rebreather mask, and two 16-gauge peripheral intravenous lines were established. After a rapid infusion of 2 L of crystalloid, the patient's blood pressure rose to 151/98 mm Hg with sinus tachycardia at 110 beats/min by cardiac This article has been peer reviewed. Can J Emerg Med 2005;7(4):278-81