Pericardiocentesis followed by thoracotomy and repair of penetrating cardiac injury caused by nail gun injury to the heart.
BACKGROUND
Work site injuries involving high projectile tools such as nail guns can lead to catastrophic injuries. Generally, penetrating cardiac injuries are associated with a high mortality rate.


METHODS
A construction worker was brought to the emergency room having sustained a nail gun injury to the chest. The patient was hypotensive, tachycardic with prominent jugular venous distention, and had a profound lactic acidosis. Bedside ultrasound confirmed the presence of pericardial fluid. Pericardiocentesis was performed twice using a central venous catheter inserted into the pericardial space, resulting in improvement in the patient's hemodynamics. Thereafter he underwent left anterolateral thoracotomy and repair of a right atrial laceration. He recovered uneventfully.


CONCLUSIONS
Penetrating cardiac injuries caused by nail guns, although rare, have been previously described. However, pericardiocentesis, while retaining a role in the management of medical causes of cardiac tamponade, has been reported only sporadically in the setting of trauma. We report a rare case of penetrating nail gun injury to the heart where pericardiocentesis was used as a temporizing measure to stabilize the patient in preparation for definitive but timely operative intervention.


CONCLUSIONS
We propose awareness that percardiocentesis can serve as a temporary life saving measure in the setting of trauma, particularly as a bridge to definitive therapy. To our knowledge, this represents the first reported case of catheter pericardiocentesis used to stabilize a patient until definitive repair of a penetrating cardiac injury caused by a nail gun.
Division of Trauma, Acute Care Surgery and Surgical Critical Care, Department of Surgery New York Medical College, Westchester Medical Center University Hospital, Valhalla, NY, United States.
Vasu
V
Chirumamilla
Division of Trauma, Acute Care Surgery and Surgical Critical Care, Department of Surgery New York Medical College, Westchester Medical Center University Hospital, Valhalla, NY, United States. Electronic address: Kartik.Prabhakaran@wmchealth.org.
Kartik
K
Prabhakaran
Division of Trauma, Acute Care Surgery and Surgical Critical Care, Department of Surgery New York Medical College, Westchester Medical Center University Hospital, Valhalla, NY, United States.
Petrone
P
Patrizio
Division of Trauma, Acute Care Surgery and Surgical Critical Care, Department of Surgery New York Medical College, Westchester Medical Center University Hospital, Valhalla, NY, United States.
John A
JA
Savino
Division of Trauma, Acute Care Surgery and Surgical Critical Care, Department of Surgery New York Medical College, Westchester Medical Center University Hospital, Valhalla, NY, United States.
Corrado P
CP
Marini
Division of Trauma, Acute Care Surgery and Surgical Critical Care, Department of Surgery New York Medical College, Westchester Medical Center University Hospital, Valhalla, NY, United States.
Zobair
Z
Zoha
Cardiac injury; Nail gun; Pericardiocentesis; Thoracotomy; Trauma