P Yeh, D Kim, J Nates
ards, cardiac, cardio-pulmonary support, care unit, complications, critical care, education, emergency medicine, head, hemodynamics, injury, intensive, intensive care medicine, medicine, multiorgan failure, nail gun, nails, neuro, open, outcome, patient care, pediatric, penetrating, respiratory failure, surgical i, tbi, therapy, ventilation
P Yeh, D Kim, J Nates. Case Of The Month: Case 1/2001. The Internet Journal of Anesthesiology. 1999 Volume 5 Number 1.
A 55 year-old white male arrived to the Neuro-ICU of our institution with an altered mental status and under the influence of alcohol. The patient had been found in his garage unconscious, and had repeatedly stated that he had tried to kill himself shooting 2 nails in his head with a carpenter’s nail pistol. By the time he arrived to the emergency room, he was awake and alert, responsive and conversant. He did not have any cranial nerve palsies, and his peripheral examination was normal, with no motor or sensory deficits.
What structures have been injured?
What other tests would you request to confirm your diagnosis?
What is the management of this condition?
What are the possible complications of this injury?
What do you think was this patient’s outcome?
There is normal filling of the distal vertebral, basilar, bilateral posterior cerebral, superior cerebellar, anterior inferior cerebellar and posterior inferior cerebellar arteries. There is no evidence of acute arterial injury despite 2 nails traversing the posterior fossa.