Cerebral damage caused by nail gun injury

Abstract

Abstract:Background Accidents with nail guns are rather common, especially in the construction industry. Most injuries involve the extremities and several present with intracerebral injuries. When the patient is unconscious, it can be a big challenge to determine whether the injury is an accident, self-inflicted or a criminal act. Case presentation A 43-year-old male worker was brought to the emergency department after his coworkers had found him on the floor in the cafeteria at work. He was admitted to the hospital due to a possible apoplexy. The CT scan revealed a nail in his skull and acute surgery was performed. The forensic examination showed lesions of intracranial surgery and minor bruises on the arms. No sign of defense injuries was found. There were no signs of malfunction of the nail gun-wielding robot. On the side of the machine, there were a handheld nail gun and the police investigated the case as a possible criminal act. They found bloodstains on the back of the machine. When awake, the man explained, that by accident, he had hit his head against a nail gun and as a result of this, the nail gun delivered a nail into his skull. Conclusion Sometimes, the circumstances of a case are not clear and the investigators need to work with more than one theory. In criminal cases, it is important to carry out the forensic examination as soon as possible to preserve the trace evidence. In this case, the investigation of the scene of the accident disproved that a crime was committed. Keywords: Nail gun injury;work related accident;head injury FORENSIC SCIENCE Scandinavian journal of Nordisk rettsmedisinCopyright© Holstad Grafisk, Oslo -Print: prografia, Oslo -ISSN 1503-9552 1 nail was removed. A few days after the surgery, he was awakened from the induced coma and he regained consciousness. CLINICAL EXAMINATIONThe prehospital medical doctor who examined the male worker found CASE PRESENTATIONA 43-year-old Lithuanian male worker was hospitalized at the emergency department for treatment for a possible apoplexy. He worked at a factory where he was making wooden pallets, operating a robot, which had a nail gun structure. His coworkers had found him on the floor in the cafeteria at work. The corner of his mouth was hanging and his left arm and leg were paralyzed. He was admitted to the hospital to get an acute thrombolysis.The CT scan revealed a 6.5 cm long nail in his skull, surrounded by blood and a minor displacement of the brain. Acute surgery was performed and the Axial CTC scan showing the nail inside the brain, surrounded by blood Sagittal view showing the size of the nail, bleeding and thickness of the skull

Nail Gun Suicide

“…7 Nail gun users often circumvent the safety mechanisms employed in the nail guns to increase productivity. 1,11,16,17 Nail gun injuries can still occur, even when in use with proper safety mechanisms. 15 In self-inflicted nail injuries reported in literature, Stanbridge 18 reports a case where the patient had pressed the gun firmly against the chest to overcome the safety mechanism.…”

“…36 However, if the victim is unconscious after such an injury, it would be challenging to determine the circumstances of injury, to differentiate from an accident, suicide, or homicide. 17,36 Finding a nail lodged in victim's body or the surrounding work environment usually assists in differentiating nail gun injuries from other injuries with similar small caliber entry wounds. 37 Therefore, a scene visit, together with questioning of the witnesses and examination of the alleged tool of injury, is of utmost importance in the investigation of the case.…”

“…Splinter guards are fixed around the muzzle end of a nail gun to avoid ricocheting of nails and also other splinters from work piece striking the user 7 . Nail gun users often circumvent the safety mechanisms employed in the nail guns to increase productivity 1,11,16,17 . Nail gun injuries can still occur, even when in use with proper safety mechanisms 15 .…”

“…When victims are conscious after a nail gun injury, they may speak of a motive of a suicide 36 . However, if the victim is unconscious after such an injury, it would be challenging to determine the circumstances of injury, to differentiate from an accident, suicide, or homicide 17,36 . Finding a nail lodged in victim's body or the surrounding work environment usually assists in differentiating nail gun injuries from other injuries with similar small caliber entry wounds 37 .…”