Diaphragmatic Irritation Caused by Nail-gun: An Unusual Cause of Bradycardia

Abstract

A 42-year-old construction worker presented to the emergency department following an accident in which a nail gun had been fired 1 meter away from him. The nail was embedded in his chest at the anterior axillary line in the tenth right intercostal space. Physical examination revealed a healthy -looking male, with a small puncture wound visible at the anterior axillary line in the tenth intercostal space. The only positive symptom of the patient was the decrease in the pulse rate when the patient turned around on the stretcher. Posteroanterior (PA) chest radiographs showed a 3 cm nail entering into the right costadiaphragmatic area on the liver (Figure 1). Computerized tomography scan showed penetration to the liver (Figure 2). The patient was consulted with a general surgeon and they decided to remove the nail under local anesthesia in the operating room without open surgical intervention. He was admitted to hospital, all observations of the patient were stable. He was discharged with full recovery two days after admission.