• Herman Lim, Laurence Weinberg, Chong Oon Tan, Stanley Tay, Constantine Kolivas, and Philip Peyton.
• Department of Anaesthesia, Austin Hospital, 145 Studley Road, Heidelberg, VIC, 3084, Australia. laurence.weinberg@austin.org.au.
• J Med Case Rep. 2013 Jan 1;7:137.

IntroductionWe report a case of deliberate self-harm in which three three-inch nails were fired from a nail gun resulting in mandibular fixation and two penetrating injuries to the right cardiac ventricle. This combination of high-velocity penetrating injury has not been previously described.Case PresentationA 69-year-old Caucasian man with a medical history of chronic depression was brought to hospital after a failed suicide attempt. The attempt consisted of self-asphyxiation with car exhaust fumes and shooting himself thrice with a three-inch nail gun. He sustained a penetrating nail injury to the floor of his mouth, effectively pinning his mouth closed, and penetrating injuries to the right ventricular free wall and at the junction of the right atrioventricular septum. The patient required emergency surgery with requirements for thoracotomy and sternotomy, lung isolation and cardiopulmonary bypass.ConclusionsThis is the first reported case of a combination high-velocity penetrating nail gun injury to the face and the right cardiac ventricle. This rare case offers airway strategies to accommodate the surgical requirement for lung separation for penetrating chest trauma in a patient with iatrogenically limited mouth opening.

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