Death from exsanguination due to power drill injuries in a complex suicide: a case report.

We present a case of a complex suicide of a 66-year-old man with a history of several psychiatric disorders. He attempted to commit suicide by inflicting cut wounds on his forearms, wrists, and neck but afterwards changed the method of suicide by using an electric power drill. After several unsuccessful attempts to drill a hole in either his head, thorax, or abdomen, he managed to perforate the common carotid artery on the right side of his neck and subsequently died from exsanguination.

Penetration performance of protective materials from crossbow attack: a preliminary study.

Crossbow-related injuries resulting in serious and mortal consequences have increased in recent years, and although significant research exists for both injury and fatality on the human body, limited data exists on the lethality of the bolt and the failure modes of protective materials. This paper concerns itself with the experimental validation of four differing crossbow bolt geometries, their effects on material failure and potentially lethality. During this study, four different types of crossbow bolt geometries were tested against two protection mechanisms that differed in mechanical properties, geometry, mass and size. The results show that at 67 ms-1, ogive, field and combo tips do not provide lethal effect at 10-m range, whilst a broadhead tip will perforate both the para-aramid and a reinforced area of polycarbonate material consisting of two 3-mm plates at 63-66 ms-1. Although perforation was apparent with a more honed tip geometry, the chain mail layering within the para-aramid protection and friction caused by polycarbonate petalling on the arrow body reduced the velocity enough to demonstrate the materials under test are effective at withstanding crossbow attack. Subsequent calculation of the maximum velocity that arrows could achieve if fired from the crossbow within this study shows results close to the overmatch value of each material and therefore a requirement to advance the knowledge in this field to influence the development of more effective armour protection mechanisms.

Massive Subcutaneous Emphysema after Hydrogen Peroxide Irrigation of a Penetrating Facial Injury.

We present the case of a child impaled in the face by a meat thermometer who subsequently suffered a significant complication due to the administration of hydrogen peroxide to the wound. The soft tissues of the face rapidly expanded and blanched, the child experienced mental status changes, and imaging revealed massive subcutaneous emphysema, pneumomediastinum, and pneumo-orbit. Herein we review the literature on this rare complication and provide photodocumentation in the hopes that other practitioners, patients, and parents avoid administering hydrogen peroxide into or near any penetrating injury. Laryngoscope, 134:2954-2957, 2024.

Homemade Dart Attacks in Hawai'i.

Over a 4.5-year period (September 2014 to March 2019), 7 patients presented to the State's only Level I Trauma Center with penetrating injuries inflicted by homemade metallic darts. Previously described in Micronesia, these are the first domestic cases of assaults utilizing this type of weaponry. Retrospective chart review was conducted for all patients who presented to our institution with a dart injury within the study period. Details regarding demographics, imaging, and patient management were collected and described herein. All 7 patients were male with a median age of 24.6 years impaled with darts that penetrated through the deep muscle and tissue layers of the neck, torso, or extremity. Three patients required operative intervention and no mortalities were observed. The depth of penetration and proximity to vital structures highlight the potential for life-threatening injuries from these homemade darts.

[Acute care of soft tissue injuries in the head and neck region]. / Akutversorgung von Weichteilverletzungen im Kopf-Hals-Bereich.

BACKGROUND: Soft tissue injuries are a common consequence of head and neck trauma. With injuries being highly individual and varying depending on the underlying trauma, it is difficult to establish standardized guidelines for head and neck trauma in general. The main goal of this study was to showcase the distribution of soft tissue injury types and the principles pertaining to acute care of the individual clinical presentations. MATERIALS AND METHODS: A retrospective evaluation was carried out using all trauma-relevant ICD-10 codes for trauma to the head (S00.- to S09.-) and neck (S10.- to S19.-) among patients who were treated at the authors' clinic-a certified national trauma center-during a period of 10 years (2012 to and including 2021). RESULTS: A total of 8375 patients with head and neck trauma were treated during the observation period, i.e., an average of 836 patients per year. Within this collective, 2981 trauma cases involving soft tissue injuries were documented. Superficial injuries to the head (S00.-) and open wounds to the head (S01.-) were the most common head and neck soft tissue injuries, with 1649 and 920 cases, respectively. CONCLUSION: The case numbers of soft tissue injuries generally show an inverse correlation to the required underlying trauma: diagnoses of the categories S00 and S01 occur very often; injuries which only occur after severe trauma, such as traumatic amputation at neck level (S18), are rare. According to current literature, penetrating neck traumas should be treated using a no-zone approach. In Europe, penetrating neck injuries are rather rare because of low crime rates and strict weapon laws.

Characteristics of skin injuries caused by power drill.

Skin injuries caused by power drills have been rarely reported. A case is described of a 51-year-old woman who was found dead on a motorway after committing suicide by jumping from a bridge. The body showed a total of nine circular/oval penetrating injuries of the chest and abdomen with very regular, smooth margins, and particular features due to the presence of "skin islands" inside the lesion and "short radial linear abrasions" around the margins. These injuries were caused by a power drill, which was later found in the woman's apartment. For comparison, experimental tests were carried out with the same drill and different bits on pig skin, whose appearance resembled those found on the body. Especially skin islands were also reproduced in the experimental tests. The presented case shows the possibility of this rare method of suicide (or suicide attempt) and the typical characteristics of such peculiar skin lesions that pose problems of differential diagnosis with other injuries such as gunshot injuries.

Prehospital Simple Thoracostomy Does Not Improve Patient Outcomes Compared to Needle Thoracostomy in Severely Injured Trauma Patients.

BACKGROUND: ATLS suggests simple thoracostomy (ST) after failure of needle thoracostomy (NT) in thoracic trauma. Some EMS agencies have adopted ST into their practice. We sought to describe our experience implementing ST in the prehospital setting, hypothesizing that prehospital ST would reduce failure rates and improve outcomes compared to NT. METHODS: This was a retrospective review of adult trauma patients who received prehospital ST or NT from 2017 to 2020. RESULTS: There were 48 patients with 64 procedures included. 83.7% were male and 65.8% injured by penetrating mechanism and of median (IQR) age of 31 (25-46) years. 28 (43.8%) procedures were NT and 36 (56.3%) were ST. Rates of improved patient response (P = .15), noted return of blood/air (P = .19), and return of spontaneous circulation (P = .62) did not differ. On-scene times were higher for ST (16.8 vs 11.5 minutes; P < .02). Overall mortality did not differ between ST and NT (68.2% vs 46.4%, respectively; P = .125). For patients that survived beyond the ED, procedure-related complication rates were 2 of 21 patients (9.5%) in ST and 1 of 12 (8.3%) in NT. In penetrating trauma, simple thoracostomy had longer on-scene time and total prehospital time. DISCUSSION: ST did not improve success rates of ROSC and was associated with prolonged prehospital times, especially in penetrating trauma patients. Given the benefit of "scoop and run" in urban penetrating trauma, consideration should be given to direct transport in lieu of ST. Use of ST in blunt trauma should be evaluated prospectively.

Pediatric Penetrating Neck Trauma Resulting From a Metal Boat Cleat: A Case Report.

BACKGROUND: Clinical decision making for pediatric neck trauma is challenging because data and reports are sparse. We present a case report showing current recommendations for managing pediatric neck injuries. CASE PRESENTATION: This is the case of an 11-year-old boy who presented to our Level I trauma center after a slip and fall on a metal boat cleat (metal fixture used to secure rope). He suffered a penetrating injury to his neck, requiring operative exploration. This case report provides an overview on the rare incidence of pediatric penetrating neck trauma and treatment options. CONCLUSION: This case highlights penetrating neck injuries, which are uncommon in the pediatric population. This case report is unusual due to the method of injury and nature of the object. Neck trauma via a metal boat cleat is particularly rare. A comprehensive understanding of the anatomy of the neck, mechanism of injury, thorough clinical examination, and proper workup are essential to providing effective care.

A rare case of penetrating intra-abdominal trauma by a fishing speargun.

Spearfishing is a popular sport in New Zealand. While there have been a few reported self-inflicted speargun injuries causing fatal intracranial damage, accidental speargun injuries while fishing are less common. Intra-abdominal speargun injuries are even less common. Its occurrence in a 30-year-old male patient reported here highlights the potential risk of life-threatening injuries. A 30-year-old male sustained an accidental speargun injury, with the spear passing through central small bowel loops and its pointed tip penetrating the left iliac wing. The patient underwent laparotomy, and the spear was removed in an antegrade fashion with primary closure of small bowel enterotomies and repair of the mesenteric defects. He had a re-look laparotomy 48 hours later with resection and anastomosis of two primary small bowel repairs and was eventually discharged after 12 days. Information obtained by radiological evaluation using computed tomography (CT) scan and angiography regarding the spear trajectory, injured organs, vasculature and spear tip mechanism is important to decide the best surgical approach. The spear should be removed in an antegrade fashion, because pulling the spear in the retrograde direction can cause further tissue and/or vascular injury. Currently, there is no legislation regarding the use of spearguns and users do not require a license, despite the potential for severe penetrating trauma similar to that caused by firearms. Spearguns can produce life-threatening injuries and the removal of the spear depends on the location of the tip in relation to adjacent structures and whether the flapper is open. It often requires a multidisciplinary team approach. Safety guidelines need to be published and widely available, and the potential risks of speargun injuries should be included in fishing rules. Introducing license requirement for possession and handling of this firearm-like weapon also needs to be considered.

Enfoque terapéutico en el trauma penetrante de esófago cervical / Therapeutic Approach in the Penetrating Cervical Esophageal Trauma

Introducción: Las perforaciones del esófago cervical por traumas externos son lesiones raras asociadas con una morbilidad significativa. Los mecanismos primarios son los traumatismos penetrantes por heridas de bala, cerca del 80 por ciento de los casos, seguidas de las heridas con armas cortopunzantes en el 15 al 20 por ciento. Objetivo: Describir los criterios actuales sobre la conducta y enfoque terapéutico ante el trauma penetrante de esófago cervical. Métodos: Se realizó revisión descriptiva narrativa, de fuentes primarias y secundarias que abordaron el tema durante el primer semestre del año 2021. Los criterios de selección de los artículos a examinar fueron determinados, entre otros, por el objetivo de la actual revisión. Desarrollo: El estándar diagnóstico para estas lesiones, en ausencia de inestabilidad hemodinámica, se basó en estudios como el esofagograma, la endoscopia y la tomografía. La reparación primaria con o sin reforzamiento fue la opción más utilizada, aunque las condiciones locales y tipo de lesión en esófago cervical marcan en gran medida el proceder a realizar. Conclusiones: Las lesiones traumáticas del esófago cervical son raras pero muy mórbidas. El tratamiento depende de la ubicación de la perforación y cualquier lesión concurrente. La mayoría de los casos son susceptibles de reparación primaria con refuerzo de colgajo. Otros principios del tratamiento incluyen el drenaje adecuado alrededor de la reparación, la descompresión del esófago y el estómago (mediante sonda nasogástrica o sonda de gastrostomía) y nutrición enteral distal (yeyunostomía de alimentación). El cirujano ha de ser incisivo en los esfuerzos por descubrir la lesión de forma temprana y manejarla adecuadamente(AU)

Introduction: Cervical esophageal perforations for external trauma are rare injuries associated with a significant morbidity. The primary mechanisms are penetrating trauma for gunshot wounds, accounting for about 80 percent of cases, followed by sharp weapon injuries, accounting for 15 percent to 20 percent. Objective: To describe the current criteria on the behavior and therapeutic approach to cervical esophageal penetrating trauma. Methods: A descriptive narrative review was carried out of primary and secondary sources that addressed the subject during the first semester of the year 2021. The selection criteria of the articles to be examined were determined, among others, by the objective of the current review. Development: The standard diagnosis for these lesions, in the absence of hemodynamic instability, was based on studies such as esophagogram, endoscopy and tomography. Primary repair with or without reinforcement was the most commonly used option, although local conditions and type of lesion in cervical esophagus largely mark the procedure to be performed. Conclusions: Traumatic cervical esophageal injuries are rare but very morbid. Their treatment depends on the location of the perforation and any concurrent injury. Most cases are amenable to primary repair with flap reinforcement. Other principles of treatment include adequate drainage around the repair, decompression of the esophagus and stomach (by nasogastric tube or gastrostomy tube), as well as distal enteral nutrition (feeding jejunostomy). The surgeon must be incisive in efforts to discover the injury early and manage it appropriately(AU)

Sharp cardiac trauma through the sternum caused by an automatic nail gun: A case report.

Automatic nail gun injuries to the hand commonly occur with the use of these machines in construction. However, such injuries to the cardiothoracic area are atypical. Herein, we report a case of emergency surgery to remove a nail, which was accidentally shot through the sternum and reached the heart. A 24-year-old man was working in a narrow space at a construction site, where he tripped over the air hose of an automatic pneumatic nail gun. The trigger was accidentally pulled, while the machine was facing his direction, and a nail entered his sternum. The patient felt chest pain, walked to a nearby orthopedic clinic, and then was transferred to our hospital for treatment. On examination, the nail was completely embedded in the midline of the precordial chest. Chest X-ray and computed tomography (CT) images showed a rod-shaped nail penetrating the sternum from the precordial region and reaching the anterior medi-astinum. The nail tip was located between the pulmonary artery and the aorta; it was touching the main trunk of the pulmonary artery. Emergency surgery was performed to remove the 45-mm-long nail (2 mm in diameter) on the same day, considering the possibility of massive bleeding and infection. An auxiliary circulatory system was not used, and intraoperative blood transfusion was not required. The patient was extubated on the same day. On post-operative day 7, CT confirmed that there were no issues of concern and no signs of infection. The patient was discharged on post-operative day 8 and returned home on foot. The patient was followed up for 6 months in the outpatient clinic, and there were no signs of infection or abnormal hemodynamics. This case demonstrates the need for careful assessment of nail gun injuries, which may initially appear insignificant.

An Unusual Attack by a Blue Bull Resulting in Penetrating Horn Injuries.

Owing to multiple factors, human-wildlife interactions are increasing, and conflict can result in fatal injuries. A 21-y-old man was brought to the emergency department in critical condition with 2 puncture wounds over the thoracoabdominal region after a nilgai, or blue bull (Boselaphus tragocamelus), had gored him. The patient sustained double gastric perforation, which was managed laparoscopically and complicated by an abscess formation in the lesser sac 1 wk later, which required further surgical exploration. The operative culture showed growth of Klebsiella pneumoniae. Intravenous antibiotics were given as per the culture sensitivity report, and the patient improved. Many horn injuries are described as puncture lacerated wounds owing to the rugged nature of animal horns. However, in this case, the margins of the wound were regular and incision-like owing to the smooth and straight structure of blue bull horns. Early surgical exploration and monitoring of treatment progress are crucial in reducing morbidity in penetrating horn injuries.

Management of Renal Artery-Inferior Vena Cava Fistula Following Nephrectomy for Penetrating Trauma.

Background: Renal artery to inferior vena cava fistula is a rare event postnephrectomy. We report a case of an adult male in whom a renal artery to inferior vena cava fistula was detected on non-invasive studies following nephrectomy for penetrating trauma. Case Report: A fistula between the right renal artery and inferior vena cava was confirmed with diagnostic angiography. The fistula was successfully embolized using microcoils. Discussion: This case highlights the importance of exploring retroperitoneal hematomas secondary to penetrating trauma.

An unusual penetrating shrapnel in the heart.

Penetrating heart trauma is a surgical emergency and can be fatal. However, cardiac penetration occurring due to non-explosive shrapnel is a rare occurrence. We report a case of a 20-year-old man, who sustained a laceration in his left chest, while he was breaking a rock with a chisel and a hammer. He was diagnosed to have an intramyocardial foreign body in his left ventricle. He underwent left ventriculotomy, foreign body localization under fluoroscopic guidance and successful extraction of the shrapnel from the left ventricular cavity.

A 10-year study of penetrating head and neck injury by assault in the North East of England.

INTRODUCTION: Assaults inflicting penetrating head and neck trauma have potential for serious morbidity or mortality. This paper studies in-depth all cases treated at a level one trauma centre in the North East of England over 10 years. METHODS: All patients assaulted with sharp implements to the head and neck treated from 2010 to 2019 were identified using clinical codes. RESULTS: Retrospective data collection were as follows: 214 patients identified (189 male, 25 female). Average age was 31.5 years (range 3-80). The majority presented between 20:00 and 05:00. Knives were the commonest weapon. Fifty-two had scalp, 137 face and 69 neck injuries. Forty-eight percent had additional non-head and neck injuries. Eighty-six percent required admission, 16.6% to intensive care. Oral and maxillofacial and plastic surgeons provided most treatment. One hundred two required treatment under general and 96 local anaesthetic. Sixteen patients had significant vascular injury, 1 brachial plexus injury, 4 facial nerve injuries (of which 3 repaired) and one required parotid duct repair. Mean length of stay was 3.7 days. No mortality was recorded. Incidence significantly increased from 2010 to 2019. CONCLUSIONS: Head and neck penetrating injuries occur frequently, often with other injuries and mainly in young males. Incidence of significant vascular or nerve injury was low. This study provides important data for those planning trauma services.

Delayed Tracheal Perforation Following Total Thyroidectomy.

Delayed tracheal rupture following total thyroidectomy (TT) is rare and represents a potential airway emergency. A 34-year-old female with Felty Syndrome underwent TT for Hashimoto's thyroiditis. On post-operative day 10, she presented with subcutaneous emphysema and an anterolateral tracheal perforation on CT scan. Urgent operative exploration revealed transmural tracheal necrosis and a 5 mm perforation. This was oversewn with non-absorbable suture and a strap muscle flap rotated over the defect to promote healing. Repeat direct laryngoscopy at 72 hours revealed healing tissue. Tracheal necrosis and perforation following TT constitutes a potential airway emergency and should be promptly explored and repaired. Laryngoscope, 132:17-19, 2022.