BMC Saves Patient Impaled by Nail Gun

Patrick Matheson was working on a new house on Nantucket Dec. 1, nailing plywood on the second floor, when he made what he calls a “rookie mistake.”

X-ray

 

An X-ray of the nail in Matheson

“I was holding the gun at an angle when I shot it and the nail bounced off the wood,” says the 31-year-old carpenter. “I felt the nail hit me but there was no blood. I couldn’t see it and I could breathe and talk. I slowly climbed down the ladder, alerted my coworkers and then walked out to the end of the road to wait for the ambulance to arrive.”

What Matheson didn’t know was the three-and-a-half-inch nail had entered the base of his neck and plunged directly into his chest.

Matheson was rushed to Nantucket Cottage Hospital and then quickly transported by MedFlight helicopter to Boston Medical Center. He arrived in the Emergency Department (ED) where he says staff made sure he was very comfortable, before meeting the man who would be his surgeon, Michael Ebright, MD, Cardiothoracic Surgery.

Ebright’s first task was to determine the extent of the injury. The nail, which had been traveling at 1,400 feet per second when it entered Matheson’s chest, had pierced his trachea and esophagus before lodging in his vertebral column.

“My chief concern was whether the nail had injured any of the large arteries branching directly from the aorta above the heart,” says Ebright.

Ebright obtained an arteriogram that revealed the nail had miraculously, and narrowly, missed the large arteries sitting within the trajectory of the nail. In fact, a large artery supplying the brain and right arm actually was nudged over to the side, yet remained intact.

In surgery, Ebright discovered just how close to death Matheson had come. Had the nail entered his chest just a millimeter to the right, it would have severed this major artery and he would likely have bled to death at the construction site. And had the nail been just one inch longer, it would have pierced his spinal cord, possibly leaving him a paraplegic.

Patrick Matheson 
Patrick Matheson

Ebright also discovered something else: the nail lodged in Matheson had barbs coming off the shaft, making its removal past the artery it was nestled against that much trickier.

“We operated through an incision at the base of the neck and were able to tease the major artery off the nail,” says Ebright. “We wanted to make sure the barb didn’t catch the artery, so we put a gauze buffer between the nail and the artery. There was no major bleeding, no problems, and we repaired the trachea and esophagus.

“Patrick is very lucky to be alive and walking,” he adds.

Following his two-hour surgery, Matheson recuperated on 8 East Newton Pavilion for a week. He says his whole experience at BMC has been terrific.

“Everyone has been amazing,” he says. “Nurses have been checking on me even when they have a lot going on. Dr. Ebright has stopped by every day. The level of care and professional, from top to bottom, has been terrific. It’s really lifted my spirits.”

He looks forward to going home and spending time with his girlfriend and baby. And he plans to take a few weeks off from the construction business.

 

BMC operates the longest, continuously verified Level 1 Trauma Center in New England. Read some of its patient success stories.

 

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