Tuesday, September 2, 2014

Dr. Orthochick: Nails in feet

I had a guy the other day who shot himself in the foot with a nail gun. Fortunately, he wasn't an idiot so he was wearing steel-toed shoes, unfortunately that meant the nail went through the top of his shoe before coming out the other side. So it was straight through his shoe and foot.

Once i finally got his shoe off, removing the nail took 30 seconds. Until that point, however, it was me, a scalpel, a pair of scissors, some four-letter words, a cast saw, and my fingers. Seriously, this took forever. And since it was the middle of the day, apparently no one else had anything interesting going on so half of the ER was clustered outside the room watching me attempt to get this guy's shoe off. Since it was a heavy-duty construction shoe it was built to last, and i really think we should send a letter to the company congratulating them on making such an indestructible shoe. Because I was hacking away at it with a scalpel for a while. Technically I had to change scalpels every 45 seconds or so because they kept on getting dull, but that probably helped me out when I stuck the stupid thing into my own hand. (so there was a 30-second pause in the action when I got a bandaid) Even using a cast saw I couldn't get the stupid thing off. I appreciate light carpentry as much as the next orthopod, but this was getting a little ridiculous.

I know it seems counter-intuitive to take the shoe off when I could have just pulled the nail out through the top, and that was my first idea, but according to the patient (a construction worker), his father (a construction worker), and his brother (a construction worker) this type of nail had to be removed from the bottom. You had to cut the head off and then pull it out the bottom of the foot. Something about the way the threads were going. I don't know but I decided since it was their occupation, they probably knew what they were talking about.

Patient: Whenever you shoot yourself, you have to pull off the head and pull it out the bottom.
Brother: Yeah, normally we can just do it ourselves but since the shoe was in the way, we came here
Father: When it's in your hand, you can just pull it out.
Me: Wait, so have all of you shot yourselves?
Patient: Oh yeah, we do it all the time.

I was tempted to dictate in my H&P "family history is positive for multiple family members with nail gun injuries."

It took the better part of an hour, but I finally managed to dig the shoe off so I could get to the head of the nail to cut it off. (the nail was really embedded in there. Those nail guns have force, yo) I don't know why we keep pliers in the ER, but they came in handy there. Then I just grabbed the bottom of the nail, pulled and twisted it a little, and, thank G-d, that thing came out. I asked the patient if he wanted it, but he said to just hold on to it as a souvenir. I tossed it in the sharps container.

What's the difference between a carpenter and an orthopedic surgeon?
A carpenter can name at least 2 antibiotics

1 comment:

  1. Hat off for the tough guy and his family wisdom.
    P.S. I don't think it has to do with lack of work. Almost every orthopedic got his/ her crowd in ER. I saw it happens times and times again. Still can't solve the mystery of it though.