*Department of Emergency Medicine,CHU de Québec - Université Laval,Quebec City,QC.
†Department of Surgery,CHU de Québec - Université Laval,Quebec City,QC.
CJEM. 2018 Sep;20(5):788-791. doi: 10.1017/cem.2017.5. Epub 2017 Mar 7.
This report describes a rare but life-threatening case of a suicide attempt initially considered as intentional overdose at the emergency department. Persistent altered mental status, despite normal toxicology investigations, led the attending team to order a head computed tomography scan, which revealed a bilateral penetrating nail gun injury with a right temporal hematoma for which a decompressive craniectomy was performed. Although voluntary intoxication is the most frequent form of suicide attempt, emergency physicians must be alert and maintain a broad differential diagnosis. Although rare, penetrating head injuries have increased in recent decades. As neurological symptoms can be minimal and penetration wounds small, this type of injury could potentially be overlooked.
本报告描述了一例罕见但危及生命的自杀企图病例，最初在急诊科被认为是故意过量用药。尽管进行了常规毒理学检查，但持续性的意识改变导致主治团队要求进行头部计算机断层扫描，结果显示双侧贯通钉枪伤，右侧颞部血肿，行去骨瓣减压术。虽然自愿中毒是最常见的自杀企图形式，但急诊医生必须保持警惕并进行广泛的鉴别诊断。尽管罕见，但近年来穿透性头部损伤的发生率有所增加。由于神经症状可能很少见，且穿透性伤口较小，这种类型的损伤可能容易被忽视。
