Nail Gun Suicide: An Atypical Case Report and Review of the Literature.

Nail guns are pneumatically driven or powder-actuated tools, which are used to drive nails into wood or concrete. A 42-year-old man, who was a builder by profession and history of antidepressant use, was found dead in his vehicle, holding a "Ramset" nail gun in his right hand. A straight metal nail and a book with a small hole were recovered from the scene.At autopsy, an irregularly circular puncture wound was seen on the forehead and a cruciate laceration was seen on the posterior aspect of the scalp. No burning, blackening, or tattooing was present around either injury. Both internal and external beveling was present with the latter being relatively larger. Toxicological analysis revealed alcohol and methamphetamine in blood. Psychiatric history and substance abuse must also be considered when individuals in construction industry are given access to tools like nail guns.Several unique features not previously reported were observed in this case. The deceased had overcome the built-in safety mechanism of the nail gun, by placing a book in between his forehead and muzzle. Another unique feature is that the nail had exited the cranium. Beveling, a feature commonly found in firearm injuries, was also seen in this case.