Description
Instructions
On April 19, 2004, Isidro Mejia was working construction on the roof of a house when he lost his footing on the scaffolding and fell on top of another worker, who was using an automatic, high-powered nail gun. As the man holding the nail gun tried to regain his balance to prevent himself from falling off the second floor, he grabbed Mejia, tumbled on to him, and discharged the pressure-sensitive nail gun into his head and body. This particular nail gun is extremely powerful, as it has to drive nails into two-inch by four-inch wooden planks, enough power to penetrate through bone (Wan 2004). Upon impact, the nail gun drove six 3 ½ inch nails into Mejia’s head, face, and neck within seconds.
Barely breathing, Mejia was rushed to Providence Holy Cross Medical Center in the Mission Hills region of Los Angeles, California. As paramedics escorted Mejia into the emergency room, he stopped breathing. He was quickly resuscitated, but remained in a comatose state after resuscitation (Wan 2004). “At first, the extent of damage could not be determined because the nails were driven beyond the initial wound,” commented staff radiologist Dr. Stephen Greenberg, but after receiving the x-ray images, he later reported, “the initial x-rays display the six nail placements and that the jaw bones were intact” (Thompson 2004). Neurosurgeon Dr. Raphael Quinonez had little hope for Mejia after his preliminary examination, but with no options available, he had Mejia prepared for surgery to remove the nails (Wan 2004).
The six nails were oriented as follows:
Nail #1 punctured the skull and entered the midline of the brain; major blood vessels such as the superior and inferior sagittal sinuses that drain deoxygenated blood from the brain were not ruptured
Nail #2 passed just 2 mm from the brainstem.
Nail #3 entered the spinal column, 3 mm lateral to the spinal cord (on the right side)
Nail #4 pierced the brain. Nail #4 probably entered the parietotemporal region.
Nail #5 entered the jaw musculature
Nail #6 projected through the base of his skull into the facial region and rested medially to the mandibular condyle on the right side, in close proximity to several branches of the carotid artery (If those branches were severed during extraction, there would be no way to control the bleeding internally and Mejia would have suffered brain damage).
The skull X-Ray
Look at the X-ray images showing a frontal and lateral view of Mejia’s head and complete the following tasks:
Correlate the nail in the image with the nails described above.
Describe the type of symptoms that might be caused by damage in each region of the brain impacted by the nails.