There are many stereotypes about people of different national origin. For Australians, it has to do with being pretty hard-as-nails, hence the Foster’s “How to speak Australian” ads.  This guy that I saw in residency was the personification of that image. He came into the ER because he had accidentally pounded a nail through his hand while working as a carpenter. Not with a nail gun as is usually the case with these injuries, but actually hammering a nail into his palm by hand. (how one could do this, I am not sure) He did look in some degree of pain but when I started to draw up the lidocaine to numb the area before I attempted the nail’s removal, he demurred. “Just yank it out Mate!” as he simply grabbed onto the bed-rail with his other hand. I said, “Are you sure?, it might get hung up and could hurt a lot.” “Just yank the bloody thing out!” he exclaimed as he handed me a pair of carpenters pliers from his tool belt.

So with one swift yank, the nail came out, albeit painfully appearing I would gather. It was hard to get him to accept the tetanus booster shot afterwards but he acquiesced and then was on his way with a ‘Thanks Mate!” and an antibiotic prescription I am sure he would not fill. I almost wonder why he didn’t just have one of his coworkers pull it out at the job site!

This was orginally posted on Dec 21, 2007.  I reposted it after I read this article about some very harsh Australians here

But really.  This person perhaps took that with a little too much enthusiasm.

At least she was practising safe sex. I have Dr Grumpy to thank for this story.

Everyone was sad when Steve Erwin, the “Crocodile Hunter” died.  He violated a rule that one should heed – assuming they are able to keep their composure after a terrible penetrating injury.  That is DON’T PULL IT OUT.  What ever stabbed into you, leave it in there until you get to the ER.  It acts as a tamponade – keeping pressure on the wound and minimising blood loss.  Remove it, and you have basically uncorked a bottle.  

When Steve Irwin pulled that stingray stinger out of his heart, he bled out rapidly.  I remember a case when I was a resident where a young man, after arguing with his girlfriend, shot himself in the chest with a nailgun. It bascially pinned his sternum and his heart and the anterior wall of the aorta all together!  He did not pull it out thank God.  Anyway, it was safely removed in the OR and he wound up doing fine. 

The reason I bring this up is that this concept also applies to the eye.  I know, I know, it seems pretty horrific to leave something sticking out of you eye resist that urge to pull it out!    Recently we had a guy take a ricocheted nail from a nail gun in the eye – stuck straight into it.  He freaked and pulled it right out – taking along a good portion of his aqueous and vitreous humours. This action also cost him the lion’s share of vision of this eye.   You can see on the CT that the left orbit is smaller and deformed – and most impressively the left lens.  It’s totally disrupted.

Of course the REAL lesson to this tale is WEAR SOME DAMN SAFTEY GOGGLES!!!!!