{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T21:49:01Z","timestamp":1791668941047,"version":"4.3.4"},"reference-count":12,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T00:00:00Z","timestamp":1791590400000},"content-version":"vor","delay-in-days":9,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>A 60-year-old male with a history of depression and a prior nail-gun thoracic injury was found in shock at home, with inferior ST-segment elevation on the paramedic electrocardiogram prompting pre-hospital ST-elevation myocardial infarction pathway activation. Initial high-sensitivity troponin was elevated, consistent with the presumed diagnosis. Normal coronary angiography and preserved ventricular function were discordant with the patient\u2019s ongoing haemodynamic instability. Four small anterior chest puncture wounds and radiopaque foreign bodies demonstrated on chest radiograph and angiographic imaging did not initially prompt consideration of penetrating injury. Computed tomography pulmonary angiography, performed to exclude pulmonary embolism, identified four nail-gun projectiles penetrating the heart and stomach. The patient underwent sternotomy and laparotomy with repair of cardiac, diaphragmatic, and gastric injuries. The case illustrates the challenges of situation awareness and diagnostic reassessment within time-critical, protocol-driven care.<\/jats:p>","DOI":"10.1093\/jscr\/rjag914","type":"journal-article","created":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T11:54:34Z","timestamp":1790855674000},"source":"Crossref","is-referenced-by-count":0,"title":["Self-inflicted thoracoabdominal nail-gun injury presenting as STEMI: diagnostic challenges in a time-critical care pathway"],"prefix":"10.1093","volume":"2026","author":[{"given":"Charles","family":"Belling","sequence":"first","affiliation":[{"name":"Department of General Surgery, Westmead Hospital , Cnr Hawkesbury Road and Darcy Rd, Westmead, New South Wales 2145 ,","place":["Australia"]},{"name":"Westmead Trauma Service, Westmead Hospital , Cnr Hawkesbury Road and Darcy Rd, Westmead, New South Wales 2145 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hye Rim","family":"Suh","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Westmead Hospital , Cnr Hawkesbury Road and Darcy Rd, Westmead, New South Wales 2145 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kayna","family":"Fichadia","sequence":"additional","affiliation":[{"name":"Western Sydney University, School of Medicine , Locked Bag 1797, Penrith 2751, New South Wales 2751 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saimurooban","family":"Muralidaran","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Westmead Hospital , Cnr Hawkesbury Road and Darcy Rd, Westmead, New South Wales 2145 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arooj","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Westmead Trauma Service, Westmead Hospital , Cnr Hawkesbury Road and Darcy Rd, Westmead, New South Wales 2145 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susmit","family":"Roy","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Westmead Hospital , Cnr Hawkesbury Road and Darcy Rd, Westmead, New South Wales 2145 ,","place":["Australia"]},{"name":"Westmead Trauma Service, Westmead Hospital , Cnr Hawkesbury Road and Darcy Rd, Westmead, New South Wales 2145 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy","family":"Hsu","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Westmead Hospital , Cnr Hawkesbury Road and Darcy Rd, Westmead, New South Wales 2145 ,","place":["Australia"]},{"name":"Westmead Trauma Service, Westmead Hospital , Cnr Hawkesbury Road and Darcy Rd, Westmead, New South Wales 2145 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