Visual Diagnosis
in Emergency Medicine
FRONTAL SINUS TASER DART INJURY
Madelene C. Lewis, MD* and Daniel E. Lewis, MD†
*Department of Radiology, Medical University of South Carolina, Charleston, South Carolina and †Roper Emergency Physicians, Charleston,
South Carolina
Reprint Address: Madelene C. Lewis, MD, Department of Radiology, Medical University of South Carolina, 96 Jonathan Lucas Street, MSC 323,
Charleston, SC 29425
CASE REPORT
A 41-year-old man arrived by police escort to the Emergency
Department (ED) for evaluation and removal of a
TASER dart (TASER International, Scottsdale, AZ). Prior
to arrival, the patient was involved in an altercation
with police and was inadvertently shot by a TASER
(Figure 1) at close range. As the TASER was ﬁred, the patient
turned, resulting in one dart striking the patient in the
face. The patient immediately became cooperative and
was transported without further incident to the ED for evaluation
and dart removal. The patient endorsed resisting arrest
and alcohol consumption prior to the confrontation.
The patient complained of local facial pain at the TASER
dart entrance site but was without other complaint.
He denied loss of consciousness, headache, fever, chills,
nausea, vomiting, epistaxis, blurred vision, or neck pain.
All vital signs were within normal limits.
On physical examination, the patient was noted to
have a TASER dart with attached wire embedded in the
right side of his forehead with associated puncture wound
(Figure 2). There was a small amount of dried blood surrounding
the wound but no active bleeding. The
remainder of the patient’s head, eye, ear, nose, and mouth
examination was unremarkable. He had no other injuries
noted and no additional complaints.
A physician assistant attempted to remove the TASER
dart with direct traction, perpendicular to the site and
angle of penetration, which was unsuccessful. The patient
was then locally anesthetized with a more aggressive
attempt, which was also unsuccessful. At this point the
attending physician was notiﬁed and an attempt was
made to maneuver the barb, also unsuccessful. After multiple
failed attempts at dart removal, there was concern
the dart was embedded in the skull. Curved hemostats
were placed under the neck of the TASER dart and direct
traction was applied. At this point the TASER dart body
was separated from the metallic barb, with the barb remaining
embedded in the patient’s forehead. A noncontrast
computed tomography scan (CT) of the head was
ordered for further evaluation.
‘‘WHAT IS YOUR DIAGNOSIS?’’
Noncontrast CT of the head revealed a ‘‘metallic foreign
body penetrating the right frontal sinus and possibly
breaching the integrity of the bone between the sinus
and the anterior cranial fossa. The tip does not appear
to extend into the brain parenchyma. Blood is noted
within the frontal sinus. No intracranial hematoma
seen’’ (Figure 3).
Based on the CT report and physical examination, it
appeared the TASER barb penetrated the anterior and
possibly posterior table of the frontal sinus. The patient
had his tetanus status updated and intravenous (i.v.) antibiotics
were immediately begun (1 g of ceftriaxone i.v.).
RECEIVED: 20 August 2015;
ACCEPTED: 17 September 2015
490
The Journal of Emergency Medicine, Vol. 50, No. 3, pp. 490–492, 2016
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Ear, Nose, and Throat (ENT) and Neurosurgery were
consulted.
An ENT physician evaluated the patient in the ED and
removed the barb at bedside by extending the wound with
a #11 blade, rotating the barb, and applying pressure to
remove the barb in its entirety. The wound area was irrigated
copiously with sterile saline. A follow-up noncontrast
CT of the sinuses was obtained post barb removal
(Figure 4). CT conﬁrmed complete removal of the barb
with no remaining metallic foreign body and no deﬁnitive
fracture of the posterior table of the frontal sinus. The patient
was discharged with clindamycin 300 mg four times
a day for 14 days and topical bacitracin. He did not follow
up with ENT and was lost to follow-up.
DISCUSSION
The TASER (Thomas A. Swift’s Electric Riﬂe) is an energy
weapon used to temporarily stun an individual. TASERs
are increasingly being used by law enforcement
ofﬁcers as a less lethal alternative to handguns. TASER
mechanism of action is via compressed nitrogen propelling
two barbed probes attached to conductive wires up
to 15 feet (1). Transmission of up to 50,000 volts (peak
voltage though the body is actually around 1200 volts,
and average voltage during the 100-ms duration of the
pulse is about 400 volts) between the two probes causes
the individual to lose complete neural control (2). The
barbs are 9.5 mm long and 0.8 mm in diameter (3).
More frequently used by law enforcement ofﬁcials, they
have been regarded as ‘‘relatively safe when compared
to shooting with more conventional weapons’’ (4). TASER
injury patterns generally can be grouped into primary
barb strike injuries, electrical injury, and
secondary trauma from falling (3). These patients should
be evaluated for all three types of injuries. The areas most
commonly affected by barb strikes are the trunk or back
(5,6).
The goal of TASER dart removal is to remove the dart
in its entirety in an expedient fashion. This diminishes
pain, risk of infection, and prevents complications.
Dart embedment in the face occurs in only about 1%
of cases (4). Rarely, darts can result in intracranial
injury. There are three previous cases of intracranial injuries
due to TASER dart penetration (2,7). In all three
cases of skull penetration, device removal at the
bedside was unsuccessful due to penetration of both
the inner and outer tables of the skull. Two of these
cases required small surgical craniectomies, which
were successful in completely removing the embedded
TASER barb, without permanent neurological sequelae
(7). In one case, a small fragment remained in the
skull; however, the patient had no known long-term
Figure 1. Metallic barbed TASER dart with attached barb.
Retrieved from: http://smg.photobucket.com/user/harnett65/
media/Album11/pic1843a.jpg.html.
Figure 2. Patient with TASER dart embedded in forehead.
Figure 3. Noncontrast computed tomography scan of the
head bone window shows the fractured portion of the TASER
dart embedded in the right frontal sinus (arrow). Blood is also
seen layering in the right frontal sinus.
Figure 4. Noncontrast computed tomography scan of the sinuses
shows complete removal of the TASER dart.
Frontal Sinus TASER Dart Injury 491
complications (2). It has been proposed that if no fracture
of the inner table of the skull is present, the wound
may be closed, leaving behind a small barb fragment (1).
If a barb is embedded in a patient’s eye, Ophthalmology
should be consulted, and the barb removal should not be
attempted in the ED (3).
Our case was unusual in that the initial CT was inconclusive
in determination of barb penetration through the
inner table of the skull. Both ENTand Neurosurgery consultants
had no previous experience or exposure to TASER
dart injuries to the skull. After direct exploration,
the barb was removed in its entirety under local anesthesia,
and subsequent CT conﬁrmed no penetration
through the inner table of the skull or intracranial complication.
This unusual case report should be added to the
growing body of evidence that TASER dart injuries,
though potentially concerning at ﬁrst glance, can usually
be handled in an outpatient setting.
Take home points:
1. In all documented cases of skull penetration from
TASER darts, none had intracranial bleeding or
permanent neurological compromise.
2. Dart removal in all four cases at the bedside
initially caused separation of the barb from the
dart, leaving a foreign body embedded in the skull.
3. Local exploration and rotation of the barb with
direct traction was successful for extraction of the
intact barb with our patient, who had penetration
of only the outer table of the skull.
4. If both inner and outer tables of the skull are penetrated,
Neurosurgery evaluation is recommended.
5. A summary of these cases might be a pertinent education
point for our ENT-, Neurosurgical-, Radiology-,
and Trauma-trained colleagues.
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492 M. C. Lewis and D. E. Lewis