The use of pneumatic and explosive cartridge-activated nail guns is common in the construction industry. The ease and speed of nailing these tools afford enhance productivity at the cost of increased potential for traumatic injury. Although extremity injuries are most common, life-threatening injuries to the head, neck, chest, or abdomen and pelvis may occur. During a 20-month period, eight potentially life-threatening nail gun injuries were admitted to a Level I trauma center, including injuries to the brain, eye, neck, heart, lung, and femoral artery. Mechanism of injury included nail ricochet, nail gun misuse due to inadequate training, and successful suicide. Nail guns have significant potential for causing severe debilitating injury and death. These findings indicate a need for improved safety features and user education. The various types of nail guns, their ballistic potential, and techniques for operative management are discussed.