Bullet removal

[Karim Brohi]

Dear all

I've archived these indications on the website, as it makes a great list.
There's a case of a retroaortic bullet you probably wouldn't want to go
after up there too.

K


On 30/07/07, Hall, John R <John_R_Hall at wellmont.org> wrote:
>
> CM
> We once had a "court order" to remove the bullet for evidence.
> j
>
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org on behalf of caesar ursic
> Sent: Mon 7/16/2007 12:37 PM
> To: Trauma &amp, Critical Care mailing list
> Subject: Re: Bullet removal
>
> Consensus?  What's that?
>
> I do know one thing: failure to remove all bullets will severely
> compromise
> your credibility as a trauma surgeon with the family.  In their eyes, the
> primary purpose of emergency surgery is to get the bullets out.
>
> However, I was indoctrinated to believe that only bullets in the following
> areas actually require removal:
>
> 1. when in contact with synovial fluid (i.e. joints): because they
> compromise joint integrity and mobility and, if unjacketed, may lead to
> lead
> intoxication;
>
> 2. when in a vessel lumen, to avoid distal missile embolus and vascular
> occlusion;
>
> 3. when inside the heart, because, well... because loose objects within
> heart chambers will only cause mischief.
>
> 4. when under the skin on weight-bearing surfaces (eg: the buttocks) or
> surfaces subject to contact with clothing (eg: belt line) that produce
> discomfort or pain.
>
> 5. when visibly bulging beneath the skin and causing cosmetic distress.
>
> I've never heard that the indications are different in women versus men.
>
> Once in a while a law-enforcement type will tell me that I need to remove
> a
> bullet for 'evidence.'  I've never done that nor think that one can be
> forced to do so, at least in this country (USA).
>
> CM Ursic, MD
> Santa Fe
>
>
>
> On 7/16/07, William Bromberg <brombwi1 at memorialhealth.com> wrote:
> >
> > Hey there,
> >
> > Is there any consensus on indications for bullet removal in:
> >
> > asymptomatic men (I vote leave it)
> > asymptomatic child-bearing age women - this is where I'm uncertain
> >
> > Symptomatic, in joints/blood vessels, impinging on the SC I figure need
> > to come out.
> >
> > Any advice appreciated.
> >
> > Bill Bromberg
> >
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