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Mon Jul 30 13:07:34 BST 2007

I recently had a pt "threaten" my partner, myself and my staff to have a bullet removed from deep within his lats muscle.? I refered him to security.? ( he was also threatening for "percs") Pts and families do not believe that these do not need to be removed.? It does not help that they can always find someone to do it.? The pt then shows up and your office stating that a Dr in FL removed one so this has to come out.

Rebecca Wolfer, MD, FACS, FCCP
Associate Professor, Marshall University School of Medicine
Dept of Surgery
Director Thoracic Surgery
Director, Surgical Critical Care Cabell Huntington Hospital
Director, Trauma Cabell Huntington Hospital

-----Original Message-----
From: Hall, John R <John_R_Hall at Wellmont.org>
To: Trauma &amp; Critical Care mailing list <trauma-list at trauma.org>
Sent: Sun, 29 Jul 2007 11:31 pm
Subject: RE: Bullet removal

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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