Bullet removal

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Okay, I'm here to learn:

The court can order it; but must a doctor violate his or her oath in the
process of compliance?  Seems to me that even if the State gives proxy
consent, you still have to get past the medical necessity condition
before this passes the ethical straight-face test...

Pret

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Hardcastle, Tim, Dr
<tch at sun.ac.za>
Sent: Monday, July 30, 2007 6:33 AM
To: Trauma &amp; Critical Care mailing list
Subject: RE: Bullet removal

Unless he is "under arrest"

In most places then the court may order such a step!

On the topic: our five indications for bullet removal:
-You see it in the wound
-You feel it under the skin / in the soft tissue
-It communicates with CSF or joint space fluid = risk of electrolysis
and lead poisoning long term
-In or near a vascular injury - embolisation risk and sepsis of graft /
repair
-The justice system orders the removal of an awaiting trial prisoner's
bullet.

In my mind these are the only sound reasons for removing bullets
anymore, this is our day to day practice and we see anything from 5 to
20 GSW's per week!

Tim
Dr T C Hardcastle
M.B.,Ch.B.(Stell); M.Med(Chir); FCS(SA)
Senior Surgeon / Senior Lecturer: Surgery (Trauma and ICU)
ATLS  instructor and DSTC Cape Town Course Director
Intern program Coordinator: Surgery
M.Med (Emergency Medicine) Executive Committee member
Clinical Head (Director): Diana Princess of Wales Trauma Unit
Division of Surgery (General) Room 4064
Department of Surgical Sciences
Tygerberg Hospital / University of Stellenbosch
PO Box 19063
Tygerberg 7505
Western Cape
South Africa
e-mail: tch at sun.ac.za
Cell: +27824681615
Office: +27219389281 or 4911 pager 0302



-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org]On Behalf Of Pret Bjorn
Sent: Monday, July 30, 2007 11:18 AM
To: 'Trauma &amp; Critical Care mailing list'
Subject: RE: Bullet removal


You comply with such an order only after the patient's consent, I
presume.
Otherwise it sounds like a good case for your ethics committee: you're
both
committing assault and violating his Fifth Amendment rights.  That is,
if
America still has a Bill of Rights.

Wait.  We still have amendment number two, don't we?  Hence the missile
of
interest...

Pret Bjorn, RN
Bangor, ME USA


-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org]
On Behalf Of Hall, John R
Sent: Sunday, July 29, 2007 11:31 PM
To: Trauma &amp; Critical Care mailing list
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
>
> --
> trauma-list : TRAUMA.ORG
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>



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