List Archives

Mon Sep 1 22:47:20 BST 2008

I realize I'm really going out on a limb here, but I agree with Drs. Mattox
and Stein. I trained in Occ Med back in the day and we tried to look for
evidence of the effect of lead exposure through bullets. Sort of an overlap
thing at Cook County Hospital. Everything was pretty equivocal at best.
Sometimes you could find elevated serum Pb levels but the exposure to a
variety of non-gunshot lead sources for patients from the South Side of
Chicago was pretty high. But not necessarily uniform, you know. So it was
hard to figure out to what we were or should be comparing the GSW victims
to. I definitely don't ever remember a pt. with "poisoning" from a bullet.
The worst possible scenario I could imagine would have been a lead bullet
left exactly in the spinal canal. And how often would that happen??

Rob Smith

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of KMATTOX at aol.com
Sent: Monday, September 01, 2008 4:51 PM
To: trauma-list at trauma.org
Subject: Re: question about projectile composition

Mickey's skepticism regarding "lead or metal" poisoning from metal  
projectiles is several quantum less than mine.     I have  read some
laboratory issues 
regarding this subject, but have never seen either  in street fighters, war 
wounds, referred patients, or any others any problems  that I was smart
enough 
to identify.    I was taught and  continue to leave missiles stay where they

are, unless they have caused bleeding  problems.      I am aware of the 
literature that real  LEAD bullets exposed to a synovial joint can result in
lead 
absorption, but have  never seen any good evidence for such.      Many of
the  
projectiles we see are really not LEAD.    I do believe that  there is a
great 
deal of urban legend here and a great deal of old wives tales  and retold 
culture which either needs to be killed or have some science behind  it.

But what do I know after being involved in and or supervising more than  
70,000 injured patients during my clinical career as a medical student,
resident, 
soldier, and faculty since 1960.     

k

In a message dated 9/1/2008 3:39:32 P.M. Central Daylight Time,  
mgstein at bezeqint.net writes:

Hello  all,

I am a bit perplexed!!

I began Med School  in 1972.  Served as a Medic (1973) and Doctor
(1982,1991,2006) in four  wars. Seen thousands of war casualties and
personally treated hundreds of  shrapnel/projectile victims of explosives
and
firearms.  Treated  hundreds of suicide bombing victims (and have data on
some 8000 others from  other med. centers around the country) from all sorts
of stuff that the  terrorists' twisted minds try to add to the explosives.

In all  these years (1973-2008) I have never never never seen a metal
substance  poisoning from these projectiles.  Oh, we did see these particles
to  cause severe problems.  However, all were mechanical or  infectious
complications.  Those (infectious complications) were seen  more commonly
with the non-metalic projectiles or if traversed through  contaminated
organs
(i.e. hollow viscus etc.).  More so, I have never  heard of anyone who saw
these types of complications (including the 2 years  I spent at STC in
Baltimore MD 1993-5).

Personal experience  is Level 6 :-) or less evidence but.

Am I blind?

Am I  deaf?

Is it such a scarce issue?

Are my patients just  LUCKY?

Do they use different "Metals" in the Middle East?

Are we  divinely protected from this type of complication in the
"Holy-Land"?

Is the King Naked?

All or some of the  above?

Your humble devils  advocate.

Mickey

*******************************************************************

Michael  Stein MD

Chairman, Israel Trauma Society

Director of Trauma,  Attending Surgeon

Department of Surgery,

Rabin Medical Center -  Beilinson Hospital,

Petach-Tikva,  49100

ISRAEL

******************************************************************

-----Original  Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org]
On Behalf Of listasmsd
Sent:  Monday, September 01, 2008 1:28 PM
To: Trauma &amp; Critical Care  mailing list
Subject: Re: question about projectile  composition

old data

Am J Forensic Med Pathol. 1983  Jun;4(2):165-9. Links

A fatal case of lead poisoning due to a retained  bullet.

DiMaio VJ, DiMaio SM, Garriott JC, Simpson P.

Lead  poisoning from a retained bullet or missile is rare and is usually  

dependent on the location of the missile in a bone or immediately  adjacent 

to a joint. A review of the literature revealed only 14 cases  in which
there

was adequate laboratory documentation of plumbism  caused by a retained 

bullet or missile. Only one of these previously  reported cases resulted in 

death. We report a second death due to lead  poisoning from a retained
bullet

with elevated blood lead levels  documented by toxicologic analysis.>

> 

> 

>  Hello again all, In the news today I saw that the army is studying  the

> longterm effects of shrapnel left in the bodies of soldiers.  It made me

> think of all the GSW fragments I have seen left in  patients over the

> years. The standard missile composition I  understand to be copper
jacketed

> lead. Also common hollow point  and softpoint projectiles have no covering

> at all. Does anyone  know of the longterm health effects of tihs either in

> civillian  studies or anecdotes? What about projectiles with tungsten?
Does

>  location in the body have an effect on outcome? Look forward to the
input

> from the list. thanks again,Mike

> 

>  

> 

> --

> trauma-list : TRAUMA.ORG

>  To change your settings or unsubscribe visit:

>  http://www.trauma.org/index.php?/community/

>  

--

trauma-list : TRAUMA.ORG

To  change your settings or unsubscribe  visit:

http://www.trauma.org/index.php?/community/

--

trauma-list  : TRAUMA.ORG

To change your settings or unsubscribe  visit:

http://www.trauma.org/index.php?/community/

--
trauma-list  : TRAUMA.ORG
To change your settings or unsubscribe  visit:
http://www.trauma.org/index.php?/community/

**************It's only a deal if it's where you want to go. Find your
travel 
deal here.      
(http://information.travel.aol.com/deals?ncid=aoltrv00050000000047)
--
trauma-list : TRAUMA.ORG
To change your settings or unsubscribe visit:
http://www.trauma.org/index.php?/community/

List Archives

For your convenience, find the Trauma List Archive Below

question about projectile composition