Curriculum · Surgery
Management of a retained bullet
What it is
A bullet that has come to rest in the body does not have to come out. We can keep the bullet inside untouched, and removal is what needs an indication. Bullet removal is listed among the conclusions of the trauma course, alongside the primary survey (ABCDE) to diagnose and treat life threatening conditions, resuscitating aggressively and early, the rule that management of abdominal injury depends on hemodynamic status and FAST and CT findings, that tension pneumothorax is a clinical dx, the definition of massive hemothorax, and that head injury survival is dependent on cerebral perfusion pressure.
When it comes out
The indications are four:
- In a joint
- Near a vital structure
- Superficial
- Found during surgery
Outside these, it stays where it is.
Handling the bullet, and the record
Two notes are added about the removal itself:
- Do not touch the bullet with a metal, because you will ruin the print of the gun that is on the bullet. Take the bullet with the surrounding tissue, or take the bullet with the gauze.
- Document everything about the witnesses who saw you remove the bullet, and their names and all.