Just kidding. But seriously; in most works of fiction, one of the first orders of business in treating a gunshot wound is to dig out the bullet (assuming the bullet is still in the body, natch). Real life, of course, tends to be more complicated—President Garfield’s eventually fatal gunshot wound is now thought to have been survivable, except for his doctors’ constant probing to try and find the bullet; and I remember seeing a documentary (and the X-Ray) of a man who’d unknowingly shot in the head (!), the bullet traveling through his brain to lodge in the other side of his skull (!), where the doctors decided not to try and remove it.
So, generally—and I realize how wildly this could vary from patient to patient and from injury to injury—when would you just leave the slug in?
Pretty much you leave it in if there’s minimal risk of long term issues, as opposed to the problems of cutting it open, surgical risks of infections or such (if it’s been in there for a while), or the patient is in too critical of a condition to risk another surgery like that.
I’d say the first order of business is to stop the bleeding and treat for shock. Getting the bullet out must be why so many supporting characters die in the movies.
Getting the souvenir out is considerably lower on the list, and I’d wager doctors won’t do it unless they know where the bullet is first - requiring X-rays.
Most bullet wounds to body cavities are explored. If, in the process of exploration, the slug is found, then it is removed. Such removal is typically incidental, and for the most part there isn’t much focus on actually finding the slug. Obviously, it’s common to find it since what you are exploring is the path of the bullet. However the primary focus is on injured tissue.
For bullets not entering a cavity (chest or abdomen), efforts are directed at assessing vasculature and nerves. Without evidence of injury to those structures, bullets can usually be left alone.
Consider also shotgun wounds, which are fairly common. In those cases dozens of pellets are embedded in soft tissue, and for the most part they are left alone.
Bullets which penetrate the skull are usually removed in the course of evaluating and treating the associated trauma to the brain.
Modern imaging lets us identify with a fair degree of precision exactly where a bullet is located, so in the rare event that the final resting place is deemed to be problematic, specific exploration to “dig out the bullet” can be undertaken. I do not know why Westerns and the like make such an event of digging out the bullet (or arrowhead, for that matter). By themselves they are not usually much of an issue and even when made of lead are not felt to be a source of any systemic toxicity. There seems to be a notion that foreign objects “make their way” to vital organs, but for most objects–certainly blunt ones–this is not the case. It does happen, of course, but it’s not the typical course.
I also asked her if she was concerned about lead leaching from the bullet. She said the doctor said it was a non-issue. :dubious: Even though the bullet is FMJ, isn’t the base of the bullet not plated?
Also it is good to leave it in place when you are a world-dominating villain who has been shot in the head with a bullet which is migrating through your brain and will eventually kill you but makes you stronger as it goes on.
I learned this from a Bond film. I also learned that nuclear physicists look like Denise Richards.
I have a friend with a piece of shrapnel lodged near his left optic nerve, if they try to remove it he will probably lose sight in that eye. They opted to leave it in place. It has been there for about 10 years now …
I remember one episode of Trauma when a doctor had to remind one of the patients that it was in his best interest to let people know he already had a couple of bullets in him whenever he is brought into the ER for future gunshot wounds. They spent a lot of wasted time trying to find wounds that weren’t there because of what showed up on the X-ray.
Metal shards of all types are fairly inert. The body will wall them off with a surrounding layer of connective tissue and for the most part they will stay in place. There are some occasions when they move–“migrate” in medical-speak–but not very often. Infection and inflammation are not a problem for the most part if it’s just metal. Cloth and wood are examples of foreign bodies that do harbor bacteria and can result in inflammation. These sorts of more porous materials are much more difficult for the immune system to sterilize. Not only do bacteria which were on the original porous material have a place to hide, so do bacteria circulating around the bloodstream (we all get the occasional bacteria that gets loose in the blood and floats around awhile before it’s cleared out). Porous foreign bodies provide a nidus for circulating bacteria to hide and multiply, and even courses of antibiotics have a hard time getting to them (bone can sometimes present a similar problem).
Ordinary bullets are fairly sterile to begin with and seldom have deep unreachable crevices, so they don’t get infected. An embedded torn piece of clothing or the tip of a wooden arrow would be an example of foreign bodies that would be problematic (from an infection standpoint) if not removed.
Thousands of asymptomatic soldiers walk around with a great deal of metal in their bodies.
Systemic lead toxicity is seldom a problem. When the lead happens to end up in a part of the body where it’s exposed to fluids that can leach out the lead, there have been reports of systemic lead toxicity. See, for example: http://www.springerlink.com/content/qp28j96wj6270010/fulltext.pdf?page=1
This is unusual enough to be reportable, and when one considers the number of folks who didn’t have a problem, it’s reasonable to say it’s a non-issue. For almost all final resting places, the lead will get walled off with connective tissue and not leach into the rest of the body. In the example I cited, the intraarticular (inside the joint space) destination created an exception to the general rule b/c the lead was constantly bathed in fluid from the joint, and the weight-bearing nature of the hip joint ground up the lead a bit. In addition, the hip joint where the fragment was located in the first patient probably degenerated as the patient aged, and helped grind off small fragments which just made the problem worse. For most of his life, the patient experienced no symptoms and only became systemically toxic many decades after his original injury.
My patient clientele (prison inmates) tend to extrude bullets at a pretty steady rate. At least 2 or 3 times a year one presents with an old bullet rising to the surface, trying to break out through the skin!
Is it fair to say these are typically sterile migrations–e.g. long-standing, non-inflamed, perhaps granulomatous inclusions slowly making their way to a subcutaneous location–versus, perhaps–actively infected tracts where the foreign body is the nidus of an ongoing indolent infection? I think a number of people might think the process is like a festering deep splinter as opposed to something more like a marble gradually working its way to the surface…
When I went in for bunion surgery the x-rays showed a BB lodged at the base of my right index toe. I vaguely remember some drunken college BB gun-play (we wore sunglasses!) but I thought the wound was on my big toe. It’s shallow and palpaple but I never knew it was there until I saw the pics.
I asked my doc if he was going to make an incision to free it while he was performing the op. He asked, “Does it hurt?” I answered no and he said, “Well, then let’s just leave it alone, shall we?”
I don’t; sorry. There are hundreds of interesting articles written about penetrating trauma and retained foreign bodies, though. Perhaps better Googling than mine will pull up just what you are looking for. Despite the fact that it’s unusual in general for retained metal projectiles to be a problem, there are some very interesting reports of various retained foreign bodies gone wrong, so to speak.
But seriously; in most works of fiction, one of the first orders of business in treating a gunshot wound is to dig out the bullet (assuming the bullet is still in the body, natch). Real life, of course, tends to be more complicated—President Garfield’s eventually fatal gunshot wound is now thought to have been survivable, except for his doctors’ constant probing to try and find the bullet; and I remember seeing a documentary (and the X-Ray) of a man who’d unknowingly shot in the head (!), the bullet traveling through his brain to lodge in the other side of his skull (!), where the doctors decided not to try and remove it.