Do You Need To Remove a Bullet?

Do You Need To Remove a Bullet?

Bullet Removal Is Super Interesting

Short answer: In general, once the bullet has done its initial damage, it does not hurt the person. Exceptions include the occasional lead poisoning and possible migration of the bullet which can lodge itself in other arteries causing strokes. See this article: Shotgun wound and pellet embolism to the intracranial carotid artery.

Let’s first myth-bust the Hollywood style removal of a bullet.

  1. Good guys gets shot.
  2. Good guy is DYING.
  3. Good guy digs out bullet and it hurts like hell.
  4. Good guy gets better after digging it out.

The implication here is that the bullet needs to come out and that taking it out results in patient better.

For the most part, this is WRONG!

Gunshot Wound Cavitation

First off, the bullet typically goes deeper than skin deep. Second, it’s the damage to arteries and organs that can cause bleeding or organ injury. This damage is already done by the time you even realize you are shot. If shot the in abdomen, a bullet can tear the intestines open and lead to leakage of stool into the abdominal cavity. This can cause infection and death.

However, the bigger danger of a high speed bullet is due to a concept known as cavitation. The bullet effectively creates a shock-wave like effect spreading damage far BEYOND the tract of the projectile. Attempting to take out the bullet does nothing to stop these problems.

Next let’s bust some myths

Myth: Bullets are sterile from the heat -> FALSE!

See this experiments where they shot bullets coated in Staph into sterile gel and found the bullets were still contaminated. Autosterilization in low-velocity bullets.

What else can bullets do?

Well here is a case where a bullet caused a tear in the small bowel and then migrated to the large bowel causing a life threatening infection of the abdomen known as peritonitis. An Elusive Bullet in the Gastrointestinal Tract: A Rare Case of Bullet Embolism in the Gastrointestinal Tract and a Review of Relevant Literature

So when is bullet removal indicated?

Well, in medicine we talk about “Levels of Evidence” – which is related to how much knowledge the medical community knows about a topic. As far as bullet removal goes, there are not any GREAT studies. There are mediocre ones and “expert opinion”. That being said most bullets can stay in place. Indications for removal include: bullets “in a joint, in the eye, in a location that causes skin pressure when sitting, causing infection, inside a blood vessel, or causing elevated lead levels.” Indications for Bullet Removal

So all in all, if a bullet isn’t in a joint, isn’t going to migrate and isn’t causing an infection then let it stay – the damage is done!