My recent Slate interview - migrating bullets and Cheney

Dear readers, Well I just finished an interview with one of the contributors to the online magazine Slate (www.slate.com). The topic was the "moving bullets and pellets". The obvious reason for the discussion is the recent shotgun injury to Mr. Whittington of Texas. The reason the reporter called me is the fact that I am the senior author of a recent medical journal article on moving bullets.

Reference = Bullet migration within the inferior vena cava.
South Med J (United States), Jan 2003, 96(1) p96-8
Raghavendran K, Evans JT
I explained at length the problems of bullets and pellets that are lodged in blood vessels following firearms injury. There is the problem of obstructing a vessel, serving as a nidus for clot formation, and mycotic aneurysm formation.
Furthermore, I went into the problems of foreign materials such as clothing and debris including wadding which can also become imbedded in patients shot with shotgun pellets.
The reporter also asked about the problem of lead levels indicating that physicians have been downplaying the need to remove lead fragments and shrapnel. I told him that was not as well documented as since the medical profession had not generally done sufficient research on that topic to provide definitve evidence, but that I had personally changed my trauma practice to now include removal of suspected lead fragments based on the well done though small study from LA. Reference quoted below:

The effects of retained lead bullets on body lead burden.
J Trauma. 2001; 50(5):892-9 (ISSN: 0022-5282)

McQuirter JL ; Rothenberg SJ ; Dinkins GA ; Manalo M ; Kondrashov V ; Todd AC
Department of Oral and Maxillofacial Surgery, Charles R. Drew University of Medicine and Sciences and the King/Drew Medical Center, 1731 East 120th Street, Los Angeles, CA 90059, USA. jmcquirter@dhs.co.la.ca.us

BACKGROUND: Numerous case reports have demonstrated that lead poisoning with potentially fatal consequences can result from retained lead projectiles after firearm injuries. To assess the impact of retained projectiles on subsequent lead exposure in the population, one cannot rely on self-selected cases presenting with symptoms of lead intoxication. This preliminary study seeks to identify increased lead burden and identify risk factors of elevated blood lead levels for individuals with retained lead bullets. METHODS: Forty-eight patients were originally recruited from gunshot victims presenting for care at the King/Drew Medical Center in Los Angeles, California. An initial blood level was measured for all recruited patients and repeated for the 28 participants available for follow-up, 1 week to 8 months later. Medical history, including a history of prior firearm injuries and other retained projectiles, was taken, along with a screening and risk factor questionnaire to determine other sources of lead (occupational/recreational) to which the patient might have been, or is at present, exposed. The participants also had K-shell x-ray fluorescence determinations of bone lead in the tibia and calcaneus in order to determine past lead exposures not revealed by medical history and risk factor questionnaire. Multivariate models of blood level were made using risk factor and bone lead concentration data. RESULTS: We demonstrated that blood lead tends to increase with time after injury in patients with projectile retention, and that the increase in significant part depended on the presence of a bone fracture caused by the gunshot. CONCLUSION: We encountered evidence suggesting that the amount of blood lead increase in time after injury is also dependent on the tibia lead concentration. There were too few cases in the study to fully test the effects of bullet location, or the interaction of bullet location with bone fracture or bullet fragmentation.

Well readers, that's all for now. JTE aka Jedimaster.