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Re: The Definitive Tool Thread

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  • Tue, Apr 21, 2009 - 06:59pm

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    Peak Prosperity Admin

    Peak Prosperity Admin

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    Re: The Definitive Tool Thread

[quote=PlicketyCat]What about retractors?  I’m thinking for deep wounds, time-sensitive emergency surgeries, or bullet removal situations here. And, would you just use foreceps to remove a bullet (or other deep foreign object) or is there a better tool?[/quote]

I’m going to post my offline answer to C1ouldfire regarding bullet wounds:

 

Generally, modern bullets can be left in tissue, if the bullet passed directly from muzzle to skin.  The bullet itself is fairly inert (one could argue about the lead, however), and is probably free of most microorganisms, just from the heat of the process of being fired.  The major concern would be the entry of other tissue into the bullet wound, such as clothing or environmental debris.
 
If a bullet is very superficial, palpable below the skin, for example, it could easily be removed, either through the bullet tract itself, if not overly long, or, more commonly, through a counter-incision made directly over the palpable bullet.  For a bullet below the subcutaneous tissues, beyond the muscular fascia, I would not recommend trying to remove it, unless the "surgeon" had some reasonable knowledge regarding anatomy, as to where the important nerves and vessels are located.  For a bullet that enters a body cavity, of course, I would not recommend any attempt at retrieval by anyone who is not trained to do so.
 
Instruments that could be used to retrieve a bullet should be short, so that one is not blindly poking into tissue to find the bullet.  A hemostat, needle driver, or DeBakey forcep would work well.  And, don’t forget fingers, they are a great tool; soft, fairly atraumatic, and with thousands of nerve endings!
 
For a bullet that cannot be removed, I would simply cleanse the wound as well as possible, using generous irrigation with water, or a Betadine-water solution, and a final cleanse with straight Betadine. This should be followed by a sterile dressing, placed with some compression if there is any significant bleeding.  No attempt should be made to close such a wound.  A small amount of gauze can be placed into the wound tract to ensure the tract remains patent, if there will be a delay in seeking professional medical assistance.  Depending upon conditions, it would be ideal to change the bandage twice daily, or PRN saturation of the dressing.
 
If available, I would also start the injured victim on oral antibiotics (Keflex, Amoxicillin or Augmentin, for example).  Then, get them to a medical professional.
 
I’ll get to your other questions later, as they are very good, but right now I need to get back to work. But, before I do, keep in mind my sign-off line, primum non nocere. It is very easy to make things worse by our efforts. Some basic ability to provide medical and/or surgical care is useful, but one should know their limits. One of the earliest and best things I remember being taught as a young surgical resident is to learn when not to operate. If one’s skill set is not up to the task at hand, it is better to leave that task for others.