CT confirmed pregnant woman had entire bullet lodged in cheek

by Thomas Dworetzky, Contributing Reporter | February 15, 2016

CT Emergency Medicine Risk Management X-Ray

These include the following:

Perform surgery at an ancillary site, safely away from gas lines, potentially combustible material and other people, if at all possible.

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Triage should be aimed at patient comfort, and safety of others, especially surgical staff, if the situation is a crisis in which the ability to care for many in a mass casualty scenario with limited staff is a factor. For this reason, if possible and necessary, nurses or other personnel should care for a person with an unexploded ordinance, rather than surgeons needed to care for others, until the actual operation to remove the projectile.

Use care when using advanced imaging technology. "Plain radiographs are generally considered safe with respect to potential inadvertent triggering of the UXO [unexploded ordnance]. The patient should not be reoriented to obtain the films, again because any movement can inadvertently complete the triggering mechanism and cause an explosion. The effects of ultrasound or CT scan on unexploded ordnance are not well documented in the literature. However, it is prudent to avoid these imaging modalities unless they are absolutely necessary," state the guidelines.

Electrical instruments, such as "electrical cautery should be avoided always, because the trigger could be energized. Likewise, mechanical saws that emit an electrical field should be avoided in favor of non-powered manual saws. The same type of electrical field is emitted by such devices as blood warmers or pumps, which should be avoided," it states.

During the operation, staff should be kept to a minimum. To reduce head-count, suggest the guidelines, "necessary equipment should be laid out in advance of the operation, eliminating the need for an OR tech; an assistant surgeon should not be used unless absolutely needed to safely remove the ordnance.

When general anesthetic is used, advises the military, general anesthetic and/or nerve blockers should be given "in an appropriate bolus dosage, and the anesthetist should then move out of the OR. Supplemental oxygen should be "limited," as well.

The guiding principle is to remove the ordnance by the most expedient means possible, avoiding banging or vibration, and stabilizing life and limb, but putting off any additional surgical steps until the ordnance is safely removed and out of the OR.

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