BIG T Trauma Ep. 28: Retained Ballistic Fragments: What We Were Never Taught

The majority of non-fatal gunshot wound survivors walk away with a bullet still inside them. Most are discharged without a removal attempt, without a surveillance plan, and without a conversation about what comes next. This episode fills that gap.
Dr. Patrick Georgoff is joined by BIG T co-host Dr. Teddy Puzio (UT Houston), gun violence survivor and trauma surgeon Dr. Madhu Subramanian (Duke), and Dr. Tyler Simpson (Duke ACS Fellow) for a practical, honest conversation about one of trauma's most overlooked topics.

What we cover:

• Epidemiology: how common retained fragments really are, and why the downstream burden is underappreciated
• When to remove (and when not to): a framework for both index hospitalization and delayed removal
• Forensic evidence: how to handle bullets in the OR without destroying their evidentiary value — and who to call when you don't know
• Lead toxicity: the rare but real complication that can surface a decade later, which blood lead levels should prompt action, and when to call hematology or toxicology
• The psychology: retained bullets are independently associated with depression and reduced return to work — and that belongs in the risk-benefit conversation

DOMINATE THE DAY

BIG T Trauma Full Series: https://behindtheknife.org/podcast-series/big-t-trauma

This episode of Big T Trauma was sponsored by Teleflex, a global provider of medical devices. Learn more at teleflex.com and at the Teleflex Trauma and Emergency Medicine LinkedIn page.

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