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: 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.
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: behindtheknife.org/listen
Behind the Knife Premium: behindtheknife.org/premium
Oral Board Review:behindtheknife.org/oral-board
Oral Board Simulator: behindtheknife.org/oral-board/simulator
General Surgery Oral Board Review Course: behindtheknife.org/premium/general-surgery-ora…
Trauma Surgery Video Atlas: behindtheknife.org/premium/trauma-surgery-vide…
Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: behindtheknife.org/premium/dominate-surgery-a-…
Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: behindtheknife.org/premium/dominate-surgery-fo…
Vascular Surgery Oral Board Review Course: behindtheknife.org/premium/vascular-surgery-or…
Colorectal Surgery Oral Board Review Course: behindtheknife.org/premium/colorectal-surgery-…
Surgical Oncology Oral Board Review Course: behindtheknife.org/premium/surgical-oncology-o…
Cardiothoracic Oral Board Review Course: behindtheknife.org/premium/cardiothoracic-surg…
Download our App:
Apple App Store: apps.apple.com/us/app/behind-the-knife/id16724…
Android/Google Play: play.google.com/store/apps/details?id=com.btk.…