BIG T Trauma Ep. 28: Retained Ballistic Fragments: What We Were Never Taught
About this episode
This episode discusses the implications and management of retained ballistic fragments in gunshot wound survivors.
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…
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