Most bullets made of lead alloy

Oral antibiotics for 72 hours as effective as IV

IV antibiotics not indicated unless for prophylaxis for surgery

If perforate bowel and injure joint, consider irrigation and debridement

Higher incidence of infection

• Higher incidence of infection

• Knapp et al, JBJS, 1996

• Consider operative debridement, especially if antero-medial wound

Arterial injury can occur from:

• Arterial injury can occur from:

• Direct contact
• Cavitation
• Associated fractures

• Evaluation

• Physical examination
• Non invasive doppler
• Arteriography

Ankle-brachial index (ABI) <.90

• Ankle-brachial index (ABI) <.90

• 95% sensitivity
• } presence of arterial injury
• 97% specificity

• Ankle-brachial index (ABI) > .90

• 99% negative predictive value for arterial injury

Pulses absent

• Pulses absent

• Must proceed to OR for revascularization,
• intra op angiography helpful if location of lesion uncertain

• Discrepant pulses

• If ABI < .90 angiography to look for lesion
• If ABI > .90, serial documentation of limb vascularity necessary