Anonymous asked: Is it actually useful to dig bullets out of your own arm in a public restroom in an emergency situation, or is that something that just happens in movies?

maggie-stiefvater:

doctorfiction:

About self-surgery in the bathroom of the local Exxon Station… Psychologically we all feel that getting the bullet out will help the problem but generally speaking it is best to let sleeping dogs lie and to bastardize Hamlet, “Get thee to a surgery.” The greatest concerns immediately post gunshot are circulation and airway. You are probably not going to have a breathing problem other than hyperventilation from fear, if you are shot in the arm. Your big concerns are bleeding and nerve damage. Have your character dorsiflex (hyper extend) his wrist, make an “O” with his thumb and index finger, spread his fingers apart, and then smile when he realizes everything is still hooked up. He flexes his arm a few times to see if blood is spurting or just oozing. If its just oozing, cover with a wad of moist paper towels, tear of a shirt sleeve and wrap tight enough to apply pressure to the wad of paper towel, but not tight enough to constrict. Have the character check the pulse at his wrist and note the color and temperature of his arm. If the arm is cold, pale white, numb or the nerve check is bad, your character has problems and needs to find his/her buddy who is an EMT.

The only indication for digging out the bullet would be if the bleeding is uncontrollable, otherwise, the bullet may actually be tamponading the tissue and slowing the bleeding at this point. Infection is later concern. The wound will ultimately need attention and the character will need antibiotics, but he has a few hours to worry about that.

If the bullet does need to come out, no probing with a pocket knife. Consider having him pour rubbing alcohol over a pair of “needle nose” pliers (from the nearest convenience store,) and then gently probe the wound path until he feels the metallic click of the plier’s tip on the bullet. He can then try to open the pliers, grasp the bullet and retrieve it. Apply firm pressure for 5 minutes and observe. If no bleeding he can do the towel and shirtsleeve thing. If significant bleeding, have him apply as much direct pressure as necessary to stanch the bleeding.

If your character is in the habit of being shot, he may carry a “Bloodstopper” product. They are small, useful, and I have them nearby all the time. The powder can be sprinkled on and will help with clotting. There is a product that you can insert directly into the wound track, “ouch,” that has the same chemical. They can buy your character some time.

Writers, here’s a fun resource: a real life doctor helping writers with medical details in their novels-in-progress.