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kellyj00
May 11, 2007, 12:58 PM
A friend's teenage son was shot by a friend with a pellet gun and removed the pellet with just a pair of tweezers... that's what I would have done.

He's in the hospital now, they're saying tetanous. I'm not sure of his condition, but my friend was pretty bummed when he told me about it. I'm going out tonight to visit them in the hospital.

I called up a nurse friend and asked her what happens with tetanous. After explaining the story she told me that a tetanous shot lasts for 10 years. I asked how a LEAD pellet could be rusty and have tetanous...she said that it's just a wives tale that it has to be rusty metal to have tetenous. Any would is just as susceptable to tetanous as any other infection, but if you get a shot every 10 years you pretty much eliminate the possibility. She said that it is very possible to die from tetenous.

Not sure if I'm spelling it right...tetenous is also known as 'lock jaw'. She also noted that since it was a lead pellet, heavy metal poisoning could also be an issue. She said that on many occasions a gun shot victim may experience heavy metal poisoning because surgeons miss a part of a bullet that broke off.

She also noted that it's best not to be shot in the first place. I told her my friend is very responsible with his kids and guns but it was just a pellet gun and it was his son's friend who was being reckless. The kid is probably about 15. Keep an eye on youngens, even with pellet guns.

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JamisJockey
May 11, 2007, 01:02 PM
After being attacked and bitten on the right hip by a loose dog I had to get an updated tetanous shot.....not my most favorite day.....

Rickstir
May 11, 2007, 01:07 PM
Last December I had a knee replacement. As part of the pre-op exam they gave me a tetanous shot and a pnuemonia shot.

buck00
May 11, 2007, 01:10 PM
She also noted that it's best not to be shot in the first place. I told her my friend is very responsible with his kids and guns but it was just a pellet gun and it was his son's friend who was being reckless. The kid is probably about 15. Keep an eye on youngens, even with pellet guns.

Back when we were kids we used to have "BB gun wars" in the woods during the winter. We'd put on heavy clothing and goggles and basically play capture the flag. I think we had a 3 pump limit for the rifles. This wasn't the smartest idea (considering a BB could hit someone in the mouth) but at 12 yrs old you don't always make good decisions. :rolleyes:

Of course, this was back before paintball, laser tag, and air soft.

Hope he recovers without lock jaw.

Library Guy
May 11, 2007, 01:14 PM
Letís pretend for a moment that I know what Iím talking about. Tetanus is caused by a bacteria that can enter the body through any wound though puncture wounds are more susceptible because they bleed less.

Tetanus is a serious life threatening condition. Vaccines and boosters are an easy way to prevent a painful death.

Lead poisoning is almost always a result of ingestion of the metal. Lead foreign bodies left in human tissue pose almost no toxicological risk.

Car Knocker
May 11, 2007, 01:15 PM
but it was just a pellet gun

"Just a pellet gun" can, and has, caused serius injury and death when used improperly. They should be treated with respect, like a more powerful firearm, and children taught that they are not toys.

Thursday, December 28, 2006
Alabama boy was killed with pellet gun
From The Pensacola News Journal
PENSACOLA - An Alabama boy who was airlifted to Pensacola's Sacred Heart Hospital after an accidental shooting was killed by a pellet rifle, a coroner said.

7-year-old Austin Hunter Champion was shot in the chest by a playmate of the same age during a Christmas eve party at the home of Champion's father.

The boy lost consciousness on the scene and was pronounced dead in Pensacola at noon on Sunday.
http://tallahassee.com/legacy/special/blogs/2006/12/alabama-boy-was-killed-with-pellet-gun.html
---------------------
Death of Low Moor boy shot by pellet gun ruled accidental

LOW MOOR, Iowa Clinton County officials say the death of a Low Moor boy in March has been ruled accidental.

Seven-year-old Blake Hargrave died on March 29th, a day after he was shot in the eye with a pellet gun.

Authorities say was hunting with his older brother and a friend when his brother's gun accidentally went off.
http://www.wqad.com/Global/story.asp?S=6452177&nav=menu132_3_3
---------------
Pinson boy, 12, dies of pellet-gun wound

BIRMINGHAM (AP) ó A 12-year-old Pinson boy died after being shot in the chest while he and other children played with an air-powered pellet rifle.

Brendan Willis was shot by a 9-year-old playmate outside his father's home Saturday just before 6 p.m. The victim had taken a pellet rifle belonging to his father out of the garage and loaded it. He and four other neighborhood children had been playing with it.

The victim pumped the rifle seven times, handed it to the 9-year-old and stretched out his arms stating "Shoot me, I am wearing a bulletproof shirt." He was wearing an Under Armour T-shirt that he apparently thought was bulletproof. The 9-year-old fired one shot from the pellet rifle, striking the victim in the chest area.

The victim then went into the house and told his father he had been shot, showing him the wound. The father called 911, and the victim was transported to Children's Hospital, where he died in surgery.

Sheriff's office spokesman Sgt. Randy Christian said the district attorney's office will determine if charges should be filed.
http://www.decaturdaily.com/decaturdaily/news/050405/pension.shtml

JWarren
May 11, 2007, 01:19 PM
If they say I need a tetanous shot, I won't argue. Back when I lived in FL, I got hooked through the arm by a fisherman while I was surfing. He actually set the hook and started reeling before he realized he had me on the line.

It probably wasn't a bad idea to get a tetanous shot that day. :)


-- John

DogBonz
May 11, 2007, 01:21 PM
Back when we were kids we used to have "BB gun wars" in the woods during the winter. We'd put on heavy clothing and goggles and basically play capture the flag.

We used bottle rockets. Being 4th of July time, heavy clothing was not so good so we would put on a hooded sweatshirt, jump in the pool to soak it, then get out and put on dad's faceshield that he uese for woodworking, and then use a piece of 3/4" pvc pipe like a bazooka. Boy thoes were that days.

As you said, teenagers don't always use the best judgement.

DoubleTapDrew
May 11, 2007, 01:25 PM
If they say I need a tetanous shot, I won't argue. Back when I lived in FL, I got hooked through the arm by a fisherman while I was surfing. He actually set the hook and started reeling before he realized he had me on the line.

How long did it take him to land you? :p

I had to get a booster when I was about 16. I made the mistake of waking up my dog in the middle of a bad dream by shaking him and got a tooth through my hand. My shoulder hurt for a couple days from that shot.

JWarren
May 11, 2007, 01:29 PM
How long did it take him to land you?


Hehe... a LOT longer than I would have liked. The wind was blowing offshore, so my voice didn't carry to him. I had to wrap the line around my left arm (the hooked one-- hooked in the bicep) around the line and start swimming in.

As soon as he realized it, he cut his line and went to me. We had to cut the barb off with wire cutters that he had in his tackle box and then pull the hook back through my arm. He even offered to pay for my Dr. visit.

Those things do happen, but it's no biggie. The people who live in Bethune Beach, FL are some of the nicest people you will ever meet. And it's a beautiful little coastal town.

-- John

unspellable
May 11, 2007, 01:42 PM
When I was a kid, I was reaching into the ditch for something when the neighbor kid shot into the ditch with a BB gun. The BB ricocheted off a rock and hit the upper side of my index finger between the knuckle and first joint. It opened the skin, one presumes the BB had a jagged edge from bouncing off the rock. This wound later festered up like a boil and then developed into blood poisoning, resulting in a shot of penicillin in the right cheek in the mornings and in the left cheek in the afternoons for a few days. I’d suppose in the days before penicillin they might have considered sawing my arm off.

A few years later, in a town about 26 miles away where my dad worked, they had a Christmas display on the courthouse lawn with some deer in a pen. During the night, some one shot one of the deer at close range with a plastic bullet and primer load. This is a bad combination. The plastic bullet usually causes a bruise and the sharp front edge will open the skin at close range. An open wound over a bruise is an invite to infection due to the restricted circulation. This wound festered and by the time they realized what was going on it was too late to save the deer.

ArmedBear
May 11, 2007, 01:46 PM
I told her my friend is very responsible with his kids and guns but it was just a pellet gun and it was his son's friend who was being reckless. The kid is probably about 15.

VERY important lesson for teenagers: your friends are not always as smart or as responsible as you. Don't worry about hurting their feelings; worry about your own safety. He and his buddies will be driving soon. Part of responsibility is knowing who ELSE can be trusted.

I'm not blaming the victim. I'm just suggesting something that could save his life. I was a teenage kid once, too.:)

Quoheleth
May 11, 2007, 01:54 PM
Lead poisoning is almost always a result of ingestion of the metal. Lead foreign bodies left in human tissue pose almost no toxicological risk.

Any lead that is taken into the body can be dangerous - whether orally, via a cut (i.e. a wound), breathed in, or other ways (???). The point is that a heavy metal is now where it shouldn't be: inside the human body. That being said, lead poisoning is probably most common via the mouth or by breathing and least common via a wound. One pellet probably would do no major harm...the human body is incredibly resiliant...but then again, why take a chance?

FYI: I had to get a tetanus booster after getting burned! I fussed at the nurse that it was a plastic bowl and plastic spoon - no metal at all. (Using the same logic as the anti-gun crowd, I should have sued Ramen Noodle for not having a fail-proof safety on their package, failing to put a lock on the microwave, or a temperature control system built into the noodles!) Nope, she said, burn patients always get a shot. So, it was bend over and smile - let's see the dimples in those cheeks!!!

Q

Bob R
May 11, 2007, 01:56 PM
You have to be careful out there. Tetanus bacteria lives in the soil, and loves an oxygen free (anaerobic) environment like a puncture wound, or deep slashing injury.

In my ER, if you have a wound needing a tetanus shot and it has been more than 5-7 years (or you don't know) since your last one you will get one. The dirtier or deeper the wound, the less time since your last booster to now to get one.

Hopefully this kid has had his prior immunizations, that will lower his chances of something very, very bad to about 6%, versus much higher if he has never been immunized. At this point I could go on a rant about illegal aliens and the cost to our health care due to lack of immunizations, but I will save that for another day. Besides, I don't think there have been any formal studies conducted. Hmmmmm...do I smell a grant?

For us that shoot at an outdoor range (shooting reference :) ), it is important to keep your tetanus up to date. You never know what is lurking in the ground. There are about 5 deaths per year in the US due to tetanus. With your immunizations complete and up to date, the chance of contracting tetanus is very rare. So, go check your tetanus status and get a booster if it has been more than ten years (my public health spiel for the day).

I figure tetanus boosters are a lot like garlic, it is really hard to get too much of either.

Sending thoughts that your friend's son recovers fully from this.

bob

frostbiker
May 11, 2007, 02:00 PM
The jacketed portion of a .45 slug sliced me open pretty good last year. This was during a defensive pistol class. We were standing about 15 feet from the backstop of an indoor range. Bullet struck and the fragment blew back and nicked me good. Needed two stiches and a new tetanus shot. I haven't had a tetanus shot for over ten years...more like 20. And I've had plenty of run-ins with other pokey metal things perforating my body.

Princi
May 11, 2007, 02:26 PM
Let's see: My Beeman pellet gun is 1000fps, just a little enemic by today's standards. My 1911 shooting .45 ACP is 835fps. No, my pellet gun is not a toy, and there are a lot of dead toads and rabbits that if they were still alive could attest to that. Hey, didn't they see the "No Trespassing" sign in my backyard.

obxned
May 11, 2007, 02:44 PM
Good reminder for us all who haven't gotten a Tetanus shot in a long time!

El Tejon
May 11, 2007, 02:50 PM
Dr. Bob, I take my fish oil and garlic pill every morning and evening. Do I need to get some tetanus pills too?:p

Had not considered the risk of tetanus and shooting, well, very seriously considered. I get whacked every now and then from bounce backs. I should get updated then.:)

CountGlockula
May 11, 2007, 03:06 PM
Back in my middle school days, my buddy decided to become a sniper using a BB rifle and aimed at another friend on the street. He aimed and shot him in the chest.

We all laughed it off. Found out later that the friend that got shot didn't go to a doctor or hospital, but left it there. The BB eventually moved around his back and fell off out of his skin. Funny how the body works.

MDW GUNS
May 11, 2007, 03:12 PM
Tetanus is one of the shots everyone should have.
Just working in the yard, little scratch and you are at rist.
So what is a little shot in the arm.

XavierBreath
May 11, 2007, 03:15 PM
First, I'm a registered nurse, have been practicing for close to 15 years. I have done complex wound care and surgery. I know a bit about this kind of thing.

Tetanus (AKA Lockjaw) is a potentially fatal disease caused by a neurotoxin (tetanospasmin) produced by an anaerobic sporing bacterium, Clostridium tetani. C.tetani thrives in the abscence of oxygen, therefore making it exceedingly dangerous in a puncture wound, which closes upon itself and is difficult to irrigate thoroughly. I am not certain, but to definitively diagnose tetanus, I believe a culture must be done. The results usually can be read two to three days after innoculation of the growth medium. However, it is estimated only 1 in 3 people with tetanus have a positive culture. Antibody serology testing is also often negative. The disease is only suspected unless there are positive results. It is, however often treated symptomatically due to the severity of the consequences if left untreated.

The symptoms of tetanus are pretty well defined. They are:
A dirty wound (this is any wound outside a surgical environment)
Descending muscle stiffness and spasms
Problems with swallowing or breathing
Arching of the back and neck
Inability to pass urine
Sweating
Erratic tachycardia

Most practioners agree that within 72 hours of a puncture wound, a patient with no previous history of a tetanus immunization first needs tetanus immune globulin or tetanus antitoxin to get temporary protection. Next, he needs active immunization with tetanus toxoid. A patient who hasn't received tetanus immunization within 5 years needs a booster injection of tetanus toxoid.

If tetanus appears anyway, the patient requires airway maintenance and a muscle relaxant, to decrease muscle rigidity and spasm. If muscle contractions aren't relieved by muscle relaxants, a neuromuscular blocker may be necessary.

A person with tetanus commonly needs high-dose antibiotics, usually a form of penicillin administered IV if he isn't allergic to it. If he is allergic to PCN, tetracycline can be substituted. Some Docs now use Fagyl.

Vaccinations prevent tetanus. Children who are less than 7 years of age can receive DTaP vaccine, a one shot combination vaccine against diphtheria, tetanus and whooping cough. Teenagers and adults should receive booster doses of Td vaccine, a combined vaccine against tetanus and diphtheria every 10 years.

Now, here's the reality of the situation.........There is a very good chance that the tetanus (assuming it is present) was introduced through the use of non-sterile tweezers in the amateur medicine attempt to remove the BB. Obviously, don't increase the parent's feelings of guilt by telling them this. I say it here just to inform others. If you have a puncture wound with a foreign object beneath the surface of the skin, do not go probing around underneath the skin looking for the object unless you have the sterile equipment and skills necessary to safely complete the task. Doing this kind of amateur medicine can lead to this type of infection (among other types) sepsis and death. Whether you want to or not, have the object removed by someone with the skills and equipment to do it without introducing more non-sterile objects into the body. If you can squeeze it out, fine. If you can pull it out by a part above the skin, fine. If it is embedded, you take the risk of causing greater harm without the right sterile equipment.

This applies, obviously, to small objects in the flesh, not arrows in the torso or knives in the neck. Infection and sepsis of any type can be very dangerous. I have seen people lose limbs and even die as the end result of small wounds introducing a pathogen into the body. The best course of action is always, when in doubt, seek treatment.

Bob R
May 11, 2007, 03:22 PM
Dr. Bob, I take my fish oil and garlic pill

Actually, Nurse Bob..

I also take my fish oil pill daily, but prefer my garlic the old fashioned way, in "everything" I cook. :neener: :)

I wish there were pills for a lot of the stuff that many of us forget or let slide, I also wish there was a pill so my wife would quit saying things like "Another gun, didn't you just buy one?"

bob

thexrayboy
May 11, 2007, 10:46 PM
Xavier and BobR have covered Tetanus and its complications very well. Moral of story is keep your immunization current. As for lead poisoning from bullets left behind?...theoretically possible but in the real world the risk is minimal at best. Thousands of war vets and crime victims have lead souvenirs left in the body due to the fact that fishing for the bullet will frequently cause more injury and damage than the bullet did. All do well once they have recovered from the incident that introduced them to the Pb. Lead poisoning occurs when lead is ingested, absorbed or inhaled into the body and becomes an active part of the metabolism. Lead that is introduced through violent physical energy bypasses the metabolic process and is a very low risk source for poisoning. Over the course of many years your serum blood level of lead may rise due but this process is long and slow. Lead poisoning via GSW is so rare as to be basically a non event, possible but not something to be highly concerned about.

revolverman357
May 12, 2007, 10:06 AM
My doctor told me that I was allergic to tetenous shots. My arm swells up and is so painful I can hardly move it for about a week. He never really said if there was an alternative.
Any suggestions?

Lupinus
May 12, 2007, 10:21 AM
according to the er doc when I took mom for stiches the most common tetnus he sees are from breaking a glass while doing the dishes.

230RN
May 12, 2007, 10:50 AM
XavierBreath:

Many many thanks for your comments!

I can't recommend this since I am not a medico of any kind, but I have found that Tincture of Iodine seems to be very helpful in first-aid treatment of these small punctures.

It seems to me the iodine sort of percolates/penetrates down into the wound and sterilizes it. My observation is that it slows down the healing quite a bit, but I rarely --almost never --get any kind of infection when I slather iodine on one of these minor wounds --pin pricks, paper cuts, pine needles in the foot, some insect bites, etc. (The iodine, an active oxidizer, seems to chemically disrupt whatever irritants are in the bite.)

I also slather it on whenever I have any unexplained itching anywhere. It kind of looks like a nitric acid stain for a while, but it seems to work.

I emphasize that whenever I use this treatment, I don't regard it as a cure-all or a "remedy," and I keep an eye on the wound for a while and will certainly seek more competent treatment if anything goes haywire.

However, I wondered if there were any comments you could offer regarding the effectiveness of Tincture of Iodine in initial treatment of these small wounds.

(When the FDA banned Tincture of Iodine for a while some years back, I found the substitute, an aqueous solution of a complex ammoniated iodine, woefully inadequate. And of course mercurichrome(sp) is banned totally.)

Comments, please?

Lupinus
May 12, 2007, 11:06 AM
I miss mercurichrome. Funny how all the stuff we seem to have banned or forgotten about for the new wonder stuff worked just fine or in some cases better. Give me some mercurichrome and/or Iodine anyday over tripple antibiotic creams.

Ghengis Kahn
May 12, 2007, 01:01 PM
hell, my dad and his buddies played tag with .410 birdshot. They wore Carhart coveralls. Dumbasses :banghead:

XavierBreath
May 12, 2007, 02:11 PM
230RN,
Here is my take on Tincture of Iodine. It will disinfect wounds, but not sterilize them. In my opinion, it is impossible to sterilize a dirty wound without surgical debridement. All wounds outside the surgical suite must be considered to be colonized with bacteria. The real question is not whether the wound is contaminated, but rather how well is the body responding to the infection. It is only possible to prevent even a sterile surgical incision from becoming contaminated for a short period of time. Thus, in my mind, all wounds are infected. Is the infection under control?

Betadine, used for a long time in surgery is a well known antimicrobial, and it works fairly well, except you simply smear dead microbes all over the prepped surface of the skin prior to draping and making the incision. That is why incisable drapes, such as 3M's Inoban have become the standard. They are like a Tegraderm with an iodophor impregnated adhesive, and are stuck over the standard sterile drape's opening to provide a sterile surface all the way to the wound edge.

When it comes to puncture wounds (and only puncture wounds), here is my method, backed up by nothing but my own experience. First, let it bleed, as long as it's not arterial bleeding, or even if it is arterial, as long as it's not excessive. This flushes the wound from the inside out. Anything placed into the wound, even a prep around it to "sterilize" the area runs the risk of introducing more pathogens from the surrounding skin. Second, once it has bled and stopped bleeding (use a sterile compress straight down if the bleeding lasts longer than a few minutes), evaluate the injury using your eyes. Get an Xray to see if there is a foreign object still inside. If you have an intact object that created the puncture, this step can be omitted.

At this point, I like a bit of Inoban stuck over the surface, using sterile technique, to prevent the migration of any more bacteria. Then a small, quarter inch sterile incision through the Inoban to the wound itself, to allow it to drain. If you are going to do a FBR, you must use sterile protocol. Now is the time to do it.

Next, apply a sterile dressing to contain the drainage for evaluation. Dressing changes should be timed to cope with the drainage, or when soiled from outside. They should be performed BID for the first 2 days to evaluate the surrounding area, then QD. Obviously, the protocol for tetanus should be followed as well.

To heal the wound, I rely on the patient's immune system first and foremost. I boost the immune system with high protein, beans, red meat, fish, Omega 3 fatty acids, zinc, multi-vitamins. Those white blood cells are pathogen hit men. Get them going! This is not a time to scrimp on calories. I am not a fan of broad spectrum antibiotics being given prophylactically, but in this case, it's not a bad idea, especially if the puncture was done by a nasty object. I evaluate the immune system's response with a CBC after about 24 hours. If the immune system is not responding well, or if complicating symptoms appear, I do not hesitate to get the Doc to re-evaluate and I want to see changes in the plan of care.

For punctures, that is what I do. For a GSW or other severely tramatic punctures, I will increase the frequency of dressing changes for wound assessment. I assess color, odor, swelling, temperature, pain, and especially the condition of distal tissue and pulses on affected limbs. Compartment syndrome is always a consideration until the infection is under control. I assess the drainage as well as the wound. There is a difference between inflammation and infection. Inflammation is the body's response. Infection is the pathogen's presence. I expect inflammation. It tells me the immune system is working. It is not a bad thing at all.

Some of these protocols deviate from standard, but I achieved very good results using them. I think far too often the thinking is a wound is a wound, is a wound. Wounds are not all alike, each is unique, and each presents unique challenges. I do not treat wounds though. I treat patients.

FWIW, my protocol I have stated here is for punctures that are considered complex wounds. For pin pricks and the like on myself, I just bleed them and watch them. I wash my hands in alcohol each AM as I am in the locker room changing into scrubs. If I have a break in my skin integrity, the alcohol will burn and alert me. I cover the break with Inoban, an Opsite, or Tegraderm and go about my business. This is not a necessary thing for anyone else to do, just a good tidbit for nurses and docs who often deal with infectious diseases and infectious environments.

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