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-- [ From: Martin Herman * EMC.Ver #2.5.1 ] --
 
> From: Mgreenberg               \ Internet:    ([log in to unmask]
edu)
> To:   Multiple Recipients Of List Toxlist \ Internet:
> ([log in to unmask])
>
> Subject: Re: your mail
>
> The bullet will undoubtedly pass easily as do most ingested foreign
bodies.
> Given the general rate of GI motility I doubt that the presence of the
bullet
> in the stomach will pose a special problem if it sits there for a
period of
> hours. Longer than, lets say, four hours, i might become concerned. I
would
> give the patient activated charcoal despite the fact that it will not
> adequatley adsorb lead (if thats your main concern) But, I believe I
would give
> the patient polyethylene glycol solution in routine doses in order to
eprform
> whole bowel irrigation to remove the bullet and allay all concerns
about
> leakage, poisoning from lead or perforation. I do not believe that a
bullet in
> the stomach will lead to the same concerns we generally have about
bullets
> lodged against serosal surfaces or within joint spaces where, over
time, the
> bullet may leak significant amounts of lead which can be absorbed
systemically.
> Nonetheless, we would recommend  WBI.
>
>
> M. Greenberg, M.D., MPH, FACEP
> Associate Professor-Emergency Medicine Attending Physician-Medical
Toxicology
> Service Allegheny University of the Health Sciences Phila. PA
>
 
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