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Bullet fragment removal from a transabdominal approach
3%
51/1751
Bullet fragment removal from a retroperitoneal approach
55/1751
Broad-spectrum oral antibiotics for 3-5 days
9%
163/1751
Broad-spectrum intravenous antibiotics for 7-14 days
76%
1327/1751
IV methylprednisolone at 5.4mg/kg/h for 48 hours
149/1751
Select Answer to see Preferred Response
The patient in the scenario has a GSW to the lumbar spine with neurologic deficits but without a retained missile in the spinal canal. In patients with visceral injury, the treatment is broad-spectrum antibiotic coverage for 7 days. Kumar et al reviewed 33 patients with GSW to the spine and associated visceral injuries. They concluded that 7 days of antibiotic treatment targeted at colonic flora is the treatment of choice. Roffi et al reviewed 51 low-velocity GSW that perforated the viscus prior to the spine. They concluded that broad spectrum antibiotics combined with bedrest significantly reduced the risk of spinal or paraspinal infections. Furthermore, bullet removal had no effect on infection rates. Velmahos et al followed 153 GSW to the spine for 28 months. While rates of sepsis were higher in the lumbar spine than cervical and thoracic spine, they concluded that retained bullets do not increase the likelihood of septic complications. Incorrect Answers: Answer 1 & 2: Indications for surgery with a GSW to the lumbar spine include 1) spinal instability 2) a neurologic deficit is present that correlates with radiographic findings of neurologic compression by the missile. 3) Lead missile is in contact with the cerebrospinal fluid (CSF). This patient does not have any of these criteria. Answer 5: GSWs are a contraindication for spinal dose steroids.
3.3
(41)
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