Pellet Gun

Normally they don't hurt this much; even birdshot is more of a nuisance, really, than true pain. I saw one guy with about thirty pellets in the side of his face and chest who didn't really need more than a dose of pain medicine. So I'm taken aback that he's sweating and arching before I even push on his belly. The sweat and penetrating trauma don't go together well. Heart rate's over 120--but it's just a bb. Can't be that bad, right?

He had come in with mom through front triage, and the nurses, bless them, had already labeled her hysterical. One nurse says 'she doesn't think we're doing enough to take care of them'. Ok, fine, but...'I think the bb is still in there', mom says, worried. She didn't see what happened and the patient is not in the mood. So, look for other witnesses--his friend. The bb gun, or air rifle, was really close when it went off. Like, really close. Neither one thought it was loaded. Mom pushes around the tiny dimple of exposed, red, subcutaneous tissue through the center of the wound in the lower stomach. 'I could feel it', she says, 'and now it's gone'. Has anyone seen the bb? No?

I can't feel it either, so x-ray it is; on the lateral abdominal film, it's deep, and there's that subtle rim of free air on the decubitus film. It's just a bb! That no one found because it's deep to the intestines. Away he goes, stable, luckily.

Moms certainly do go after those who harm their little ones at times, and yes, they can be hard to deal with. But if mom says she 'feels the bb', maybe that's because she carried this 14 year old boy inside for 10 months and nursed him for years, and can 'feel' the bb through the layers of fat, muscle, and peritoneum. So if she's worried, I'm worried.

Pellet and air guns have a muzzle velocity at times as great as a hunting rifle. The energy is low because of the low mass of the pellet or bb, but in this case, it wasn't the energy--it was the penetration.

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