Grazed (twice)

Chief Complaint: Leg Pain

HPI: Pt heard gunshots and ran away, felt pain in his right leg, thinks he was "grazed by a bullet." Hurts to walk on his right leg. Denies other complaints.

Exam: One cm open wound to right leg with localized swelling and tenderness. Dried blood extending inferiorly from the wound down to the ankle. Quick primary survey reveals no other wounds. Slight limp to right. Distal neurovascular status normal.

X-ray: bullet fragments noted in soft tissues of right leg. No fracture.

While cleaning the wound, I noticed a 2 mm scab on the opposite leg at approximately the same level as the primary wound. It initially appeared to be either an unrelated minor scratch or dried blood which had been transferred or splattered from the primary injury, but when it was cleaned there was clearly a tiny open wound present with mild adjacent tenderness but no swelling.

X-ray: bullet fragment noted in soft tissues of left leg. No fracture.

Morals: 1) Removing all of the dried blood from a patient is necessary to exclude occult wounds. 2) Distracting injuries can be distracting to both patient and physician.