<p>A CAT scan showed that the piece of metal, about two and a half inches long, was probably a cartridge fragment — again, not at all unusual.<br /><br />But as the patient, an Afghan soldier in his 20s, was prepared for surgery, the chief radiologist, Lt Col Anthony Terreri, took a closer look at the CAT scan. Stunned, he realised the object was an explosive round, primed to go off.<br /><br />“It looks like we have a problem here,” he announced. To say the least.<br /><br />Docs in armour<br /><br />Maj John Bini, a trauma surgeon and a veteran of homemade-bomb injuries from two previous deployments in Iraq, immediately evacuated the operating room. Only the anaesthesiologist, Maj Jeffrey Rengel, who put on body armour, was left to watch the patient.<br /><br />The surrounding hallways were secured, and a bomb disposal team was urgently summoned. All electrical monitoring devices in the operating room were turned off for fear of detonating the round. To keep track of the patient’s vital signs, doctors turned to manual blood pressure cuffs and a battery-operated heart monitor, and they began counting drips per minute to estimate the amount of the intravenous anaesthesia they were giving the patient. “It was taking anaesthesia back about 30 years,” Dr Rengel said.<br /><br />Within 30 minutes, the bomb disposal team arrived and confirmed that the patient indeed had unexploded ordnance in his head. “They said, the way these things are set up, this type of round has an impact detonator on the front of the charge,” Dr Bini said. “They just said, ‘Don’t drop it.’ ”<br /><br />With that for reassurance Dr Bini put on body armour as well, and he began the process of surgically removing the round from the patient’s head, joined in the operating room only by Dr Rengel and a member of the bomb team. He cut through scalp tissue and made a large incision encircling the round, which was lodged under a piece of skull bone and jutted down the right side of the head. Within 10 minutes, he pulled out the live round. With care, he handed it to the bomb technician, who put it in a bag and left.<br />Did Dr Bini breathe a sigh of relief before handing off to a neurosurgeon?<br /><br />Uncommon<br /><br />“I didn’t even think about breathing a sigh of relief,” Dr Bini said. “It wasn’t a complicated procedure, and I had the confidence that I wasn’t going to drop it on the floor. This is something we train for — though it’s a very uncommon event.”<br /><br />The patient, who was not named by the doctors, has since been discharged and is recovering. Although he has brain injuries from bone fragments, the Afghan was able to walk, to talk and to eat on his own.<br /><br /></p>
<p>A CAT scan showed that the piece of metal, about two and a half inches long, was probably a cartridge fragment — again, not at all unusual.<br /><br />But as the patient, an Afghan soldier in his 20s, was prepared for surgery, the chief radiologist, Lt Col Anthony Terreri, took a closer look at the CAT scan. Stunned, he realised the object was an explosive round, primed to go off.<br /><br />“It looks like we have a problem here,” he announced. To say the least.<br /><br />Docs in armour<br /><br />Maj John Bini, a trauma surgeon and a veteran of homemade-bomb injuries from two previous deployments in Iraq, immediately evacuated the operating room. Only the anaesthesiologist, Maj Jeffrey Rengel, who put on body armour, was left to watch the patient.<br /><br />The surrounding hallways were secured, and a bomb disposal team was urgently summoned. All electrical monitoring devices in the operating room were turned off for fear of detonating the round. To keep track of the patient’s vital signs, doctors turned to manual blood pressure cuffs and a battery-operated heart monitor, and they began counting drips per minute to estimate the amount of the intravenous anaesthesia they were giving the patient. “It was taking anaesthesia back about 30 years,” Dr Rengel said.<br /><br />Within 30 minutes, the bomb disposal team arrived and confirmed that the patient indeed had unexploded ordnance in his head. “They said, the way these things are set up, this type of round has an impact detonator on the front of the charge,” Dr Bini said. “They just said, ‘Don’t drop it.’ ”<br /><br />With that for reassurance Dr Bini put on body armour as well, and he began the process of surgically removing the round from the patient’s head, joined in the operating room only by Dr Rengel and a member of the bomb team. He cut through scalp tissue and made a large incision encircling the round, which was lodged under a piece of skull bone and jutted down the right side of the head. Within 10 minutes, he pulled out the live round. With care, he handed it to the bomb technician, who put it in a bag and left.<br />Did Dr Bini breathe a sigh of relief before handing off to a neurosurgeon?<br /><br />Uncommon<br /><br />“I didn’t even think about breathing a sigh of relief,” Dr Bini said. “It wasn’t a complicated procedure, and I had the confidence that I wasn’t going to drop it on the floor. This is something we train for — though it’s a very uncommon event.”<br /><br />The patient, who was not named by the doctors, has since been discharged and is recovering. Although he has brain injuries from bone fragments, the Afghan was able to walk, to talk and to eat on his own.<br /><br /></p>
