A thorough neurovascular exam: The zone of injury of a bullet wound is defined by the cone of energy dissipation surrounding the bullets path, not just the linear path of the bullet. This makes the tissue injury much larger than the caliber of the bullet, often, and the energy imparted to surrounding tissues can cause neurapraxia or vascular injury.

Skin examination: Entrance and exit wounds should be examined; if there is no exit wound, the location of the bullet must be identified. Intra-articular bullets or fragments are indications for surgical irrigation and debridement.

Concomitant injuries should be ruled out.

Timing: If a patient has an operative fracture, it will be treated as an open fracture—provide antibiotics immediately.

Agent: Weight-based cefazolin should be given. Often this is the only antibiotic that is required.

Neurovascular compromise

Intra-articular/intrathecal fragments