Representative
Steve Scalise, wounded by a gunman on a baseball field on Wednesday, is
likely to endure multiple operations as surgeons try to stanch bleeding and repair the damage to his internal organs.
Officials
at MedStar Washington Hospital Center said that the bullet, fired from a
rifle, entered Mr. Scalise’s left hip and tore across his pelvis,
cracking bones and injuring internal organs.
On
Thursday, he underwent a second surgery for internal injuries and a
broken leg. Doctors said his condition was critical but improving. He is
expected to remain in the hospital “for some time,” according to a hospital statement released Thursday night.
It’s the kind of trouble trauma surgeons see often, and they have learned though bitter experience how best to deal with it.
The
first priority is to operate to stop the bleeding and control any
contamination that might arise from something like a torn intestine.
Afterward, hospital staff members wheel the patient from the operating
room straight to intensive care, often with the abdomen still open.
The next steps are to seal small blood vessels that may be torn and then to operate, if necessary, to permanently repair damage.
A
gunshot victim may undergo two to 10 operations, said Dr. Jeremy
Cannon, a trauma surgeon at the University of Pennsylvania, and may
remain in the hospital anywhere from days to several months.
Still,
the results are far better than in the old days, before the early
1990s, when surgeons tried to do all the repairs at once, operating for
hours at a time.
In a study that
changed medical practice, surgeons found that trauma patients with the
most severe abdominal injuries who received one long operation had just a
15 percent survival rate. But those with the same sort of injuries who
got multiple operations to repair the damage had a survival rate of 77
percent.
The
lesson for surgeons is that long operations can be fatal to trauma
patients. “The body can only take so much,” said Dr. Thomas Scalea, a
trauma surgeon at the University of Maryland School of Medicine.
Surgeons now employ the multistage approach.
These
days trauma patients who do not bleed to death right away usually
recover, said Dr. Sean Montgomery, a trauma surgeon at Duke University.
Patients
with gunshot wounds through the abdomen may need as much as 10 units of
blood — two-thirds of the entire amount in the human body. “The most
immediate threat to life is bleeding to death,” said Dr. Alok Gupta, a
trauma surgeon at Beth Israel Deaconess Medical Center who is not
familiar with Mr. Scalise’s specific injuries.
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