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Comments by YACCS
Monday, February 13, 2006

What peppering looks like

So, that's pellet 79? Only
321 to go

From a surgeon: What Cheney's victim may be facing
by AmberJane [Subscribe]
Mon Feb 13, 2006 at 12:44:35 PM PDT

I haven't examined Mr. Whittington, the man the Vice President shot, nor seen much detail on his case. But facial plastic surgery is what I do, and I have seen fairly awful traumas to the area. Both during residency in the US and as a volunteer in Kosovo, it's my judgment that it doesn't get a lot worse than a shotgun discharge to the face - few traumas cause pose a greater challenge to surgeons in my field.

Patients with shotgun injuries to the face need to be intubated and sedated at once. Protection of the airway is paramount because hemorrhaging is virtually certain. The primary concern here is aspiration of the hemorrhaged fluid. A secondary concern is emesis of ingested fluid from the fast bleeders in the area - particularly the superficial temporal artery, the angular artery, or the facial artery.

Once the patient is stabilized, the attending physician will examine, visually and by palpation, from the scalp downwards and outwards. He or she will be looking for bone fracture, nerve damage, asymmetry - that sort of thing. It's not typically possible to assess the sensory or motor functions of the face at this stage because the patient is unconscious - and this is probably why Mr. Whittington is in the ICU.

At this point I'd order radiographs to see how much damage is done, and ideally an MRI except that if they use steel shot in Texas, you can't do that. So a CT is probably indicated - lateral obliques through the orbits especially. The anatomy is complicated and fragile in the area, so you really need to be careful.

Finally, surgical repairs. The surgeon will carefully assess and reduce any jaw or bone fractures, debride any remaining shot, bone fragments, and soft tissue that can't be salvaged and then put any displaced but viable soft tissues back where they're supposed to go. And a 28 gauge round contains, depending on the shot size, somewhere between 200 and 400 individual pellets. For a surgery like that, I'd expect to be in the OR pretty much all day. This is not a 90 minute rhinoplasty.

Assuming the patient survives to this point, a complete facial reconstruction procedure can be undertaken, which, assuming good patient health and no postoperative infections, can take several years. Careful counselling both of the patient and his family is indicated, and the surgeon needs to be very honest about expectations.

Remember, this is a 78 year old man who will be going under general anesthesia. He may well die from the stress of the surgery or underlying conditions

posted by Steve @ 3:34:00 PM

3:34:00 PM

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