Wednesday, November 28, 2007

NFL tragedy

Sean Taylor died from a gunshot wound to the groin yesterday. It sounds like he sustained a significant injury to his femoral artery and lost massive amounts of blood. When EMS arrived he was barely conscious and vitals signs were negligible. Untimately he underwent 7 hours of surgery to fix the artery (and fasciotomies I presume) but he expired the next day. It's unusual to die from a gunshot wound to a peripheral vessel in civilian penetrating trauma. The femoral artery is ensheathed in layers of fascia and muscle such that, even in transecting injuries, the pressure of the surrounding hematoma will tamponade the pulsatile flow. I've seen plenty of major femoral and popliteal gunshot injuries from my time at Cook County where the patient presented relatively stable because the proximal injury had simply thrombosed. I suspect that perhaps Mr Taylor was shot by a high velocity firearm that caused significant soft tissue destruction around the vessel, thereby exposing the artery and allowing it to simply bleed out. The fact they were able to get him to surgery indicates that they were able to resuscitate him to some extent with blood products and saline. Why he died 24 hours after the attack is probably due to secondary events such as anoxic brain injury, ARDS, and SIRS caused by the initial insult of such massive blood loss. Just a nightmarish occurrence.

7 comments:

Sid Schwab said...

And maybe the artery wasn't completely transected, so it couldn't retract.

make mine trauma said...

Thanks for answering that question. I was a little confused as to how he died post op from a femoral art. injury.

DKV said...

Does 7 hours seem a bit long? If he was that sick I would have expected some damage control and then off the to SICU for resuscitation. 7 hours sounds like someone tried to turn him back into an NFL safety.

Buckeye Surgeon said...

DKV-
They probably kept losing the distal doppler signals and were forced to keep revising the graft. Some of these vascular injuries can turn into a nightmare where you're jumping secondary grafts off primary ones and everything keeps clotting on you. They may have had to to do a fem-pop bypass and harvest all the vein required, so 6-8 hours could be reasonable.

DKV said...

When do you say enough is enough and just tie the sucker off?

Buckeye Surgeon said...

Tying it off means a an above knee amputation; tough to go that route with a young professional athlete.

DKV said...

That's what I was hinting at - remain an NFL athlete, stay in OR longer, get colder, get coagulopathic, remain under-resuscitated, die.