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January 10th, 2011
06:25 AM ET

Gupta: What helped Giffords survive brain shot

CNN's Chief Medical Correspondent Dr. Sanjay Gupta is a practicing trauma neurosurgeon and associate chief of neurosurgery at Grady Memorial Hospital in Atlanta.

Rep. Gabrielle Giffords is in critical condition on a ventilator after being shot through the back of the left side of her head, yet doctors are “cautiously optimistic” about her survival. That she is alive at all is surprising to many people, but people survive these types of injuries more often than you may think.

While every patient and injury is different, on average – around 2/3 of patients with a gunshot wound (GSW) to the head don’t live long enough to make it to the hospital. Of the third that do make it, only 50% of those patients survive longer than 30 days. And of course, those numbers say nothing of long-term neurological function in the survivors.

So far, according to her doctors, Giffords is likely to be in the small minority of patients who will beat the odds. So, what placed those odds in her favor?

First off, she received very quick care, and was in the operating room within 38 minutes after arriving at the hospital. Her overall health and youth also provide some benefit. The injury was a “through and through” injury, meaning there was both an entry and exit wound. That’s significant because some of the energy of the bullet was dissipated into space, as opposed to all within her cranial cavity.

Neurosurgeons will want to know if the bullet passed across the midline of the brain. If it does, there is a much poorer likelihood of survival. In Giffords' case, it did not. Other positive factors: Her blood pressure didn't drop as a result of the bleeding, and the oxygen supply in her body was maintained, according to her doctors that I interviewed.

Finally, the fact Giffords was “following commands” even before she had an operation was a very positive sign.

To follow commands signifies a higher level of brain function than simple reflexive movement. It indicates that she was able to hear the command. She was able to process the meaning of that command, and finally, she was able to execute the command. I spoke to Dr. Randall Friese, the trauma surgeon who examined Giffords when she arrived at the hospital. He told me she was clearly able to understand him, and squeezed his hand when asked to do so. And, after the operation, Giffords was still able to follow commands.

During an operation like this, doctors want to control bleeding, remove fragments of bone that have penetrated the brain, and remove any dead brain tissue along the trajectory of the bullet.

Also, her neurosurgeon, Dr. Michael Lemole, removed additional bone on the left side of her head, as I explain in the video above.  That is called a craniectomy, and is done to prevent the catastrophic consequences of brain swelling, which is a big and real concern over the next several days. Think of it like this: Unlike organs in others parts of your body, if the brain swells, it has no place to expand - as it is confined by the rigid skull. Because Lemole removed portions of the skull, he provided extra room for the brain to swell. Incidentally, the bone that’s removed is saved, and put back in the head during a future operation.

In medicine and surgery, doctors are reluctant to quote statistics, because every patient is a true individual –that includes Gabrielle Giffords. And, no doubt, Giffords is not “out of the woods” yet. But, “cautiously optimistic” sounds pretty good after an injury as devastating as this one.



soundoff (324 Responses)
  1. HeyZeus

    I've heard the stories of the man that jumped in front of his wife to safe her, hero BTW. I would like to know though, The Congresswoman seems to have gotten the immediate treatment, but what of the 9 year old? Where was she shot? Was she killed on bullet impact?

    This isn't as shallow as it might seem. i would like to know if all attention was on the congresswoman, or were EMT's also helping the child at the same time? When you triage wounded you are supposed to identify the most likely to survive if resources are low. Unless the child had died already, why weren't her wounds treated over a head injury. Don't get me wrong, I am happy the Congresswoman has a chance to survive, I would just like to know if anyone was 'overlooked' due to their lack of DC address.

    January 10, 2011 at 09:53 | Report abuse | Reply
    • HeyZeus

      *to save her.. sorry for the typo

      January 10, 2011 at 09:54 | Report abuse |
    • HayZapperman

      @HeyZeus..how easy for you make a statement when you're not there when it happens. I hope you're comfortable sitting that chair you bought from walmart while punching non-sense on that keyboard.

      January 10, 2011 at 10:15 | Report abuse |
    • hersh

      HeyZeus, to get accurate answers to your questions, you probably would need to ask someone that was there and witnessed the ordeal after the shooting and not try to find answers on a comment thread. It just seems that the congress woman got treatment first because of all the publicity due to her being a public servant and the apparent "target" in the attack. just because I didn't read (or see) as much coverage about the treatment of the man and his wife, doesn't mean that they weren't cared for quickly....or the other 3 victims for that matter. I did read in another article that the 9 y.o. was shot in the chest and was pronounced dead later at the hospital after attempts to revive her.
      If this had not been an assaination attempt on a public servant or there be a 9 y.o. girl born on 9/11/01 involved, it wouldn't get this much attention. Thats just the nature of news reports IMO.

      January 10, 2011 at 10:23 | Report abuse |
    • hersh

      Here is an article that you should enjoy HeyZeus. http://news.yahoo.com/s/ap/20110110/ap_on_re_us/us_congresswoman_shot_heroes_5

      January 10, 2011 at 10:37 | Report abuse |
    • DesertRat

      I heard a local news report, and an eyewitness reported that the child was being treated on the scene immediately, but she was DOA. This eyewitness was a nurse who just happened to be there and was treating another bystander–she couldn't see where the child's wound was, according to her report, but it was clear that everyone was being treated. You might check out KOLD's website to see if you can find more info. They've had excellent coverage.

      January 10, 2011 at 13:11 | Report abuse |
  2. ShrNfr

    The most famous case is Phineas Gage who was distracted while tamping down a charge of dynamite when engaged in building a railroad track in the mid 1800s. The tamping rod set off the charge and shot the rod through his head. He survived for over 20 years, but since the tamping rod (a 3 foot section of iron rod 1 inch in diameter) took out his limbic system, he was a profoundly troubled person for that period. He was buried with the rod, but the family allowed Harvard to exhume the body and have both his skull and the rod. They are on view there.

    I wish all those wounded a rapid and complete recovery. Sadly the insane will always be with us.

    January 10, 2011 at 10:00 | Report abuse | Reply
    • ShrNfr

      I forgot to add my condolences to the family and friends of those who were killed. Please forgive me.

      January 10, 2011 at 10:01 | Report abuse |
  3. yobes

    Although I was interested in the article and found it informative, this string of comments I enjoyed immensely. Lesson: before sending snobby comments on spelling and grammar, proofread it. Thank you all!

    January 10, 2011 at 10:00 | Report abuse | Reply
  4. antonio

    I'm concern about those people that have worried about the spell error ... Daaaaammmm don't you guys care about peoples life....by the way this country is becoming likely mexico... It sucks.. Let's ask God mercy on us.....

    January 10, 2011 at 10:05 | Report abuse | Reply
  5. Jack Adams

    Hope she makes it. Sad day for United States. People forget that we have a right to vote someone off if they don't like them But of course putting folks under crosshair does provide these types of nuts a violent alternative. Instead of banning guns we should try and make speech that provokes hatred and violence punishable. Shame on some of these sore loser politicians for provoking this type of violence. May the kind god give peace to the families that have lost their loved ones.
    As usual – great article by Dr. SG.

    January 10, 2011 at 10:06 | Report abuse | Reply
    • ...Abby

      Are you serious? First off, blame something completely off-base yet touted by the mainstream media for it, then suggest limiting our First Amendment? . If you try and get into people's minds by deciding what they can and can't say, nothing will change. Couldn't this man have been found earlier if he had exercised his right to free speech and someone noticed? Furthermore, you blame Sarah Palin while now and before, she is getting those threats you suggest we ban.

      I don't want to start anything and am praying for the good health of all involved, but repeating a false cause and effect the mainstream media said won't help anyone or end the hate and violence you are asking for.

      January 11, 2011 at 15:57 | Report abuse |
  6. kb

    Gun control is not the answer all it does is take guns out of the hands of responsible americans. Its not going to keep the guns out of the hands of criminals, they dont care if they break the law! Soo all gun control does is allow a criminal to rob your house with a gun and u have nothing to protect yourself or your family with.

    January 10, 2011 at 10:07 | Report abuse | Reply
  7. ShrNfr

    Dr. Gupta is somewhat incorrect in his statement as to the fact that the "brain has nowhere to go". It does have an exit path through the hole where the spinal cord enters. However, in expanding through that hole, it strangles the brain stem which controls many of the lower order body systems. This is why hemorrhagic stroke is so dangerous.

    January 10, 2011 at 10:07 | Report abuse | Reply
    • Lisa

      Really? Wow.
      I'd not call a trauma neurosurgeon incorrect because he did not mention one of the possible outcomes of traumatic brain injury.I'm not qualified to do anything but ask questions and learn from someone like that, and I suspect you might not be either.
      I hope the injured recover well, and the bereaved can find some peace.

      January 15, 2011 at 23:19 | Report abuse |
  8. Sandy

    "First off, she received very quick care, and was in the operating room within 38 minutes after arriving at the hospital."

    She recieved quick care at the cost of others! Our society has always given special treatment to politicians and they in turn have always screwed us.

    January 10, 2011 at 10:09 | Report abuse | Reply
    • Alex

      Do you know this as a fact? You saw it all go down? You were there watching the EMTs ignoring everyone else? If so, you were helping as much possible as a concerned citizen right?

      January 10, 2011 at 11:58 | Report abuse |
    • Eduardo

      Alex, she is not entirely wrong you know. She did get prompt attention and to be in an operating room within 38 minutes of being shot through the head certainly helps your case. I don't agree though on the part where she blames her for other's politicians "screwing" us. They are not all bad, certainly not worthy of being viciously attacked. I stand very firm though, the guy that shoot everyone there, simply took the congresswoman as an excuse to go o a murder rampage, to take out his frustration or mental illness on society, in the utmost vicious, cruel, abusive and inhumane form possible, murder.

      January 10, 2011 at 15:32 | Report abuse |
  9. Eduardo

    I'm glad she's survived 'an injury as devastating as this one'. As is explained in this article, seemingly all ideal conditions were met. Notwithstanding, I feel heartbroken for the little 9 year old girl killed, and the other five victims. It is evident, although the Congresswoman was the intended target, she merely served as an excuse for this individual to go on a murder rampage.

    January 10, 2011 at 10:10 | Report abuse | Reply
  10. Fotios

    Sarah Palin's Facebook page may have been sanitized, but a screenshot of the way it was just before removal of the "crosshairs" map lives on at http://articlesurfing.org/politics_and_government/sarah_palin_facebook_reconstructed.html. It is worth a visit.

    January 10, 2011 at 10:11 | Report abuse | Reply
  11. abcdefghijklmnopqrstuvwxyz

    Spelling it right or wrong you know the word LMAO

    January 10, 2011 at 10:19 | Report abuse | Reply
  12. luLYFcas

    Ey..where's Dr. Gupta's reply to Lucas?. Why delete it? That was pretty cool.

    January 10, 2011 at 10:21 | Report abuse | Reply
  13. Pius Macha

    Dr. Gupta, your explaination on this incident is classy as always have been in other similar incidents.This tells big time it is from the guru medical expert. Thank you and CNN for your service.

    January 10, 2011 at 10:26 | Report abuse | Reply
  14. bspurloc

    palin stupid award to u.

    January 10, 2011 at 10:27 | Report abuse | Reply
  15. Jan

    Shut up and say a prayer for all. Involved. Instead of all your petty BC.

    January 10, 2011 at 10:32 | Report abuse | Reply
  16. Hoofleau

    Lucas, you're like the proverbial "pot calling the kettle black". (It's ok, you can google it)

    January 10, 2011 at 10:34 | Report abuse | Reply
  17. Jared

    What other word would you possibly confuse "suvive" with? It's quite obvious what word Gupta was writing. If you're that confused over it, you lack any critical reading skills.

    January 10, 2011 at 10:36 | Report abuse | Reply
  18. Hoofleau

    God bless Ms. Giffords. I hope and pray for your recovery.

    January 10, 2011 at 10:39 | Report abuse | Reply
  19. PA_Frank

    I worked in neurosurgery and operated on someone with a similar injury. I saw the patient for about a half year after the surgery and got to witness firsthand the lasting effects of the injury. She will almost inevitably suffer right sided hemiplegia. Depending on whether or not she is left handed, she may also have speech deficits, though it seems for her it will be expressive aphasia. In the short term, if can avoid hospital acquired infections, she may suffer no worse than if she had a large left sided stroke. I prayers go out to her and her family.

    January 10, 2011 at 10:40 | Report abuse | Reply
  20. Jean

    As my thoughts and prayers go out to those in this tragedy, as a mother of a son who suffered brain trauma 12 years ago, I do hope this opens up more to the medical community to fully understand the long standing issues that can occur and open discussions, and understanding of those who suffer with it daily.

    January 10, 2011 at 10:42 | Report abuse | Reply
  21. Joe

    Less than a year ago, I fell on my head while riding my bicycle with no helmet on. Long story short, I had a bone flap removed from my left upper side of skull. During the following 3 months, my brain expendad and I looked like an alien and had to wear a special helmet to protect the unprotected brain. It was so so painful despite the strong drugs Iwas on. It was also hard to ween out of these medications too afterwards. When the bone flap was re attached, pain was gone gradually, but very fast. Thank God for doctors, medicine, medical treatment, nurses and to all who hardly and passionly prayed for my recovery. I hope same for the congresswoma; it is hard, but have faith !

    January 10, 2011 at 10:48 | Report abuse | Reply
    • Jean

      Do you have any long term effects?? I have watched my son struggle and hope things do improve.

      January 10, 2011 at 10:51 | Report abuse |
  22. EE

    Some people seem to be so insecure. This was a tragic event. Sure, most of us noticed the grammatical errors. But to post a comment bashing the editors seems a bit absurd. Is your life that bankrupt? Are you the grammar police? What’s more, if you are going to correct grammar, I would imagine you would want to make sure yours is correct… Just saying.

    January 10, 2011 at 10:48 | Report abuse | Reply
  23. Josh

    What a tragedy! It is a miracle that Giffords is doing so well for the type of injury she sustained...I pray she will be able to fully recover!

    January 10, 2011 at 10:49 | Report abuse | Reply
  24. njpat

    seriously, are we discussing spelling and grammer here?

    January 10, 2011 at 10:51 | Report abuse | Reply
  25. jon

    The problem with your theroy of gun control is that ok you can take the guns away from the civi but the bad guys will still be able to get guns even if we close alll the gun stores in the whole US. the bad guys are getting them unmarked and or from the black market

    January 10, 2011 at 10:51 | Report abuse | Reply
  26. Josh

    What a blessing that the bullet was able to exit and not cause further damage!

    January 10, 2011 at 10:52 | Report abuse | Reply
  27. RRR

    Its GOD grace. nothing a doc could do if it was against HIS will.

    January 10, 2011 at 10:55 | Report abuse | Reply
    • Softship

      And why was it "his will" to let this happen in the first place?

      January 10, 2011 at 12:15 | Report abuse |
  28. njpat

    http://articlesurfing.org/politics_and_government/sarah_palin_facebook_reconstructed.html

    January 10, 2011 at 11:11 | Report abuse | Reply
  29. Keeper

    Can someone please explain to me why not one media outlet is discussing how a 23 year old mentally unstable man can walk into a hardware store in Arizona and buy a semi automatic weapon?

    Instead of talking about increasing congressional budgets for their personal security why don't they just enact a comprehensive federal hand gun legislation to prevent this from truly ever happening agai

    January 10, 2011 at 11:11 | Report abuse | Reply
  30. crtclthnkr

    First I would like to give my condolence and prayers to not only the victims,but the innocent bystanders as well. Second: I am curious as to what Walmarts policy is in concerns to selling ammo. One store denied ,and another sold it to him.

    January 10, 2011 at 11:16 | Report abuse | Reply
  31. ironic

    Bad spellers of the world untie!!

    January 10, 2011 at 11:29 | Report abuse | Reply
  32. Karen

    LOL at people calling Lucal pot. Cannot you recognize "sarchasm"? In any case, I am continually perplexed by spelling errors on CNN articles. Don't they have automatic spell checkers? It takes no time at all nowadays as the spell checker runs in the background. So no matter how tight the timeline is, running a spell checker will not slow you down any more than placing the last period at the end of the last sentence

    January 10, 2011 at 11:37 | Report abuse | Reply
    • karMAen

      @Karen...were you not "continually perplexed" with "sarchasm" insatead of sarcasm? You were just another spelling nutcase like Lucas. But in-fairness both of you would be a great couple or could a dynamic duo in a misspelling contest.

      January 10, 2011 at 15:25 | Report abuse |
    • karMAen

      instead* stupidity radiates.

      January 10, 2011 at 15:29 | Report abuse |
  33. luckyray

    God help this woman and her family. She will surely become a better politian as a result and let me tell you that the country is awaiting her to recover and render her service in the congress and to the society, and who are these cynists who are eager on spelling and stuff. Language is a means of communication and if that goal is achieved, what ever 'grammaatical' rules invented by man can be considered obsolete.

    Now CNN, let us hear stories of tragedies about the rest of victims and those in Hospital. Dont hog all the limelight just for one woman who is a congresswoman. Does it make the lives and stories of other victims any lesser ???

    January 10, 2011 at 11:41 | Report abuse | Reply
    • DesertRat

      Privacy laws won't let that kind of info out without the families' permission.

      January 10, 2011 at 13:13 | Report abuse |
  34. xyz

    if you can understand what a ccn article is saying....then it's not that big a deal, i.e. you're a loser. god bless this woman!

    January 10, 2011 at 11:47 | Report abuse | Reply
  35. xyz

    If you can understand what cnn is saying... spelling isn't an issue, ie you're a loser. God bless this woman!

    January 10, 2011 at 11:49 | Report abuse | Reply
  36. bill

    @lucas who cares,other than you

    January 10, 2011 at 11:53 | Report abuse | Reply
  37. purekenyan

    May God save her life and give her another chance.

    January 10, 2011 at 11:53 | Report abuse | Reply
  38. Mitch

    More than 6 people have been shot in Oakland since 1-1-11, where's their article? The media loves this story and covers it relentlessly, which will only serve to inspire the next j. Lee lougner

    January 10, 2011 at 11:54 | Report abuse | Reply
  39. KatR

    For those who may not be aware.....gun laws here in Arizona have been weakened to the point that a mentally unstable citizen can purchase a gun and ammo....legally. Although I am not a gun owner I agree that making guns illegal will do nothing to stop tragedies like this one. The far bigger problem is the undertreatment of mentally ill people throughout our nation. Our prisons are crowded with mentally ill inmates. Many citizens turn to illegal drugs to escape their mental demons. GOP Congressmen, especially the newly elected, are scared to death and are talking of addtl security for all govt representatives. This is a free country. Police presence at every public political gathering would turn our country into a fascist state. The better solution is for our leaders in govt to lead by example. When reps state that "government is the enemy" or "starve the (govt) beast" they are fostering insurrection and divisiveness amongst us all. Especially those who suffer from undiagnosed mental illness.

    January 10, 2011 at 11:54 | Report abuse | Reply
  40. Kyle G

    Jesus, the guy was using SARCASM! Why do people care more about a spelling comment than a shooting victim?!

    January 10, 2011 at 11:58 | Report abuse | Reply
  41. islassoc

    Fox News is discussing how this young man purchased a weapon. It clearly states that when he bought the gun sinec he did not have an AZ concealed weapon permit he was required to pass a background check managed by – you guessed it, the FBI. He apparently passed the check while he waited in the store. However all blame should not go to the FBI here as for the database to work it requires input and apparently the college never inputed their incidents with him where they required him to have a psychological evaluation before being allowed to return to campus. Again, guns do not kill people, people kill people. The same works for cars with drunk drivers; it is not the car it is the driver. We continue to fail too to punish those that violate the law.

    January 10, 2011 at 11:58 | Report abuse | Reply
  42. ayurbamey

    may tha lord be with thee throughout and after ur operatn_

    January 10, 2011 at 12:04 | Report abuse | Reply
  43. rhonda

    my prayers and condolences to all affected, great report doctor gupta, i am not a doctor but i understood what you were saying....keep it up

    January 10, 2011 at 12:07 | Report abuse | Reply
  44. KinNYC

    What was the security detail at this event? You would think there'd be a few policemen.

    January 10, 2011 at 12:12 | Report abuse | Reply
    • DesertRat

      Tucson has a small-town mindset, despite it's size. I wish there had been more security.

      January 10, 2011 at 13:15 | Report abuse |
  45. Spencer Storer

    That is just absured (in a good way) that someone can get shot in the head at point blank range in 2010 and have even the hope to survive. What a crazy world we live in.

    January 10, 2011 at 12:13 | Report abuse | Reply
  46. BalazarsBrain

    hmmm...wonder why Palin decided to take down her graphic with Gifford's district in the cross-hairs, as Palin's tweet "Don't Retreat, Instead – RELOAD!"?

    Sarah Palin: Interesting you would choose this exact time to change position on your disgusting rhetoric.

    January 10, 2011 at 12:18 | Report abuse | Reply
  47. Peter

    Wonder if it would have happened at a conservative rally since anyone who would like to attack is more likely to be shot by someone with a CHL. Cout it be that there is a greater deterent and that is the reason why the "crazy right" have less shootings at their residences and rallies.

    January 10, 2011 at 12:19 | Report abuse | Reply
    • Peter

      Could... sorry

      January 10, 2011 at 12:20 | Report abuse |
  48. Raj

    Dr Gupta makes it so easy to understand. Hats off. And we pray for all those who lost their lives or are still battling.

    January 10, 2011 at 12:21 | Report abuse | Reply
  49. Jack

    It sounds like it's time to appoint another representative from Arizona. And Republicans, be careful. The Democrats find ways of removing a their opponents after one of their own has even has so much as an accident.

    January 10, 2011 at 12:24 | Report abuse | Reply
  50. Jack

    P.S. I'm a Republican and just want to see all of our elected officials remain safe.

    January 10, 2011 at 12:26 | Report abuse | Reply
    • palintwit

      I heard that Bristol Palin has a place in AZ now. Why don't you put her on a pedestal, too, next to her trailer trash mother ?

      January 10, 2011 at 12:36 | Report abuse |
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About this blog

Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.