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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. brian d

    Ok can we see Some new news now

    January 10, 2011 at 12:33 | Report abuse | Reply
  2. JJ

    My question is this: What other signs do the physicians have of Giffords capacity to follow command besides the squeezing of the physician's hand? As a neuro ICU nurse at one of the top hospitals in the nation, one thing that is critical to ensure for following of commands is that the patient not only be able to squeeze a hand/finger upon command, but rather the patient let go of said hand/finger upon command. Many times in neurological injuries, the squeezing of a hand/finger becomes an automatic reflex, much like that of an infant. Thus, the ability to let go upon command is more indicative as opposed to a squeeze.

    January 10, 2011 at 12:34 | Report abuse | Reply
  3. surfdog11

    So YOU'RE the reason Jared Lee Loughner went on this rampage, you illiterate twit!!!! The mind is a terrible thing!!

    January 10, 2011 at 12:34 | Report abuse | Reply
  4. Anna Rya

    Thoughts and prayers for everyone involved.

    January 10, 2011 at 12:35 | Report abuse | Reply
  5. GBAKER

    Rgearding Gun Control- Keep guns away from BAD Guys not good ones- If credit checks can be done for car and home loans, why not checks for guns where innocent lives can be snuffed out if people can walk in and out of hardware stores with guns?

    January 10, 2011 at 12:42 | Report abuse | Reply
  6. Cecilia

    I wonder how many people actually read this article to learn something, other than to check for typos or spelling. The article was about how it was possible that Ms. Giffords survived such a terrible wound. "Shot in the head" generally means "dead on arrival." It was not about the little girl, who was, as I recall, shot in the chest, and sadly didn't have a hope of survival. It doesn't mean that Ms. Giffords is more important than Christine Green. Neither of them deserved this, and we should be outraged that it happened at all. I am sickened by this, and it makes me very, very afraid for our country. I wish a speedy recovery for the injured, and I wish peace and comfort for the families of the dead. And, Dr. Gupta, thank you for this article. I found it informative and educational.

    January 10, 2011 at 12:45 | Report abuse | Reply
  7. Sarah

    Fail! What a troll.

    January 10, 2011 at 12:46 | Report abuse | Reply
  8. Mytwosons

    Seriously, the only thing you people can complain about is a few typos? Get a life. Everyone knows what the intended word was-GET OVER IT! I hate people who feel the need to point typos out. This isn't high school, we all can determine what the word was supposed to be if a letter is missing! Good job CNN, even with the typos! 🙂

    January 10, 2011 at 12:50 | Report abuse | Reply
  9. Noah

    I think we should thank everyone who helped out after what happend. It was a total team effort to get everyone treated and to a hospital so they could be treated. I feel so bad for the lives lost yesterday, amd I hope the families can some day find peace amd comfort.

    January 10, 2011 at 12:54 | Report abuse | Reply
  10. george

    Can't anyone be nice. Come on who care about the spelling

    January 10, 2011 at 12:58 | Report abuse | Reply
  11. Sherelm

    At this time of this tragedy – is it really about catching spelling errors or hoping the best for Congresswoman, and thanking Dr. Gupta for explaining all this?
    Geeze. Get a life.

    January 10, 2011 at 12:58 | Report abuse | Reply
    • asdfy

      No one pointing out the sloppy spelling and grammar has implied this wasn't a terrible human tragedy. So people taking a whack at the 'spell checkers' should cool their jets also.
      The internet has real problems with accuracy in everything – spelling and especially premature reporting of what are basically rumors of the moment. Putting editors' feet to the fire to tighten up their reporting is a good thing in my opinion.
      I hope the Congresswoman has a complete recovery as well as all the other injured.

      January 10, 2011 at 16:24 | Report abuse |
  12. Brenda

    I wish I would have studies grammar a little better so I understood what you closet nerds were complaining about. Glad you could focus on the important "grammar issues" instead of on the tragedy of several people being killed (including a small child). Great job demonstrating how great American humanity is.

    January 10, 2011 at 13:05 | Report abuse | Reply
    • XINGEN

      Amen, Brenda. To ALL: "CNN welcomes a lively and courteous discussion as long as you follow the Rules of Conduct set forth in our Terms of Service."
      Emphisis on the courteous.

      January 10, 2011 at 14:52 | Report abuse |
  13. kwag

    Lucas, please read your post. I've read it over and over again and cannot understand what you're trying to say. Could use some punctuation to clarify, too.

    January 10, 2011 at 13:07 | Report abuse | Reply
  14. Rob

    This tragedy is a direct result of the hateful discourse by Palin,
    Hannity, Beck, Limbaugh, Tea Party, Right-wing Republicans, etc.
    Lock and load, revolution, and comments that their political opponents
    are trying to destroy America are all phrases used by these lunatics
    that incite hatred, violence, disrespect for the office of the
    President, and discrimination. God save the USA and the President
    from these Palin crazies. Pray for the Giffords, other victims of
    this attack on America, true American patriots, and for a return to
    respectful political discourse without personal attacks.

    January 10, 2011 at 13:12 | Report abuse | Reply
    • r

      If someone wants to mention any typos in the article that's their prerogative. If someone wants to blame everyone but the shooter that's their prerogative.

      January 10, 2011 at 15:04 | Report abuse |
  15. Carl

    Wow. This is probably the best article I have ever read on a developing news story. In such a classy, concise and careful use of language, Dr Gupta has just elevated the understanding of a very complicated issue. He did it in a way that was compassionate and devoid of ideology. He is not just America's Doctor, he is a teacher of society at his core. I am a neurologist, and look forward to sharing this column with my colleagues, so we can draw on methods to teach our students. Thank you Sanjay

    January 10, 2011 at 13:14 | Report abuse | Reply
  16. ro

    SAY NO TO GUNS!!

    January 10, 2011 at 13:15 | Report abuse | Reply
    • medic Jim

      Say no to matches and maybe we can put an end to arson.

      January 10, 2011 at 18:01 | Report abuse |
  17. DesertRat

    I hope she makes a full recovery. Good article discussing the medical info.

    January 10, 2011 at 13:18 | Report abuse | Reply
  18. cal

    REPTILE!

    January 10, 2011 at 13:21 | Report abuse | Reply
  19. ray

    Dr G, sure is an exceptional person. As for those checking for grammer keep it up maybe someday you will write a dictionary. The congresswoman is more in the news 'cos she has always been in the news even before the incidence. So losers, why not just pray for her and the other victims, and hope for a world without violence?

    January 10, 2011 at 13:27 | Report abuse | Reply
  20. Eric of Reseda

    let's not forget that intern of hers that was almost immediately by her sode, helping her to breathe and doing what it took to stem blood loss. AND – and this is no small thing, I can tell you, after suffering serious injury/trauma myself, he was at her side providing comfort. This is HUGE, because assuring and calming someone who is in a life-threatening situation does in fact up the odds of survival.

    January 10, 2011 at 13:32 | Report abuse | Reply
  21. Bflogal

    Dr. Gupta's report was the one report that I was actually looking for. Among all the blather, he is one of the few analysts whom I knew would have something meaningful to offer. I do thnk Dr. Gupta is over worked and over-exposed by CNN. CNN should really save him for the intelligent perspective that he can provide for stories like this.

    January 10, 2011 at 13:35 | Report abuse | Reply
  22. Tom

    A "sportsman" shop should not be selling a semi-automatic Glock pistol to a hooded 23 yr old. The only sport for that gun and person is killing. A few well placed questions and he should have been turned away like the college and Army did.

    January 10, 2011 at 13:39 | Report abuse | Reply
  23. billie

    out of all the evilness and destruction in this world do not forget that god is still saving lives thank god we still have kind and compassionate people that will give their ultimate to save ones life our country need prayer

    January 10, 2011 at 13:43 | Report abuse | Reply
  24. lisa

    God bless you Ms. Giffords I pray for your recovery and am confident that your God will never let you down,God expand all the skills of her neurosurgeon !

    January 10, 2011 at 13:47 | Report abuse | Reply
  25. Mars1010

    Sanjay ROCKS! I just love him.

    January 10, 2011 at 13:52 | Report abuse | Reply
  26. Sarah

    Thank you for this very informative article. Mrs. Gifford's is an example of one of God's miracles. I will continue to keep her & her family in my prayers during this critical time.

    January 10, 2011 at 13:53 | Report abuse | Reply
  27. Not Sanjay

    Hey Sanjay could it be because the young punk was a bad shot?

    January 10, 2011 at 14:00 | Report abuse | Reply
  28. californian in canada

    I wish I had CNN on my TV. Too bad...

    January 10, 2011 at 14:02 | Report abuse | Reply
  29. Zuriea

    What's missing here is how a 20 year old nursing assisntant on the scene held her head and staunched the bleeding from both wounds as well as immobilizing her – as a neck brace would do. His quick action is part of why she arrived at the hospital with not as much blood loss as might be expected. His role should be acknowledged here. I don't ever want to need this information but his interviews have taught me a lot about what to do at the scene of that kind of head injury.

    January 10, 2011 at 14:02 | Report abuse | Reply
  30. lisa

    God bless you Ms Gifford,I pray for your recovery and am confident that your God will never let you down.God, may you expand all the skills of her neurosurgeon!

    January 10, 2011 at 14:06 | Report abuse | Reply
  31. paulie walnuts

    i think the spelling errors were a function of trying to get the article out so quickly in a fast-developing situation, blame our instant gratification society more than inept editing

    January 10, 2011 at 14:12 | Report abuse | Reply
  32. asinine

    Why is everyone complimenting Dr Gupta on his explanation -thats what he gets paid to do. Most Dr's are pompous asses- use jargon to make themselves sound knowledgeable.

    And about the folks who seem to be bent out of shape because of a typo – you remind me of one demented person who also took issue with spelling and the govt.

    January 10, 2011 at 14:24 | Report abuse | Reply
  33. scrumb

    Great, now the next psycho will know how to shoot someone properly...

    January 10, 2011 at 14:30 | Report abuse | Reply
  34. davetharave

    Any nut with a gun.

    January 10, 2011 at 14:32 | Report abuse | Reply
  35. Daniel

    My sympathies and heart go out to all the victims of the evil man who carried out this shooting. I wish all of those who were injured a speedy recovery. I hope we honor the memory of the victims of this tragedy by responding to it in a dignified and honorable manor.

    January 10, 2011 at 14:35 | Report abuse | Reply
  36. canadian

    Gun control really works. I'm Canadian and we force all criminals to apply for a permit before committing a crime of this nature thereby eliminating the need for good law-abiding citizens to own firearms. There hasn't been a single gun related crime since these laws came into place. (That was sarcasm, BTW, for all you intellectually inferior fools who think that gun control actually does anything to prevent things like this).

    January 10, 2011 at 14:42 | Report abuse | Reply
  37. Nancy Young

    Obviously, the shooter was a nut job. Moreover, it is even more obvious that he was used & provoked by someone at the Capital who did not mesh with Gifford's politics or especially the way she voted just recently. It is not too hard to figure out.

    January 10, 2011 at 14:43 | Report abuse | Reply
  38. Dave

    A typo for a missing character is hardly a literacy issue, and I'm not even certain I would classify it as a spelling error. I would certainly, however, classify you as being ridiculously anal to focus on such a trivial aspect of this whole situation. You must be a blast at parties ...

    January 10, 2011 at 14:44 | Report abuse | Reply
  39. Drew

    Did it ever occur to anyone that this is a miracle from God. Maybe God saved her from dying?! I give him credit!

    January 10, 2011 at 14:47 | Report abuse | Reply
    • cherie

      If your god was involved he or she would not let this kind of violence happen. An innocent child was gunned down long with the others. Have you ever considered that your god is not involved? This happened partly because of the political rehortic by the right wing christian nuts . That has incited hate and these other nuts us. |Palin took her cross hairs with the gun down over her picture and made excuses and lies about it. Typical GOP with no integrity at all. She should have apologized and changed her tone. Our nation needs to find away to respectfully disagree and find common ground.

      January 10, 2011 at 15:04 | Report abuse |
    • LEB

      The miracle would be if she survived a gun shot to the head and recovered fully... which she most likely will not. Survival, in my opinion, is not enough. If surviving that kind of trauma means you're a cripple or a vegetable for the rest of your life, death is preferable. There's nothing miraculous about being reduced to a 150 lb infant.

      January 10, 2011 at 16:19 | Report abuse |
    • Colin in Florida

      If god was truly benevolent, all-loving, and al-powerful, why did he let an innocent nine year-old girl die?
      And 'he works in mysterious ways' is just mumbo-jumbo, and not an acceptable answer.

      January 10, 2011 at 19:07 | Report abuse |
  40. A. Nony

    I hope Rep. Giffords recovers and eventually returns to Congress. And, I hope her attacker pleads guilty so we won't have to read a lot of asinine drivel about his unhappy childhood. At least he survived his childhood, which is more than one of his victim's did. He should get death or Supermax prison for life. I am tired, tired, tired, of subhuman garbage.

    January 10, 2011 at 14:55 | Report abuse | Reply
  41. lisa

    Im praying for Gabrielle recovery.My prayer go to the family of all those the were effected by this tragic.
    God Bless

    January 10, 2011 at 15:00 | Report abuse | Reply
  42. Lise Quinn

    The word suvive only shows up in your post.

    January 10, 2011 at 15:03 | Report abuse | Reply
  43. uchman

    I did a search for "suvive" on this page and came up with only yours. Look b4 you leap please

    January 10, 2011 at 15:14 | Report abuse | Reply
  44. TJ

    A clear explination. Thank you. I hope she does well in her recovery. Best of luck to her!

    January 10, 2011 at 15:21 | Report abuse | Reply
  45. ybs

    OK folks, let's unite & simply wish Gabrielle a complete, expeditious recovery 'http://bit.ly/recoverwell

    All (left/right/middle/religious/non-religious folks) are welcome!

    January 10, 2011 at 15:33 | Report abuse | Reply
  46. ybs

    Folks, let's unite & simply wish Gabrielle a complete, expeditious recovery 'http://bit.ly/recoverwell

    All (left/right/middle/religious/non-religious folks) are welcome!

    January 10, 2011 at 15:34 | Report abuse | Reply
  47. PetieMac

    As a TBI survivor, I say HANG TOUGH, MA'AM! We're pulling for you all the way!

    January 10, 2011 at 15:34 | Report abuse | Reply
  48. Theodore Mann

    One should be required to pass a battery of psychological tests and MRI head scans before being allowed to acquire a gun.

    January 10, 2011 at 15:38 | Report abuse | Reply
  49. Chris

    It is amazing how a second an inch can determine one's life. A nine year old shot in the chest. A man protecting his wife shot in the head at the wrong angle. A federal judge stopping on his way home from church to visit a friend. A political director sitting in a different chair than two other staffers. A mother and her two daughters walking out of the store and not shot. Maybe the lesson here is to respect life and to live our lives as it relates to inches and seconds. To the families our thoughts and prayers. To those who responded in seconds and beyond our thanks and appreciation.

    January 10, 2011 at 15:46 | Report abuse | Reply
  50. Go Auburn

    WAR EAGLE_____GO AUBURN

    January 10, 2011 at 15:47 | Report abuse | Reply
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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.