Re: Shotgun Pellets and Migration - Know of any legal cases?
- From: "painter" <lolascarpitta@xxxxxxxxx>
- Date: 14 Feb 2006 20:18:11 -0800
February 15, 2006 New York Times
Account of Doctors Raises Questions on Heart Injury
By LAWRENCE K. ALTMAN
The account given yesterday by doctors caring for the Texas lawyer
accidentally shot by Vice President Dick Cheney last weekend raises
serious questions about how and when a pellet entered his heart and
what tests were done to establish where the pellet was lodged, doctors
not connected with his case said.
Although the public was told for the first time yesterday that a
shotgun pellet from a hunting accident had lodged in the lawyer's
heart, one of his doctors said that "we knew that he had some birdshot
very close to the heart from the get-go," but not its precise location.
Such evidence would have come from standard chest X-rays and a CT scan
if one was performed shortly after his admission to a hospital in
Corpus Christi, Tex.
Earlier accounts described as minor the pellet wounds that the lawyer,
Harry M. Whittington, suffered in the face, neck, chest and ribs.
Mr. Cheney sprayed Mr. Whittington, 78, with 6 to 200 pieces of
birdshot, the doctors said yesterday. One pellet apparently moved to
damage his heart, causing two problems: an abnormal heart rhythm,
atrial fibrillation, and a minor heart attack that were detected early
yesterday morning, the doctors said in a news conference at Christus
Spohn Hospital in Corpus Christi.
Their account left open the source of the birdshot that migrated to the
heart and how it got there.
Dr. O. Wayne Isom, the chairman of heart and chest surgery at Weill
Cornell Medical College, said it was unlikely that a pellet would
migrate to the heart through the bloodstream, as some have assumed from
the account of the Texas doctors.
The reason, Dr. Isom said, is that the pellet would have to enter a
vein, travel to and through the lung vessels that go to the heart, and
then lodge in heart tissue, not in one of its chambers. The pellets
were approximately five millimeters, about the size of a BB, and larger
than most blood vessels, said Dr. David Blanchard, director of
emergency services at the hospital.
A more likely explanation, Dr. Isom said, is that the pellet lodged in
or touched the heart when Mr. Whittington was shot.
Doctors use different X-ray techniques to determine the position of a
pellet in the heart. But the account of the Texas doctors was unclear
regarding which ones they performed and when.
Dr. Peter Banko, the Texas hospital's emergency department medical
director, said doctors there did an ultrasound, a CT scan and a cardiac
catheterization, which provide two-dimensional images. Dr. Banko said
the hospital had a 64-slice CT scan that could provide
three-dimensional images, but he did not say that the doctors performed
the more sophisticated one on Mr. Whittington, or if so, when.
Doctors try to synchronize such CT X-rays with the heartbeat to avoid
blurring from motion, said Dr. Jeffrey P. Goldman, a specialist in
heart CT scans at Manhattan Diagnostic Radiology. But, Dr. Goldman
said, doctors cannot synchronize a CT scan in patients with atrial
fibrillation.
Metal in a pellet can cause a different kind of blurring in CT scans.
But the Texas doctors did not say that they performed a 64-slice CT
scan after they learned Mr. Whittington had a pellet near his heart and
before he developed the abnormal rhythm.
Dr. Goldman said that "until you do the test you don't know how much
blurring there is."
Dr. Isom said patients could develop atrial fibrillation two to three
days after stitches were placed in a heart or it was injured.
The Texas doctors did not say how they determined that Mr. Whittington
had had a heart attack. Two standard tests are from electrocardiograms
and measuring enzymes. But injuries to the heart can cause a rise in
enzymes that may not necessarily represent a heart attack.
The Texas doctors and the White House doctors with whom they discussed
Mr. Whittington's case did not respond to a request for interviews.
.
- References:
- Shotgun Pellets and Migration - Know of any legal cases?
- From: Justine
- Shotgun Pellets and Migration - Know of any legal cases?
- Prev by Date: UPDATE:Dena Schlosser/Mother who cut off baby's arms-Trial
- Next by Date: Re: UPDATE:Carlie Brucia/Joseph Smith Sentencing Hearing
- Previous by thread: Shotgun Pellets and Migration - Know of any legal cases?
- Next by thread: Re: Shotgun Pellets and Migration - Know of any legal cases?
- Index(es):
Relevant Pages
|
