Dr. Perry. Yes. From the nature of the trajectory of the wound and the nature of the path of the bullet on the other side it was obvious that it had traversed major vessels, the aorta and vena cava. The aorta and vena cava, the heart area, and then a midline incision was made. A rapid prep with iodine was done, the patient was draped. An incision was carried rapidly into the abdominal cavity at which time we noticed approximately 3 litres of free blood which is an excess of three quarts. This was removed by suction, lap packs and by just moving it out in the form of clots with the hands. It was noted there was considerable bleeding appearing in both the right upper and left upper quadrants of the body. There was a large hematoma retroperitoneally in the midline also, causing the bowels to be pushed forward rather strikingly.
We immediately dissected over the portal vein on the right since it was apparently injured, and placed a vascular occlusive clamp of the Sittinsky type in this area to control the bleeding. Noted an injury to the right kidney and to the lobe of the liver. We also noted there was an injury to the stomach, the pancreas, the spleen. At that point it became apparent that he had indeed struck major vessels, and appeared to be the aorta, so the left colon was reflected very rapidly in order to allow us to enter the space behind the intestines, the retroperitoneal space, and at that point I controlled the bleeding from the aorta by finger pressure below and above this area.
The bullet had knocked the superior mesenteric artery completely off the aorta exposing a large area.
After I had controlled the bleeding Dr. Shires was able to dissect around the area sufficient to allow us to gain control of the aorta, superior mesenteric artery and the vena cava and the placement of vascular clamps across these vessels in order to stop the hemmorhage.
At this point, he was being given blood and, of course, the suitable anesthesia measures which were oxygen under pressure. He did not require an anesthetic agent, I am told.
Mr. Specter. Who told you that, Dr. Perry?
Dr. Perry. I think one of the residents did, one of the anesthesia residents. We at that point had restored his blood pressure. I don't know the exact recordings, but I was told subsequently it had returned to near normal levels since we had the bleeding controlled.
Mr. Specter. What was the situation with respect to his respiration at that time?
Dr. Perry. It was being assisted and controlled, of course, by anesthesiology. This was no problem. We had a tube in place and was breathing for him so he had no problem with respiration. This was completely under control of anesthesia. The blood pressure was controlled and we stopped for a moment to determine how we would best go about repairing the structures and which would have priority, all the bleeding had stopped but, as I recall, the clamping of the aorta at the level of the superior mesenteric artery means, of course, that you must prevent blood from entering the kidneys, and this in itself can be hazardous if extended, and therefore we decided this must be repaired immediately in order to restore blood into the kidneys and the lower portion of the body.
Then Dr. Jenkins informed me and Dr. Shires that his cardiac action was becoming weak, and I don't remember all the details surrounding the medications and the things that were done at this particular time, but he developed a backward cardiac failure, his heart slowed abruptly and the blood pressure fell again and it was apparent the tremendous blood loss he had had set the stage for irreversible shock and lack of pumping action from the heart although he was being given massive transfusions, I don't know the exact number, probably he had 10 or 12 units. I believe it is in the record.