THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
DARYN KAGAN, CNN ANCHOR: We want to take our viewers live to Pensacola, Florida. Doctors now giving us an update on the 8-year-old boy attacked by a shark, now fighting for his life. Let's listen in.
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DR. REX NORTHUP, SACRED HEART CHILDREN'S HOSPITAL: First and foremost want to reflect to everyone this is very much a team effort, and it began with the transport of the child from the scene of the shark attack to Baptist Hospital, where the trauma surgeons that worked with him initially there I think did a phenomenal job of stabilizing this child and resuscitating him in the initial phases of care and then the transport of the child over here to the Children's Hospital that took place yesterday.
The child remains in our pediatric intensive care unit at this time. The treating surgeons and the surgical team that worked with him initially at Baptist Hospital are continuing to work with us in providing care of the child at this time. I've been up and seeing him this morning, have spoken with a number of the other surgeons and physicians involved, including Dr. Cohalt (ph), that you all will be meeting here in just a minute.
The child does remain critically ill, is relatively stable at this time. This type of an injury results in injury not only to the areas of the bite, of the arm itself that was severed, and then the large bite on the right leg as well, but because of the extreme amount blood loss that the child experienced, went through a period of time where there was very low if any blood flow taking place essentially to his entire body.
And because of that, we see evidence of insult to his brain and brain function, evidence of insult to the lungs, to the heart, to the kidneys, to the liver and to other areas of his body, including obviously, the areas of injury, which was where the arm was severed and the large injury to the right leg itself.
Again, the child has undergone significant surgical intervention and scheduled for further surgery this afternoon about 6:30 or so. The child has undergone a lot of medical support and intervention, including some dialysis that I will let Dr. Cohalt address here in just a moment, but at this point in time, again remains critically ill with lots of different organs that we're in the process of trying to support and maintain, in order to ultimately pull him through. What I will tell you is that, at this point in time, the perfusion to the arm that was reimplanted looks good. His fingertips are warm and with good color to them, and likewise, his right lower extremity is warm with evidence of very good blood flow and all to that. So we remain cautiously optimistic at this point in time, both in regards to the survivability of the extremities and his overall survival.
QUESTION: Can you can tell us if he is coherent at all either today or in the past and if so, to what extent?
NORTHUP: At this point in time, he is not coherent in part because we are keeping him sedated and giving him some medication for analgesia to try to keep him comfortable as well. He has done a little bit of eye opening, spontaneous eye opening and blinking of his eyes, but at this point is not coherent, is not following commands or that type of thing. And, again, it is somewhat difficult to say whether that is related to dysfunction of his brain versus related to the medication that we have him on to keep him calm and quiet.
QUESTION: What procedure will do you later this afternoon?
NORTHUP: Primarily, it's going to be to look at the wounds and to see how their appearance is and to do a dressing change particularly on the area on the right leg. And that area on the right leg is a really a more complex injury and all to the soft tissue, the muscle and other tissues there on the leg. And that undoubtedly will require further surgery to ultimately close that wound.
QUESTION: We've been told that he has responded to signals or to people over the last couple of days. Have you seen any evidence of that?
NORTHUP: This morning, I have not seen evidence of that. Again, I am coming into the picture as of this morning. And what we saw this morning was again some eye opening and I happened to visit him this morning at a time when family members were present, and were doing some talking with him, so therefore, would be voices and that type of thing that he would recognize much more than ours. And even with that type of stimulus did not seem to be responding really directly to them, but more spontaneously simply opening and closing his eyes.
QUESTION: Would you still characterize him as unconscious, then?
NORTHUP: I would put him with certainly altered level of consciousness or depressed consciousness at this point.
QUESTION: So there's a chance there could be some long-term brain damage because of the loss of blood?
NORTHUP: That is a possibility, certainly.
QUESTION: Could you elaborate a little on that?
NORTHUP: Well, with this type of an injury that he went through was, there were several factors here. One, the original injury itself, the bite which severed the right arm, further injury to the soft tissue of the right thigh, which was rather extensive injury as well. Then, because of the injuries there was significant amount blood loss that took place. And that blood loss resulted in very significant drop in his blood pressure, to the point that when he reached Baptist Hospital, he had no pulse, no blood pressure, was requiring full resuscitative efforts.
Again as I say, the trauma service over at Baptist Hospital did a phenomenal job of restoring his blood volume very quickly and effectively in getting a return of a pulse and a blood pressure, but there was a period of time because of the significant amount of blood loss that he had, that basically all of his organs and his body, his brain, heart, lungs, kidney and other things, went without significant amount blood flow.
And when they lose that blood flow, they also go without delivery of oxygen, without delivery of glucose and without delivery of other nutrients that they depend on. Because of those factors, you then end up with secondary injury, things that were not directly, the shark did not do anything directly to his brain, but because of the shark injury and the loss of blood associated with that, then, his brain did go through a period of time with a very low amount of blood flow, very low amount of oxygen.
And, again, that same process took place to literally every organ in his body. And those subsequent injuries are the things that we're dealing with now, as well as the injuries that the shark did inflict.
QUESTION: How unusual is it for someone to survive after having no blood pressure, no pulse for 30 minutes or more?
NORTHUP: It's going to be a very tough situation to pull him through. And it is an unusual type of event for someone to go through full cardiopulmonary arrest for 30-45 minutes and survive that aspect of things. We are close to 72 hours out at this time. And 72 hours is a time period when we commonly will see the most severe range of injuries related to this.
And when I say that I'm relating to things like the kind of peak of the time period when there will be brain swelling, the peak of the time period when we may see other organ abnormalities and other organ functions such as the liver malfunctioning, the kidneys malfunctioning, those types of things, usually in the 72- to 96-hour ballpark. Those dysfunctions or malfunctions will slowly start to get better over time.
The big area of significance in determining his overall outcome is going to be what type of brain damage he has had as a result of this, to what extent that is, and then what degree of recovery we will see from that. The brain injury that we see with this type of injury is usually the slower one to recover. Things like the kidneys and the organ and the lungs and those types of things will usually recover if they're going to more quickly. Neurologic injury or brain injury is something can take days, weeks, months, or even a year or longer, to see what type of residual sequelae that he may have related to that.
QUESTION: (OFF-MIKE) for right now?
NORTHUP: Yes, it is.
QUESTION: If he stabilizes over the next four or five days, would you be happy with that, as opposed to getting better or are you hoping that he won't get worse?
NORTHUP: At this point in time, our big interest is that hopefully we do not see deterioration or worsening. Certainly all of us and the family most certainly would welcome any evidence of improvement with him, but I think if we can get another several days behind us where things do not deteriorate, that we certainly are going to be happy with that.
And he -- his global situation is such at this point in time, again, we were talking to the family about this earlier this morning, that this type of injury is one that unfortunately things can deteriorate, and can do that quickly. And we could be in a different situation of even wondering about survivability. On the other hand, to see significant improvement is something that we're talking about taking, again, days, weeks or even months before we're going to be seeing improvement on things.
QUESTION: From your experience doctor, someone in this condition who's undergone this kind of trauma. Is it likely he will recover most of his faculties?
NORTHUP: I would say that is going to be -- probably the odds would be against that type of thing. Have we seen children with very severe injuries that have come back and amazed us and surprised us? Yes, we have. And that is what we hope with every child that comes in with this type of a very significant, severe injury, as we put all of our efforts and resources in on the front end with the idea that then, whatever outcome we get we are thankful and everybody knows that we've done the best that we could and done the most that we could.
And that is what is taking place at this time is that we're really utilizing the resources on the medical and surgical side of things. This community and really through the other subspecialists and all that we have, representing training and services and things are available throughout the country here, in putting into this youngster with the hopes we're going to get the best outcome that we possibly can. And what that will be, it is really far too early right now to say.
QUESTION: Doctor, how is his family doing now?
NORTHUP: They -- the ones that I have interacted with as of this morning seem to be realistic about his situation, and the various possibilities and are, I think, under the circumstances, are really doing phenomenally well at this point in time. Again, they seem to be realistic in their expectations. They are, again, I think cautious optimism would be a reasonable term to describe with it.
They have expressed a great deal of thanks and appreciation to everyone from the local area here, to back in their hometown and throughout the country and all, that they are aware, are thinking about them, and pulling for them, and pulling for this youngster, and they express a great deal of appreciation for that.
QUESTION: Doctor, any word how the (OFF-MIKE)?
NORTHUP: I think he is -- as the entire family again working almost to some extent of some disbelief and shock almost still, although beginning to come to terms with things, but I think is doing okay at this point in time. Further? OK. Thank you.
QUESTION: Dr. Cohalt will address questions about some other conditions. He is a nephrologist.
DR. COHALT (ph), SACRED HEART CHILDREN'S HOSPITAL: I'd just like to echo much of what...
KAGAN: We are listening to an update here from doctors at Sacred Heart Children's Hospital in Pensacola, Florida, giving us update on Jesse Arbogast. He is the little 8-year-old boy, who on Friday was playing in shallow water at Gulf Islands National Seashore when a shark attacked him. He lost his arm and big chunk of his leg, and has been fighting for life ever since. Doctors have been telling us that the arm reattachment surgery is apparently going well, that that is healing well, also that the little boy's leg is doing well.
But he still is in critical condition, and in stable condition and more surgery is scheduled for later today for Jesse Arbogast. To understand more what this little boy's facing medically, his challenge, let's bring in our on-staff doctor, Dr. Sanjay Gupta.
Sanjay, to hear the doctor talk, he said the arm was doing well, the leg was doing well, but really little Jesse's biggest fight has to do with other battles and had to do with all the blood that he lost.
DR. SANJAY GUPTA, CNN MEDICAL CORRESPONDENT: Absolutely.
This was a very, very severe injury. The arm is obviously a significant component of it, but he lost blood. He required cardiopulmonary resuscitation for up to 30-45 minutes, they said, which is a very long time. He had no significant brain activity at the time he was taken to the hospital. His pupils were actually dilated, which is a sign that his brain may have had a significant insult. We've also heard that his kidneys showed some signs of failure early on.
Kids are very much more resilient than adults, but certainly this overall spectrum of injuries is something to be concerned about. I don't know -- sounds like the arm is doing well, but his overall body is not doing great from what we heard just now.
KAGAN: Sounded like the doctors were setting up people who were watching across the country, setting up his family that the challenge ahead isn't just keeping the arm, keeping this leg, especially in terms of brain damage, this little boy if he does make it and sounds like he is sick and the fight is still ahead. His challenges might be overcoming that brain damage? GUPTA: Absolutely. He is an extremely sick boy right now. And the brain activity has not shown activity at this point according to the doctors today. So such things as interacting with the family, showing any movement to command, any of those things have not happened. Again, you know, it'll be a wait-and-see sort of thing over the next few days, but that's certainly something to be very concerned about.
KAGAN: And they did point out, too that he's under heavy medication to keep him subdued and keep him calm. So it's hard to tell how much of that is medication, how much of that is potential brain damage.
GUPTA: That's right.
KAGAN: We will keep an eye on it. Thanks for helping us.
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