Steve Scalise's situation remains critical

House majority whip Steve Scalise remains in critical condition after the Virginia shooting, according to reports.

Many people are perhaps thinking that his being shot in the hip is not life-threatening – worst-case scenario is that he'll need a hip replacement and be just fine.  The trouble is that bullets fired by an AR-15 are 5.6mm and cause a far more damaging wound channel.  As the bullet hit, it could have taken out the hip joint altogether.  It could have caused a serious fracture of his femur.  Far more likely is that it entered his hip, destroyed the joint, and continued to fracture his pelvis.  The bullet likely shattered the head of the femur, which goes into the hip socket and is held there by ligaments.

Those on the scene, one a doctor who served in Iraq, checked for entrance and exit wounds.  He found the entrance wound but not an exit wound, which means that the bullet was still in him and that it did extensive internal damage.  After the bullet hits, it can move in almost any direction, injuring internal organs as well.

We do well to recall the bullet that hit President Reagan.  He too could have been killed by the projectile that lodged an inch from his heart and aorta, according to the surgeon who operated on him – the aorta being the huge vessel that transports fresh blood to most of the body.  The operation to remove the bullet was more difficult than the surgeon had anticipated, and he almost gave up three times trying to find it.

In Scalise's case, a fractured pelvis is extremely dangerous.  The sharp edges of the bone often slice through arteries.  That's why so much blood was found as he tried to pull himself into right field and escape the shooter.  Nobody could get to him for at least ten minutes, at which time Senator Flake and the doctor, familiar with how to treat such wounds, rushed out of the dugout to stop the bleeding.  They could not have applied a tourniquet because the injury was above the leg, so they had to apply pressure.

It's clear that he lost a significant amount of blood.  The first surgery they did was likely an exploratory surgery that enabled the surgeons to find what the "bleeders" (severed arteries and blood vessels) were and resect them (using tiny sutures, they sew the major arteries and blood vessels back together), but they don't address the fractures per se.  The goal is to get him stabilized, and I'm sure they pumped many units of blood into him.

What happens next?  After his situation is stable, he will to go back into the operating room with an orthopedic surgeon to address his fractures (a possibly obliterated hip joint, fractured femur, and fractured pelvis).  Repairing the pelvis is tricky.  There are various approaches they can take, including wiring the bone back together and then screwing in titanium plates to keep it fastened.  They will most likely do a hip replacement surgery, but that will come later.  Even though he may be stable, they can't take him to the O.R. every day without the possibility of losing him on the table.

It's now a waiting game.  If he's critical, they probably won't do any more surgeries, and they may have left the surgical incision open, or sutured with a drain in the wound.  Only if they missed a "bleeder," a blood vessel or artery that continues to bleed, will they take him back to the O.R. "stat."

He has numerous surgeries to come, and I expect that Paul Ryan will have to find a new majority whip until Scalise is able to return to his duties. 

Because the wound channel is so large, he may be wheelchair-bound.  I'm not saying that's the case, but his critical condition tells me that the wound channel is massive, and it will be some time before he can return as whip.

He is in serious peril.  He had been listed as "stable" but was changed to "critical," which indicates they may have missed a "bleeder" and he's still bleeding out.

It could have been so much worse, said Congressman Roger Williams.  It would have been a massacre, and many Republicans would have had to be replaced.

"I think these people who want to destroy our lives and our livelihood here in America.  They win if we give in," Williams said.  "America doesn't give out, and America doesn't give in, and we must play this baseball game."

"This is America, the greatest country in the world, and if you punch us, we'll punch back.  And we're going to play baseball."