Case Study #3 Shark Attack!

1. Case Study #3Shark Attack! Adapted from the National Center for Case Study Teaching in Science, University at Buffalo, State University of New York

2. Patient: Jessie Arbogast • Basic Background and Vitals: • 8 years old • Caucasian • Height = 4’ 4” • Weight = 60 pounds • Loves swimming

3. Jessie’s case: 5:00 PM, July 6th, 2001, Pensacola, FL • Jessie is swimming with his family, wading in the warm current. • Jessie begins to swim out into deeper water toward his sister and uncle. • Suddenly and without warning, Jessie begins screaming, “Get it off me! Get it off me!”

4. Before anyone knew what was happening, a shark had attacked Jessie, bitten off his arm about 4 inches above the elbow, and then swam away. • Yelling for help, Jessie’s sister and uncle get him out of the water and up onto the beach. • As Jessie’s blood stains the white sand, 911 is called and lifeguards begin CPR and apply a tourniquet. • Meanwhile, Jessie’s uncle noticed the shark still “hanging around” the area where Jessie was attacked. • “Help us get the shark,” Jessie’s uncle yelled as he rallied troops together in an attempt to get back Jessie’s arm.

5. Jessie’s uncle and several other swimmers converged on the shark, grabbing the 6 ½ foot bull shark by the tail and holding on for dear life. • The struggling shark was hauled ashore barehanded by the group and then shot. • The shark’s mouth was pried open and Jessie’s right arm was pulled out from between its jaws. • About the same time, paramedics arrive to stabilize Jessie for transport to a nearby hospital. • Jessie’s arm is packed in ice for transport to the hospital.

6. In the emergency room, Dr. Elaine Rogers quickly orders multiple transfusions to restore Jessie’s blood supply. • Dr. Rogers begins assembling an operating room team to reattach Jessie’s arm. • First she contacts a microvascular surgeon. • She explains to him that the sharp teeth of the shark bite cleanly severed the boy’s arm without much shredding of the tissue. • Because Jessie was 8 years old, Dr. Rogers liked the chances for a successful reattachment of the arm.

7. The surgery would take 12 hours. • The first step was to identify all the different muscles, blood vessels, and nerves in both the arm and the stump. Each item would be “marked” with a suture and a label. This would make reattachment of these structures easier once the bone was reattached. • Dr. Juliet Ramos, orthopedic surgeon, would reattach the bone. • She trimmed the bone a bit on each side of the bite so she could insert a plate that would anchor the two parts of Jessie’s arm together. • “This procedure will make the right arm a bit shorter than the left one, but the one inch difference shouldn’t be too noticeable,” said Dr. Ramos.

8. Now that Jessie’s arm was once again intact, it was time for the microvascular surgical team to go to work. • They began by reattaching the muscles and nerves on each side. • Additionally, the team needed to harvest the saphenous vein in order to reconnect some of the blood vessels. • Several hours later all the major blood vessels and nerves were reconnected. • Upon removal of clamps from a few arteries, blood once again flowed through Jessie’s arm, bringing it back to life.

9. Very proud of the work they had done, the surgeons explained to Jessie’s parents that while the surgery was extremely successful, Jessie would most likely NOT regain complete use of his arm and hand. Now that you have heard Jessie’s case, please perform research and attempt to answer the questions being handed out to you at this time.