Marathon Medical Update: Shrapnel Abounds, Leg Amputations For Some

WBUR's Martha Bebinger reports that the number of patients being treated for Marathon bomb-related injuries is now up to 187. At least 24 people are in critical condition at 14 area hospitals. Many have been treated and released. Three people have died.

Doctors at several hospitals are reporting that based on injuries, it appears that the bombs were packed with shrapnel.

Bebinger quotes Dr. Stephen Epstein, at Beth Israel Deaconess Medical Center saying: “What we were seeing looked like BBs," consistent "with the explosive devices."

WBUR's Asma Khalid was at Massachusetts General Hospital for a news conference this morning. She said doctors have treated 31 patients; 12 were admitted, 8 are in serious condition and 4 required amputations of lower extremities, according to Dr. George Velmahos, Chief of Trauma Services at MGH. They are more optimistic than yesterday, Khalid said; "everyone who was in the ICU is alive and stable."

Khalid was also at Tufts Medical Center and reports that doctors saw 14 disaster-related patients; 10 are still in the hospital. She reports that there have been no amputations so far. She said Bill Mackey, chief of surgery at Tufts, described injuries in the lower extremities and included open fractures, nerve damage and muscle damage. Most injuries were between the knee and ankle. She said the medical team detected small shards of metal, and small metallic fragments, ranging from 1 centimeter to a few millimeters.

As of this morning, seven of the 10 kids treated at Children's Hospital Boston have been released, according to the hospital. Three pediatric patients remain, with two of them in critical condition in the Medical/Surgical ICU and one on a surgical unit. Here's the official update:

Our latest patients included:

-- 2-year-old boy with a head injury in good condition.

-- 10-year-old boy with multiple leg injuries in critical condition.

-- 9-year-old female with leg injury in critical condition.

The seven patients discharged were the following:

-- 14 -year-old boy with head injury

-- A 42-year-old father of a patient
-- A 7-year-old boy with a minor leg injury
-- A 12-year old with a femur fracture
-- A child in good condition
-- A child in good condition
-- A pregnant woman who was transferred to BWH

Here's the emailed update from Boston Medical Center:

Boston Medical Center received 23 patients from the Boston Marathon incident, ranging in age from 5 to 78, who sustained injuries ranging from scalp wounds, abdominal wounds and soft tissue injuries to lower leg injuries. Of these 23, 19 remain at Boston Medical Center; 10 are listed in critical condition, 3 in serious condition and 6 in fair condition. The majority of these patients will require further surgery over the next several days.

Chelsea Conaboy reports on Boston.com that there's widespread agreement among doctors that bombs were loaded with shrapnel. She writes:

Each doctor who has spoken before TV cameras and reporters this morning has described similar things: Pellets, small BBs, headless nails—projectiles they believe were packed with the bombs, removed from some patients by the dozens.
“My opinion is that most of them were in the bomb,” said Dr. George Velmahos, trauma chief at Massachusetts General Hospital. “I think it’s unlikely they would be so consistent if they were pulled out from the environment.”

Dr. David P. Mooney, Boston Children’s Hospital trauma director, described deep shrapnel wounds in a 10-year-old being treated there who is in critical condition.

Dr. Ron Walls, chairman of emergency surgery at Brigham and Woman’s Hospital, gave a similar description of the items found, saying that nails about 1 centimeter long and small objects about twice the volume of BBs were removed from several patients. The items “clearly were designed to be projectiles that were built into the device.”

At Boston Medical Center, Dr. Andrew Ulrich said the shrapnel “could be described as buckshot.”