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Scalise Remains in Critical Condition, More Surgeries Planned

Rep. Scalise's injury includes trauma to major organs, massive blood loss
House Speaker Paul Ryan Releases House GOP Plan For Health Care Reform
House Majority Whip Steve Scalise speaks in Washington in 2016.Allison Shelley / Getty Images file

After a second surgery on Thursday, Rep. Steve Scalise’s condition has improved, although he remains in critical condition and will need further treatment.

Scalise and three other people were wounded Wednesday when a gunman open fired on a Republican baseball practice in Alexandria, Virginia. A single rifle shot left Scalise, 51, with a shattered bone in his left hip and internal injuries that caused severe bleeding. Medstar Washington Hospital Center, where Scalise is being treated, has said he will “require additional operations, and will be in the hospital for some time.”

The congressman's doctor provided an update on his condition at MedStar hospital. He explained that Scalise had been at risk of death, but that risk had been lifted. Scalise is expected to walk and, though he has been sedated, he is coherent.

Dangerous Kind of Trauma

Having a second surgery, with more surgeries planned for the immediate future, is not uncommon with these types of injuries. Although a shot to the hip might seem like a place only involving bones, this area is one of the worst to sustain this kind of trauma.

In addition to the pelvic and leg bones, there are also very large blood vessels along with the bladder and colon. A bullet from an assault rifle traveling through this area typically injures all of these vessels and organs.

The most immediate concern — and the one that is the most threatening to the Louisiana congressman's life — is the damage to the main blood vessels in the hip and pelvic region. If the iliac artery or aorta are damaged, blood loss would be rapid and significant. Medstar has said Scalise received multiple units of blood transfusion.

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The first surgery Scalise underwent was done immediately to stop the bleeding: it's the most critical part of the immediate post-gunshot recovery. Typically, a patient is then allowed to recover and build up his blood supply, either through ongoing transfusions or his own blood. Scalise was given time in between surgeries to recover and gain strength for whatever surgeries and procedures may be next.

A second surgery is done when bleeding has continued — the focus is finding the source and stopping the loss of blood. Subsequent surgeries are performed to continue to repair the less life-threatening injuries.

These staged surgeries are the latest approach to trauma, especially from gunshot wounds.

As Scalise recovered from the second surgery, thousands turned out for the annual Congressional charity baseball game Thursday evening for an emotional tribute to the victims and heroes of Wednesday's shooting.

NBC News medical producer Alexandra Galante contributed to this report