Case Report
A 52-year-old man who had a gunshot wound to both legs and knees brought to the emergency room by ambulance. He was in a state of hemorrhagic shock with vitals of respiratory rate of 24, blood pressure of 100/60 mmHg and a heart rate of 156 and a maximum Glasgow coma scale of 13. A make shift torniquet was placed on his lower thigh by bystanders but he was still bleeding profusely from the injury site(figure 1). We urgently began the resuscitation process by inserting 2 large bore IVs and a large dialysis catheter was placed in his right subclavian vein and 2 units of O positive and one liter of normal saline was given as fast as possible. Two torniquets were placed on his thigh and the extremity was put in an emergency splint and pressure was applied to the injured site. Despite these efforts the patients bleeding did not stop and his mentation and perfusion were deteriorating by the minute with minimum BP of 60 over pulse and heart rate of 175. We decided to block the blood flow the from a more proximal site, femoral artery 5cm distal to inguinal ligament was chosen due to its accessibility. A dialysis Catheter kit was used initially to insert a needle into the femoral artery, then a guide wire was threaded through the needle, the route was dilated, using a standard dilator, then small skin incision was made, then using a small Hemostat, a 6 fr foley catheter was placed over the guide wire in to the femoral artery and was guided to distal external iliac artery, subsequently balloon was inflated by injecting 5ml of Saline 0.9 %. Standard foley catheters have a side hole at their end in order to better thread the catheter, end of the catheter was cut to make end hole catheter(figure 2). Hemorrhage was controlled, and within minutes patient’s vitals were improved drastically. The patient was then transferred to a Level one Trauma Center, capable of handling vascular injuries. Thereafter in the operating room, due to extensive crush of the injury site, the leg had to be amputated. The patient survived the operation and was moved to the ICU. He was discharged on day 15.