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.