Discussion
The challenge in this case was the need to control the hemorrhage in a
rapidly deteriorating patient in a rural setting without onsite help
from any other specialties. Although it was evident that bleeding should
be controlled, this act proved to be quite challenging. This case
emphasizes the role of emergency physician to be resourceful and quick
thinking. REBOA Is a procedure to control bleeding usually used in
non-compressible torso bleeding but this device is expensive and not
readily available in our country. extremities arterial bleedings are
usually controlled either by direct compression or application of
tourniquet. Nonetheless, despite conventional efforts to control
bleeding, we were unable to occlude the bleeding site, hence the need of
a technique similar to REBOA to control bleeding. Also due to patients’
obesity no suitable pneumatic torniquets were available in the hospital
which could fit him.
There are surgical techniques to ligate the artery from a more proximal
site like ligating the artery proximally, but we did not have the
experience to achieve this in time sensitive manner. Indeed, the patient
was deteriorating at an extremely alarming pace. Using a familiar
technique(seldinger) which is remarkably similar to placing a central
venous line (something that we are quite experienced with), allowed us
to rapidly place a sheath and guide wire into the femoral artery and
occlude the mentioned artery by a small foley catheter. This technique
is also similar to the usage of Fogarty Balloon in vascular surgery.
Also, the need for adequate resuscitation cannot be stressed enough.
Conclusion
Placing a foley catheter into at the femoral artery in a profusely
bleeding patient allowed us to rapidly achieve hemostasis and adequately
resuscitate the patient enough to transfer him to a higher-level center
for definitive care. We believe due to its simplicity this technique can
be a good addition to the skillset of emergency physicians.
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