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Control of Hemorrhage in Critical Femoral or Inguinal Penetrating Wounds—An Ultrasound Evaluation

Published online by Cambridge University Press:  28 June 2012

Michael Blaivas ,
Stephen Shiver ,
Matthew Lyon  and
Srikar Adhikari
Michael Blaivas*
Affiliation:
Section of Emergency Ultrasound, Department of Emergency Medicine, Medical College of Georgia, Augusta, Georgia USA
Stephen Shiver
Affiliation:
Section of Emergency Ultrasound, Department of Emergency Medicine, Medical College of Georgia, Augusta, Georgia USA
Matthew Lyon
Affiliation:
Section of Emergency Ultrasound, Department of Emergency Medicine, Medical College of Georgia, Augusta, Georgia USA
Srikar Adhikari
Affiliation:
Section of Emergency Ultrasound, Department of Emergency Medicine, Medical College of Georgia, Augusta, Georgia USA
*
Michael Blaivas, MD, RDMS Department of Emergency Medicine, Medical College of Georgia, 1120 15th Street, AF-2056 Augusta, GA 30912-4007, USA E-mail: blaivas@pyro.net
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Abstract

Introduction:

Exsanguination from a femoral artery wound can occur in sec-onds and may be encountered more often due to increased use of body armor. Some military physicians teach compression of the distal abdominal aorta (Abdominal Aorta) with a knee or a fist as a temporizing measure.

Objective:

The objective of this study was to evaluate if complete collapse of the Abdominal Aorta was feasible and with what weight it occurs.

Methods:

This was a prospective, interventional study at a Level-I, academ-ic, urban, emergency department with an annual census of 80,000 patients. Written, informed consent was obtained from nine male volunteers after Institutional Research Board approval. Any patient who presented with abdominal pain or had undergone previous abdominal surgery was excluded from the study. Subjects were placed supine on the floor to simulate an injured soldier. Various dumbbells of increasing weight were placed over the distal Abdominal Aorta, and pulsed-wave Doppler measurements were taken at the right common femoral artery (CFA). Dumbbells were placed on top of a tightly bundled towel roughly the surface area of an adult knee. Flow measurements at the CFA were taken at increments of 20 pounds. This was repeated with weight over the proximal right artery iliac and distal right iliac artery to eval- uate alternate sites. Descriptive statistics were utilized to evaluate the data.

Results:

The mean velocity through the CFA was 75.8 cm/ sec at 0 pounds. Compression of the Abdominal Aorta ranging 80 to 140 pounds resulted in no flow in the CFA. A steady decrease in mean flow velocity was seen starting with 20 pounds. Flow velocity decreased more rapidly with compression of the prox- imal right iliac artery, and stopped in all nine volunteers by 120 pounds of pressure. For all nine volunteers, up to 80 pounds of pressure over the distal iliac artery failed to decrease CFA flow velocity, and no subject was able to tolerate more weight at that location.

Conclusion:

Flow to the CFA can be stopped completely with pressure over the distal Abdominal Aorta or proximal iliac artery in catastrophic wounds. Compression over the proximal iliac artery worked best, but a first responder still may need to apply upward of 120 pounds of pressure to stop exsanguination.

Keywords

emergency medicineemergency ultrasoundexsanguinationfemoral artery injuryprehospital medicinetactical medicine
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 21 , Issue 6 , December 2006 , pp. 379 - 382
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2006

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