Haemorrhage control in extremity stab injury

Abstract

The Foley catheter is described in the emergency treatment of penetrating cardiac injuries, and its intra-operative use to control bleeding while definitive measures for intravascular embolization are being made. We present the first reported case of the use of a urinary catheter to control haemorrhage in an extremity stab injury to obtain haemodynamic stability while awaiting definitive surgical treatment. This quick, easy and useful technique can be used for junctional vascular injuries and wounds with a narrow neck, and can be easily removed once in the operating theatre. This life-saving, simple and cost-effective technique ‘internalises’ the externally applied pressure to control massive haemorrhage while awaiting definitive operative intervention. The catheter can be sutured in place if the patient is to be transferred to another department or hospital.

The use of a Foley balloon catheter to control junctional hemorrhage in a dog with severe vascular injury secondary to penetrating trauma

“…Civilian-and combat-related mortality is as high as 56% to 87% when uncontrollable, traumatic, life-threating hemorrhage occurs before reaching definitive care. 12,17 First responders commonly use the Massive hemorrhage, Airway, Respiration, Circulation, Hypothermia (MARCH) algorithm for trauma. This algorithm has been modified for canine combat casualty care.…”

“…9,12 FBC tamponade is a technique used to control life-threatening hemorrhage and has been well-described in the human literature. [13][14][15][16][17]19 It has also been described for penetrating neck injuries, cardiac injuries, deep solid organ injury, extremity injury, and postpartum hemorrhage. [13][14][15] The use of FBC tamponade to control hemorrhage in people with the previously described injuries is successful in up to 90% to 93% of patients.…”

“…The FBC is then sutured or stapled to the skin, and the skin is closed around the catheter until resuscitation and definitive repair can be performed. [15][16][17] This technique is used to control hemorrhage by direct pressure exerted from the inflated balloon against the surrounding soft tissue at the site of hemorrhage in order to slow or stop the bleeding. 17 The types of wounds that occur in people that may benefit from FBC tamponade also occur in dogs.…”

“…Foley balloon catheter (FBC) tamponade is a well-described technique for controlling life-threatening hemorrhage in people with deep penetrating wounds that have lacerated a major vessel. [13][14][15][16][17] The use of this technique has not been described in veterinary patients with similar wounds. This case report describes the use of an FBC to control life-threatening junctional hemorrhage due to severe vascular injury in a dog.…”

Efficacy and Safety of Tranexamic Acid in Emergency Trauma: A Systematic Review and Meta-Analysis

“…Although several mechanisms correlate with the risk of coagulopathy occurrence, for example, dilution and use of anticoagulative agents, due to the plethora of mechanism involved there are still no tangible factors that can be precisely responsible for the induction of coagulopathy [ 6 ]. While bleeding in a local wound presents little to no problem because it can usually be stopped by using compression [ 7 ], polytrauma patients with severe injury, for example, a broken pelvis, require far more attention and more sophisticated methods due to the lack of compression spots [ 8 ]. Therefore, we have focused on the use of tranexamic acid (TXA), a drug introduced as early as 1968 for menorrhagia treatment [ 9 ], which works by slowing down the conversion of plasminogen to plasmin, subsequently, reducing fibrinolysis and stabilizing the blood clot.…”