Wednesday, October 23, 2013

Bloody Geyser
An ambulance brought in a man who had fallen through the glass window of a storm door. The sharp edges of the broken glass made a deep laceration in the crook of his right arm.
The ambulance packed the wound with several ten packs of 4 by 4 dressings. The bleeding slowed slightly, but kept pouring from the wound. They tried direct pressure, but couldn’t keep it constant. Instead, they applied a blood pressure cuff above the wound and like a tourniquet, they inflated it until the bleeding stopped. If they dropped pressure, the bleeding would start again.

The emergency room doctor asked that we slowly deflate the cuff. The bleeding started almost immediately, coming out through the multiple layers of the 4X4 dressings. We pumped the pressure back up to stop the hemorrhage.
 Because this incident happened on the daylight shift, the surgeon on call was in the hospital and was quickly summoned to the emergency department. He arrived in short order. He asked us to slowly deflate the blood pressure cuff. When we slowly released the pressure, the bleeding stared again. We pumped more pressure into the cuff.

We set up a surgical tray while the doctor gowned and gloved. He began to remove the packing from the wound, placing them in an emesis basin. The wound was very deep and wide. He removed five packages of the 4x4’s that the ambulance crew had stuffed inside the gaping laceration to control the bleeding. The cut was almost as wide as the man’s arm.
“Now,” he said. “Let off the pressure of the blood pressure cuff, slowly.”
I had just started to slowly release the pressure when a geyser of blood shot high into the air. It arched about two feet above the surgeon’s head, reached its apex, and started back down towards his upturned face. His eyes widened and he managed to step back out of the way just in time to dodge the descending fountain of blood.

I pumped the cuff’s pressure back up.
“Let’s try that again, but just let it out a bit and stop. Let’s do it in stages.”
I dropped the pressure just a bit and stopped; nothing. Again I eased out a bit more air. A vessel in the wound began to leak. Seeing the general area of the bleeding, he reached into the laceration and pressed on the vessel until he could clamp it with a hemostat.
“ Again.” He said. I eased the pressure a bit more.
We continued to slowly ease of the pressure off the cuff and the doctor applied hemostats until the wound only oozed blood and the surgeon was able to repair the deep laceration at his leisure.

Armed with a sling, a prescription for antibiotics and pain medications, the patient was discharged about an hour later.

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