Insidious bleeding; the danger of complacency: Case Report

Abstract

Background: A recent publication in the Journal of Trauma and Acute Care Surgery reported that patients who received a tourniquet (TQ) for severe extremity bleeding had a fourfold decrease in overall shock related mortality (Scerbo et al., 2017). A systematic review conducted in the United States (US) by Beaucreux, Vivian, Miles, Sylvain, and Pasquier (2018) showed that tourniquets are an effective tool for haemorrhage control in civilian populations with low levels of associated complications. Not a lot is known about the attitudes of Australian paramedics toward TQ’s or their use thereof, but anecdotal evidence suggests that their use is contentious. Case: We present a case of severe extremity haemorrhage involving a 90-year-old male who sustained a partial amputation to the lower aspect of the left leg proximal to the ankle whilst cutting a tree branch with a 5-inch toothed garden saw. Conclusion: In this case, the paramedics who attended to this patient believed that the use of a TQ was extreme. Standard trauma management and haemorrhage control measures that included a pressure bandage, vacuum splint and warming blanket served as confounding factors in obscuring an ongoing insidious bleed. Based on the injury profile, the patients advanced age, medications for comorbidities and associated decrease in physiological reserves this patient was a candidate for early TQ application. Failure to apply a TQ may have contributed to coagulopathy and the need for postoperative transfusions.