Page 17 - Journal of Special Operations Medicine - Summer 2014

patient was assessed to be in hemorrhagic shock. Four Figure 2 The AAJT is applied to the left groin. The C-A-T
units of emergent O-negative packed red blood cells has been left in place but loosened. The wound is seen just to
(PRBCs) were requested; they were at the bedside 12 the left of the C-A-T.
minutes after the patient’s arrival.

A Combat Application Tourniquet (C-A-T) (North
®
Ameri can Rescue LLC; http://www.narescue.com) was
applied proximal to the wound, and bleeding stopped (Fig-
ure 1). After the second unit of PRBCs and the first liter of
normal saline were transfused, the patient became more
alert and began complaining of the discomfort from the
C-A-T tourniquet. His systolic blood pressure was mea-
sured at 75mmHg. His heart rate decreased to 130 bpm.
At this time, bleeding was noted from the inner proximal
thigh wound on the left leg. An attempt to place a second
C-A-T tourniquet was made; however, the first C-A-T
tourniquet abutted the perineum, and there was no room
for a second tourniquet to be placed above the first.
transferred from the emergency department to the Level
Figure 1 Initial use of the C-A-T in the emergency I trauma center via Advanced Life Support (ALS) am-
department. The proximal femoral wound is seen with bulance with a nurse (Figure 3). Throughout transport
initial hemostasis noted.
and movement to the trauma unit, the AAJT remained
inflated, and no blood loss was noted from the proximal
left leg wound.
Figure 3 The patient is prepared for transport to the
Level 1 trauma center. The AAJT is applied to the left groin.
The C-A-T is loose but in place. The patient is awake and
hemodynamically stable.

The AAJT was applied by the primary emergency physi-
cian around the hips, with the bladder against the left
groin (Figure 2). The belt was tightened, the windlass then
was tightened and secured, and the bladder was inflated
until the manometer showed green, indicating 250mmHg
pressure. The C-A-T was kept in place, but the tension
was released. The wounds were reassessed, and no blood
loss was found to have occurred. The patient commented On vascular surgery, a transsection of the left deep fem-
that the AAJT was more comfortable than the C-A-T. oral artery was noted. The artery was ligated. No other
significant arterial injury was found. The patient recov-
The patient was assessed surgically and thought to be ered and walked out of the hospital on postoperative
stable enough to transfer to a Level I trauma center day 3. Posthospitalization follow-up has continued to
for further resuscitative measures and vascular repair. show no complications related to the use of the AAJT.
Before transfer, the patient received a third and fourth
unit of emergent O-negative PRBCs. He received a sec-
ond liter of normal saline. At the time of transfer, his Lessons Learned
blood pressure was 101/50mmHg, and he had a pulse The AAJT was quickly applied over the hips and po-
rate of 102. He was alert and oriented. The patient was sitioned over the groin. Slack removal is essential for

AAJT Controls Hemorrhage From Left Groin GSW 7