Page 34 - JSOM Fall 2019

vascular compromise. Finally, the large blood vessels of the FIGURE 2 Chovanes J, Schneider DJ, Mckee JL, Wang JL. Bridging
neck can produce rapid exsanguination when they are injured. the Gap: A novel method for hemorrhage control. J Health Educ
Res Dev. 2017;5(1). Used with permission under the terms of the
Creative Commons Attribution 3.0 License (http://creativecommons
Several recent publications have documented the efficacy .org/licenses/by/3.0/).
3–9
of the iTClamp as a hemostatic intervention for controlling
external hemorrhage secondary to craniomaxillofacial injury
(CMFI) and penetrating neck injury (PNI), highlighting the
need for this device to be considered as an addition to the he-
mostatic adjuncts currently recommended in TCCC.

Case Report*
A 44-year-old woman presented to the emergency department
with 25 stab wounds to the chest and neck. Two close Zone

1 stab wounds at the base of the neck just above the clavicle
resulted in uncontrolled external hemorrhage. The patient was
unresponsive and her systolic blood pressure was 70mmHg.
The wound was packed with Combat Gauze by physicians, but
then it became saturated with blood. The physicians removed
the saturated Combat Gauze and placed a single iTClamp over
both stab wounds. Because there was leaking observed from
the wound, the physicians removed the iTClamp, repacked the
wound cavity with Combat Gauze, and then used the iTClamp
to seal the wound (Figure 1). The physicians noted that wound
packing with Combat Gauze combined with iTClamp appli-
cation “allowed them to decrease the wound cavity and close FIGURE 3 Chovanes J, Schneider DJ, Mckee JL, Wang JL. Bridging
the Gap: A novel method for hemorrhage control. J Health Educ
the skin which resulted in hemostasis.” The patient was sub- Res Dev. 2017;5(1). Used with permission under the terms of the
5
sequently stabilized. She received 4 units of packed red blood Creative Commons Attribution 3.0 License (http://creativecommons
cells and 6 units of fresh-frozen plasma and had a computed .org/licenses/by/3.0/).
tomography (CT) scan performed for further assessment be-
fore undergoing operative treatment (Figures 2 and 3).
The surgeons explored her neck wounds and ligated the in-
jured first branch of the subclavian vein. The ability to per-
form advanced imaging before surgery allowed the surgeon

FIGURE 1 Chovanes J, Schneider DJ, Mckee JL, Wang JL. Bridging
the Gap: A novel method for hemorrhage control. J Health Educ
Res Dev. 2017;5(1). Used with permission under the terms of the
Creative Commons Attribution 3.0 License (http://creativecommons.
org/licenses/by/3.0/).

to assess other potential bleeding sites and to decide where to
begin surgical exploration of the multiple stab wounds. The
ability to rapidly stabilize this patient for further diagnostic
studies demonstrates the effectiveness of the device and the
reliability of its effect. This creates greater flexibility during
triage and provides the surgical team with more time for pre-
operative planning. Although this intervention occurred in the
emergency department, it could easily have been accomplished
in the prehospital setting, including the Role 1 environment, to
provide early hemorrhage control and prevent a patient from
developing shock.

*This case report is from Chovanes J, Schneider DJ, Mckee JL, Wang JL. Bridging the Gap: A novel method for hemorrhage control. J Health
Educ Res Dev. 2017;5(1). All the information in this section is from that reference.

32 | JSOM Volume 19, Edition 3 / Fall 2019