Palmar arches

So this guy comes in holding an ABD dressing over his left hand, and it’s absolutely soaked in blood. “Hand laceration” is his chief complaint. He looks apprehensive. This isn’t good, I thought. The staff physician was right outside signing some charts. “Can you take a quick look at this with me?” I calmly called as I grabbed a portable blood pressure cuff and pumped it up to about 180 mm Hg around his right upper arm. I lifted of the blood soaked pad, and blood continued to pump out of his cut in rhythmic squirts.

We moved him off the ob/gyn bed, to a bed appropriate for suturing with overhead focus lights. In spite of the BP cuff, direct pressure on his radial and ulnar arteries and local wound pressure, I still could not get the pumping to stop. I inflated the cuff to 220. The boss infiltrated some lidocaine into the cut to get a better look. So now we had a physician (me) trying to stem the flow of blood, and the boss who had no idea where equipment is stored. We called for a nurse to get us a suture kit with hemostats. She grabbed it, set in on the tray and walked out of the room. The Boss opened it up and clamped two of the pumpers with the hemostats, after putting on sterile gloves. The blood continued to pour out, and I continued to hold pressure wherever it seemed to help the most. Now we needed sutures…again calling to the nurse to bring some. She brought a pack, and dropped it, unopened onto the counter and began to walk out. “Can you open them please?” the boss says. She opened the pack onto the sterile field. “what else do you need?” she asked (finally). “I need you to stay in the room for awhile,” the Boss says.

We manage to tie about three or four sutures around bleeding arterial sites, but blood continues to flow out of the would despite my best attempts to apply pressure to the arteries. The Boss cries Uncle. I call the ortho clinic and tell them this guy needs to go to the OR, and fast! I tell them he’s lost about a half liter of blood. I want them to know this is urgent! Suddenly, my boss says, “It’s stopped.” Huh? He was practically hemmoraging a second ago, and all I did was take off the blood pressure cuff. Well, when we had finally stopped all the arterial bleeding, and stopped to return flow to the heart with the BP cuff, all the venous blood began oozing from unrepaired veins. By letting down the cuff, the blood was able to make it’s complete circuit back to the heart.

Sure enough, I looked at the would again, and all you could see was a 1 cm long incision. No blood at all. I called the clinic back and sheepishly told them, “Nevermind!”

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