TY - JOUR T1 - Endovascular stent-graft repair of transected left subclavian artery JF - Trauma Surgery & Acute Care Open JO - Trauma Surg Acute Care Open DO - 10.1136/tsaco-2021-000696 VL - 6 IS - 1 SP - e000696 AU - Sayuri P Jinadasa AU - Michael R Hall AU - David V Feliciano Y1 - 2021/03/01 UR - http://tsaco.bmj.com/content/6/1/e000696.abstract N2 - A 33-year-old female presented to the trauma center with multiple gunshot wounds to her left posterior axilla, right of midline in the upper back, and left lateral thigh. She complained that she did not have sensation in or an ability to move her left upper extremity.The patient was screaming and uncooperative during the examination. Her systolic blood pressure was 110 mm Hg, heart rate was 138 beats per minute, and respiratory rate was 33 breaths per minute with audible breath sounds bilaterally. There was significant bleeding from her left posterior axillary wound, and this was packed with gauze. Her left upper extremity was cool with no palpable radial pulse nor Doppler signal, and she had no strength or sensation in this extremity. Palpable pulses were present in all other extremities.After blood was drawn for type and cross-match, two large bore intravenous catheters were inserted. Given her agitation and inability to cooperate with an examination, she was intubated using rapid sequence induction with 100 mg lidocaine, 150 mg propofol, and 100 mg rocuronium. With induction, she became hypotensive to a systolic blood pressure of 70 mm Hg.With the rapid decline in the patient’s systolic blood pressure, your choice for the next step in management would be:Focused abdominal sonography for trauma (FAST) examinationTransfusion of blood productsInfusion of 1 liter lactated Ringer’s solutionStat CT aortogram with contrastA Cordis central venous catheter was placed in her right femoral vein under ultrasound guidance, and she was transfused 1 unit of whole blood with a rise in her systolic blood pressure to 140 mm Hg. An extended FAST examination was performed and was negative for any blood in the pericardium, bilateral pleural spaces, or abdomen. An X-ray of her chest showed bullet fragments over her right clavicle and no evidence of an intrathoracic injury, … ER -