TY - JOUR T1 - Needs damage control JF - Trauma Surgery & Acute Care Open JO - Trauma Surg Acute Care Open DO - 10.1136/tsaco-2021-000757 VL - 6 IS - 1 SP - e000757 AU - David V Feliciano Y1 - 2021/06/01 UR - http://tsaco.bmj.com/content/6/1/e000757.abstract N2 - A 27-year-old man presented to the trauma center with a gunshot would to the left groin exiting in the mid-right buttock. The emergency medical services technician accompanying the patient stated that blood loss was ‘1500–2000 mL at the scene’.The patient was awake and alert with a heart rate of 124 beats/min, a blood pressure of 92/48, and a respiratory rate of 22 breaths/min. There were no peritoneal signs on abdominal examination, while there was normal tone and no blood on a rectal examination. He had a hematoma in the left groin which was oozing arterial blood, but no palpable pulses in the left lower extremity, and diminished motor and sensory function, as well. There was an exit wound in the mid-right buttock without bleeding or a hematoma.Large-bore intravenous access was obtained, an infusion of lactated Ringer’s solution was initiated, a pressure dressing was applied to the left groin, and a cephalosporin antibiotic was administered. The patient was taken to the operating room within 10 minutes of arrival in the trauma center.Because of the proximity of the wound in the left groin to the inguinal ligament, a midline laparotomy was performed and vascular control of the left external iliac artery and vein was obtained. The left groin was then explored through a separate longitudinal incision, and vascular control of the left common femoral artery and vein was obtained, as well. The left external iliac artery under the inguinal ligament was noted to be transected, while the left external iliac vein in the same location was nearly transected.Based on the vascular injuries described, other presumed visceral injuries in the pelvis, and an admission base deficit of −15, your choice for management of the vascular injuries would be to:Insert intraluminal shunts in both the artery and vein.Ligate the … ER -