TY - JOUR T1 - Where is the femoral vein? A vascular case report JF - Trauma Surgery & Acute Care Open JO - Trauma Surg Acute Care Open DO - 10.1136/tsaco-2022-000979 VL - 7 IS - 1 SP - e000979 AU - David V Feliciano Y1 - 2022/07/01 UR - http://tsaco.bmj.com/content/7/1/e000979.abstract N2 - A 41-year-old man was shot in the proximal left groin with a handgun of unknown size. The emergency medical service noted exsanguinating hemorrhage with dark venous blood and applied a dressing under manual pressure.The patient was confused and agitated and had a blood pressure of 70/50 mm Hg, heart rate of 130 beats per minute, and a respiratory rate of 25 breaths per minute. He was intubated rapidly, intravenous catheters were inserted into the upper extremities, and more dressings were applied to the area of bleeding in the left groin.Appropriate management of this patient in the emergency center would be:Apply a tourniquet directly to the entrance wound.Obtain vascular control in the trauma room.Fill the entrance hole of the missile with hemostatic gauze.Transfer the patient to the operating room.After the patient’s skin was prepared and draped from the umbilicus and both lower extremities circumferentially to the toenails, a 10 cm longitudinal incision was made over the left femoral vessels. Torrential venous hemorrhage was noted from both large and small veins as two attending surgeons used large metal clips, 2-0 silk ties, and DeBakey vascular clamps to attain hemostasis. After transfusion of 42 units of packed red blood cells and an unknown number of units of fresh frozen plasma and platelet packs, reasonable control of venous hemorrhage was noted. Examination of the left groin first documented that there were no injuries to the left common femoral, superficial femoral, and profunda femoris arteries. In contrast, two-thirds of the left common femoral vein, the femoral vein in the groin, and the profunda femoris vein were destroyed.With the venous injuries in the left groin as described, … ER -