On a busy evening in a rural emergency department, a pale elderly man arrived to the front desk complaining that he was bleeding from his groin. Before the clerk could call for help, a medical student working with me in the department, who was also trained as an EMT, saw the man standing at the desk.
The right pant leg of his overalls appeared to be saturated with blood. The student grabbed some gloves and immediately rushed over, quickly laid the patient on the floor, and applied direct pressure to the patient’s right groin to control the bleeding. We all rushed to his assistance, and the patient was then transferred to a cart with ongoing pressure to the area.
His presentation was consistent with mild shock, including tachycardia, pale, cool, mildly diaphoretic skin, and normal mental status. His blood pressure was 110/80.
As the team quickly applied oxygen and an IV while continuing direct pressure, which had stopped the bleeding, I was able to get the patient’s history. It turns out, he recently had an angiogram and angioplasty.
The common femoral artery of the right groin was the access site for catheter placement during the procedure. After discharge home, he noted swelling in that groin area, and extensive bruising.
Being a stoic farmer, he was anxious to get back to work, and was probably more active than he should have been. He tried to ignore the discomfort, but it suddenly started bleeding while squatting to repair his tractor. Quickly, he grabbed a shop rag and held it to his groin, and got his son to drive him to the hospital.
A pseudoaneurysm, also known as a false aneurysm, is a blood vessel injury where blood escapes through a hole in the vessel wall but is contained by the surrounding tissue rather than the vessel itself.
This creates a pulsatile hematoma that mimics a true aneurysm in appearance, but differs significantly in structure. This type of aneurysm is usually due to trauma, surgery, or, as in this case, catheterization of a vessel. Complications of a pseudoaneurysm include rupture, distal embolization, or nerve compression. This patient’s pseudoaneurysm ruptured, resulting in hemorrhage.
The patient was transferred to the tertiary care hospital with ongoing manual compression of the groin during transport. He subsequently underwent surgical repair of the vessel, and did well.
The important point of this story is: if you have a hemorrhaging patient, stop the bleed before you do anything else!
