Lower limb exsanguination and embolism

We report a case of fatal pulmonary embolism during lower limb exsanguination in orthopaedic surgery. A 76-year-old woman underwent an open fixation of an external femoral condyle fracture one day after injury. Subarachnoidal anaesthesia was performed and Esmarch compression bandages were applied in...

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Bibliographic Details
Published inActa anaesthesiologica belgica Vol. 50; no. 2; p. 95
Main Author Boogaerts, J G
Format Journal Article
LanguageEnglish
Published Belgium 1999
Subjects
Aged
Anesthesia, Spinal
Apnea - etiology
Bandages - adverse effects
Echocardiography, Transesophageal
Fatal Outcome
Female
Femoral Fractures - surgery
Fracture Fixation
Humans
Intraoperative Complications
Leg - blood supply
Popliteal Vein
Pulmonary Embolism - diagnostic imaging
Pulmonary Embolism - etiology
Shock - etiology
Tibia - blood supply
Tourniquets - adverse effects
Unconsciousness - etiology
Veins
Venous Thrombosis - complications
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Summary:We report a case of fatal pulmonary embolism during lower limb exsanguination in orthopaedic surgery. A 76-year-old woman underwent an open fixation of an external femoral condyle fracture one day after injury. Subarachnoidal anaesthesia was performed and Esmarch compression bandages were applied in preparation for tourniquet ischaemia. At this time, the patient lost consciousness, became apneic and collapsed. Resuscitation procedures were instituted and transoesophageal echocardiography revealed pulmonary embolism. In spite of haemodynamic support and thrombolytic therapy, the patient died. Postmortem examination revealed multiple thromboemboli of recent origin in the right heart cavities, in the pulmonary arteries and in the popliteal and tibial veins of the injured leg. Preventive, diagnostic and therapeutic options of this catastrophic event and indications of pulmonary embolectomy are discussed.
ISSN:0001-5164