TY - JOUR T1 - Challenges in acute care surgery: penetrating vertebral artery injury in ‘extremis’ patient JF - Trauma Surgery & Acute Care Open JO - Trauma Surg Acute Care Open DO - 10.1136/tsaco-2021-000684 VL - 6 IS - 1 SP - e000684 AU - Juan Pablo Ramos Perkis AU - Francisco Goyenechea Miralles AU - Huascar Rodriguez Galvan AU - Julio Benítez Pérez AU - Pablo Ottolino Y1 - 2021/04/01 UR - http://tsaco.bmj.com/content/6/1/e000684.abstract N2 - A young woman was brought to the emergency department after sustaining a gunshot wound to right cervical zone 2. Prehospital personnel describe abundant external bleeding at the accident site. She was admitted to the trauma unit in a 7-minute cardiorespiratory arrest, intubated. A massive transfusion started with 2 units of packed red blood cells and 2 units of fresh frozen plasma through high-flow venous accesses. A hemostatic Foley balloon was inserted through the cervical wound (figure 1A). Her extended focused assessment with sonography in trauma was negative for the abdomen and thorax. After 3 minutes of advanced cardiopulmonary resuscitation, she recovered spontaneous rhythm. During the next few minutes, the patient entered deep shock with blood pressure 70/30 mm Hg, heart rate 110 beats per minute. As she did not achieve hemodynamic improvement despite transfusions, she was transferred to the operating room. An anterior sternocleidomastoid incision was made, maintaining hemostatic control with a Foley balloon. During the cervical surgical exploration, an undamaged common external and internal carotid artery was observed, with bleeding visible behind the neurovascular bundle (figure 1B). Do you suspect a vertebral artery (VA) injury?Figure 1 (A) Gunshot … ER -