TY - JOUR T1 - Balloons are not just for children JF - Trauma Surgery & Acute Care Open JO - Trauma Surg Acute Care Open DO - 10.1136/tsaco-2021-000808 VL - 6 IS - 1 SP - e000808 AU - David V Feliciano Y1 - 2021/08/01 UR - http://tsaco.bmj.com/content/6/1/e000808.abstract N2 - A 28-year-old man was shot at close range on the left side of the face at the level of the mandible. Arterial hemorrhage through the entrance site was observed immediately, and external compression was applied by a bystander until the arrival of emergency medical services. Manual compression over abdominal pads was maintained during transport to the trauma center.The patient was awake and alert with a heart rate of 120 beats per minute and a systolic blood pressure of 140 mm Hg. The left side of the face was edematous and covered with what were assumed to be powder burns. Removal of the saturated laparotomy pads over the entrance site resulted in vigorous arterial bleeding.Your choice for management in this patient at this time would be to:Explore the left anterior neck and ligate the external carotid artery.Maintain compression and call endovascular surgeon.Attempt balloon tamponade through the entrance site of the missile.Explore the left side of the face through a transverse incision.Because of the continuing rapid loss of arterial blood despite external compression on the left side of the patient’s face, the attending surgeon asked for a “large” Foley balloon catheter. A catheter with a 30 mL balloon near the tip was inserted into the entrance site of the missile to a depth of 2 cm. At this point, the balloon was inflated with 25 mL normal saline, and all bleeding stopped (figure 1). A quick review of a textbook of gross anatomy suggested that the vessel being compressed by the inflated balloon was the facial artery. This artery is a major branch of the external carotid artery and does not flow to the brain nor feed the ophthalmic artery.Figure 1 Foley catheter balloon tamponade to control bleeding from the left side of the face.With … ER -