Severe Life Threatening Limb Hemorrhage in Combat Trauma; Medical Challenges and Cautions

Introduction: Despite all the infrastructure damage and manpower in the wars of the Axis of Resistance, the fruitful achievements of the military medicine have not been hidden from anyone for years. Therefore, these experiences need to be passed on to the younger generations working in the field of armed forces’ health and treatment. Here, we will describe one of these experiences.
Case Presentation: A 35 years old soldier who was injured by a mortar shell. He suffered a severe left arm injury and heavy bleeding. His comrades rushed him to the field hospital immediately without controlling the bleeding. The patient is brought in a state of hemorrhagic shock and unstable vital signs. Immediately, normal saline serum followed by blood products (Packed cell, Platelet, FFP) was started. After intubation, the patient was transferred to the operating room and the upper left limb was amputated due to severe vascular and nerve damage. Thereafter, closed monitoring of the casualty prevented a potential acute renal failure and he rescued.
Discussion: In war trauma, the best means of bleeding control is a tourniquet. Of course, finding the location and its proper use is very important. Furthermore, severe life-threatening bleeding needs immediate access to blood and blood products, rather than to fluid therapy. In Crush injuries, due to the blood cytokine release and severe dehydration caused by bleeding, there is a possibility of severe renal failure.