[Pulmonary embolism after placement of an Esmarch bandage for ankle surgery].
We report the case of a woman scheduled for surgical fixation of an ankle fracture who developed a pulmonary embolism during application of an Esmarch compression bandage for exsanguination of the limb. Tracheal intubation and mechanical ventilation were needed to reanimate the patient and surgery had to be postponed 15 days. Orthopedic surgery, pneumatic tourniquets for providing a bloodless field and other risk factors contribute to the development of pulmonary embolism, which is often fatal. Accurate diagnosis by plasma D-dimer determination and imaging (perfusion scintigraphy, vascular Doppler ultrasound, echocardiography and pulmonary angiography) is discussed, along with therapeutic approaches to consider when managing pulmonary embolism.
Páez Hospital
M
M
Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Clínico Universitario de Valladolid, Avd. Ramón y Cajal, 3 47005 Valladolid.
Herrero Gento
E
E
Buisán Garrido
F
F
D016512:Ankle Injuries / Q000601:surgery*; D000925:Anticoagulants / Q000627:therapeutic use; D015415:Biomarkers; D003131:Combined Modality Therapy; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D006493:Heparin / Q000627:therapeutic use; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology* / Q000517:prevention & control; D008875:Middle Aged; D011175:Positive-Pressure Respiration; D011229:Preanesthetic Medication; D001261:Pulmonary Atelectasis / Q000209:etiology; D011655:Pulmonary Embolism / Q000097:blood / Q000188:drug therapy / Q000209:etiology* / Q000517:prevention & control / Q000628:therapy; D014111:Tourniquets / Q000009:adverse effects*
D000925:Anticoagulants; D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; D006495:Heparin, Low-Molecular-Weight; C036309:fibrin fragment D; D006493:Heparin