AAJT-S Controls Junctional Hemorrhage From a Gunshot Wound into the Axilla
Birmingham, Alabama — first documented use of a junctional tourniquet for upper-extremity hemorrhage control in a critically unstable trauma patient.
Location: Birmingham, Alabama
Clinicians: Croushorn, McLester, Thomas, McCord
Setting: Hospital
Application site: Axilla
Case ID: TBD — assign
Clinical case summary
Synopsis
Injury, intervention, and outcome at a glance
- GSW Left Axilla</strong
- Dropped at ER doors, unconscious
- HR 130 · BP undetectable
- Class IV Shock
- Bullet traversed axilla entering L chest
- Lost 6 cm of brachial artery
- AAJT-S applied to axilla
- Subclavian artery compressed at mid-clavicle
- Hemorrhage immediately controlled
- 1 unit O+ whole blood administered
- TXA and calcium administered
- Transferred to OR for vascular repair
- Vascular repair performed
- SBP restored and stabilized
- No necrosis or nerve damage
- No device-related complications
- Patient discharged in 3 days
Penetrating Axillary Trauma
A man presented to the emergency department after sustaining a single gunshot wound to the left axilla. The bullet traversed the axilla and entered the left chest, destroying approximately six centimeters of the brachial artery. Bystanders dropped the patient at the ER doors; on arrival he was unconscious, hypotensive, and in Class IV hemorrhagic shock with an undetectable blood pressure and a heart rate of 130 beats per minute.
Massive Junctional Hemorrhage
…
AAJT-S applied in the ER
The team applied the AAJT-S at the axilla, achieving proximal compression of the subclavian artery at the mid-clavicle and immediate control of the hemorrhage. Resuscitation proceeded in parallel: one unit of O-positive whole blood was administered along with tranexamic acid (TXA) and intravenous calcium. With hemorrhage controlled and the patient hemodynamically supported, he was transferred to the operating room for definitive vascular repair.
Stable discharge, no complications
The vascular team completed surgical repair of the brachial artery. Systolic blood pressure was restored and remained stable through the perioperative period. The patient demonstrated no signs of distal limb necrosis and no nerve damage attributable to the junctional compression. He was discharged from the hospital in three days, with no device-related complications. This case represents the first documented use of a junctional tourniquet for upper-extremity hemorrhage control.
Abdominal Aortic Tourniquet Controls Junctional Hemorrhage From a Gunshot Wound of the Axilla — the first reported use of a junctional tourniquet for upper-extremity hemorrhage control.
Croushorn, McLester, Thomas, McCord · Published Case Report (PubMed)
