Abstract:
We report a case of fatal pulmonary embolism (PE) following exsanguinations of lower
limb in orthopedic surgery. A 30‐year‐old man was posted for fixation of a tibial plateau
fracture on the seventh day after injury. Subarchnoid block was performed. Esmarch
bandage was used for exsanguination of the limb and tourniquet was inflated. Within
three minutes after tourniquet inflation, the patient became unconscious hypotensive,
and collapsed. Resuscitation was instituted and spontaneous circulation restored. Right
ventricular strain pattern on transthoracic echocardiography, increased levels of D‐dimer,
and Doppler examination of the lowerlimb confirmed deep venous thrombosis of right
femoral vessels and PE. In spite of thrombolytic therapy with streptokinase and heparin,
the patient died on the ninth day after the event. Cases of PE secondary to the use
of Esmarch bandage and tourniquet are reviewed here to identify the risk groups and
management of PE.
