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Discussion Starter · #1 ·
I came across a couple of videos and a publication showing some very serious femoral artery injuries. These are especially scary because they can quickly be life ending without immediate emergency care. Luckily their friends were able to save them. I thought these should be rare, but I came across two videos at random, and then two cases at a single hospital of a similar injury. So it would be good to be aware of these.

Can anyone explain how these happened? Did they hit their handlebars, or did they hit an obstacle? I've noticed some people riding with worn grips and the metal end of the handlebar exposed, so that could be safety hazard.

Other than that, I guess everyone should know basic first aid, ride with friends, have a phone and know their location coordinates.

Graphic Warning
Video 1 https://www.youtube.com/watch?v=w2sMFZIB6zA
Video 2 Cedric Gracia's Bloody Crash

Publication Common femoral artery injury secondary to bicycle handlebar trauma - ScienceDirect

1-s2.0-S0741521402895386-gr3_lrg.jpg
iliac_arteries_and_veins.jpg
 

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Norðwegr
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After seeing some of these injuries I added a tourniquet to my medkit, it's not a recommended thing to do anymore. But if someone I find or myself have the option of losing a limb or losing their life it should be a pretty simple choice.
 

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Discussion Starter · #3 ·
After seeing some of these injuries I added a tourniquet to my medkit, it's not a recommended thing to do anymore. But if someone I find or myself have the option of losing a limb or losing their life it should be a pretty simple choice.
That's great you did that, you might save a life someday. For people who don't have that, they used a bicycle inner tube in one of the videos. I have no idea how common this is, I was shocked to see two videos when I wasn't even looking for this.
 

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A rider died from a similar injury here in central VA a few years back. As he was crashing off trail he bent over a small sapling to the point that one side of the roots popped up out of the ground and one of those punctured the artery. He bled out in minutes....
 

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Discussion Starter · #6 ·
I did not view the links but if neither is related to an incident here in Colorado, here is a very good story / scary situation-

https://springsmag.com/rescue-almagre/
Thanks for sharing that. Glad he was saved.

TL;DR

* Riding alone
* Slow speed crash, steep hill
* Feet stuck clipped in
* Leg/groin hit brake lever

Thoughts
* Ride with friends
* Bring a cellphone, location info, etc
* Carry your blood type info/ID?
* Cover or replace sharp parts on your bike, especially around the handlebars?
 

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Discussion Starter · #7 ·
A rider died from a similar injury here in central VA a few years back. As he was crashing off trail he bent over a small sapling to the point that one side of the roots popped up out of the ground and one of those punctured the artery. He bled out in minutes.
That's sad. So I guess this type of accident is not a fluke, but something that happens sometimes. Maybe his injury was too severe, or he didn't have people there to help him. All the other accidents were nearly fatal, so it's probably hit or miss.
 

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since 4/10/2009
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I remember when that incident with Cedric Gracia happened and hit the internet awhile back. Scary ****. I don't think a tourniquet is going to be useful for a femoral artery bleed. That location is too close to your torso and you can't put the tourniquet far enough "upstream" to do the job. It works better on major bleeds more distal in places where you're essentially willing/able to sacrifice a limb to save a life.

What they did in Cedric's video, shoving a thumb inside the wound to place internal pressure on the artery, is probably the only thing that stood a chance at working, and saved his life. If he had been riding solo, or if someone in the group didn't have the ability to get help, he wouldn't have made it.
 

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Always in the wrong gear
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After seeing some of these injuries I added a tourniquet to my medkit, it's not a recommended thing to do anymore. But if someone I find or myself have the option of losing a limb or losing their life it should be a pretty simple choice.
Applying a tourniquet doesn't mean loss of limb. I've applied tourniquets to limbs on several occasions. It's also common practice during limb surgery, especially knee replacement. A tourniquet can stay in place for several hours before significant tissue damage begins.
 

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Your chances of getting injured go up when riding with Seth. Don't ride with Seth. Just watch his videos.


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Applying a tourniquet doesn't mean loss of limb. I've applied tourniquets to limbs on several occasions. It's also common practice during limb surgery, especially knee replacement. A tourniquet can stay in place for several hours before significant tissue damage begins.
It doesn't mean definite loss, but it could if it has to stay on long enough. Depends on how long it takes to get the person out.

If you gotta use one, you gotta use one.

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Always in the wrong gear
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Generally the standard for tourniquet use is 4 hours, then loosen slightly for 60 seconds to allow for some re-profusion before re-tightening; then you're good for another 2-ish hours. It's a pretty rare case that evac takes more than 6 hours.
That's the protocol for most lower extremity surgeries, and the standard I taught during my time as an Army combat medicine instructor, and what I used in practice as an infantry medic during my 3 Middle East tours of combat.
 

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Could you imagine?
Falling over fatiqued in an awkward spot (we've probably all done it) and the next thing you know your brake lever has severed you femeral artery. Without immediate intervention you're going to die....gah!

This is not an issue I'm at all concerned about, though I'm no stranger to injury. How about shorts with a kevlar panel on the inner thigh?
 

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A rider died from a similar injury here in central VA a few years back. As he was crashing off trail he bent over a small sapling to the point that one side of the roots popped up out of the ground and one of those punctured the artery. He bled out in minutes....
Yep, a guy also washed-out into a dead Manzanita tree and a brittle, stray branch went right thru his neck. His jugular drained in minutes. Man, that is what MTB nightmares are made of!!!
 

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Generally the standard for tourniquet use is 4 hours, then loosen slightly for 60 seconds to allow for some re-profusion before re-tightening; then you're good for another 2-ish hours. It's a pretty rare case that evac takes more than 6 hours.
That's the protocol for most lower extremity surgeries, and the standard I taught during my time as an Army combat medicine instructor, and what I used in practice as an infantry medic during my 3 Middle East tours of combat.
Good to know. Tourniquet use wasn't really addressed during the WFA course I took last summer. We spent more time practicing stabilizing broken limbs and potential neck injuries, and though we did spend some time talking about dealing with bleeds, we didn't talk about anything so major that it would require a tourniquet.

I still think a high femoral artery bleed isn't going to be a location where a tourniquet would be practical. Too close to the torso.
 

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Always in the wrong gear
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Good to know. Tourniquet use wasn't really addressed during the WFA course I took last summer. We spent more time practicing stabilizing broken limbs and potential neck injuries, and though we did spend some time talking about dealing with bleeds, we didn't talk about anything so major that it would require a tourniquet.

I still think a high femoral artery bleed isn't going to be a location where a tourniquet would be practical. Too close to the torso.
Bleeds that require a tourniquet associated with biking/hiking/running are really so rare that it's barely worth mentioning in first aid courses. It's really only the military that is 'researching' it, because of the nature of the injuries (big bullets and bombs), and variable evacuation times.

Sometimes I just get really spun up because there's so much bad info out there about them, i can't help myself but to set the record straight.

I 100% agree about a femoral bleed, it's way too high for much of any intervention. The best thing you can do is jam your knee into the groin and lean hard on it to slow the bleeding, have a cell phone out and get help.
 

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Perhaps a small pair of forcepts to clamp it off over tourniquet? Roach clip in a pinch.
 

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Jam the hole full of bandages and put on a tight compress.
Do not attempt to use a tourniquet unless there's no other way, toxic shock when relieving pressure can kill people, it's not something that should be done without proper training.
 

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bipedal
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QwikClot

Another approach to stopping severe bleeding is to use a clot promoting agent like QwikClot. It consists of zeolite, an aluminum silicate available in granular form or on hemostatic bandages. It's used in the military and by EMS and first responders, and I used to carry packets of Qwikclot granules on my off-road motorcycle and in my car for emergencies. MTB crashes usually don't result in as much trauma and moto crashes, but I should probably carry some of the bandage dressings even when just pedaling.

Here's a video that shows just how well it works in the case of complete bisection of the femoral artery:

https://www.youtube.com/watch?v=e9xvIbKBJn4
 

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Handlebar injuries are pretty common but they are mostly blunt trauma. The incidence of impalement, and especially impalement leading to femoral artery bleeding would be a pretty extreme long shot. In the case of a femoral artery injury from any cause, a tourniquet would be generally useless. Quikclot...might be useful if the bleeding can't be controlled with direct pressure or by packing the wound with gauze. Blunt trauma to the femoral artery would be far more likely than penetrating trauma, but still very rare compared to the incidence of blunt trauma to the abdomen and its contents.
 
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