It’s 2 am, when a 32-year-old male was minding his own business in the kebab shop only to be stabbed to the left side of his neck. At the scene and en route to hospital direct pressure was ineffective in controlling the profuse bleeding.
On arrival to emergency, a right subclavian MAC line was inserted, 2g TXA administered, and massive transfusion protocol commenced. Profuse bleeding continues from the wound and you suspect a carotid artery or internal jugular injury.
A 22Fr 3-way Foley catheter is inserted into the wound tract. The balloon is inflated with 40ml sterile water and gentle traction applied.
The overlying wound is rapidly closed with 0 silk to maintain Foley placement. With haemorrhage controlled, the patient can be resuscitated, investigated with CT angiography and related studies as indicated, and then taken to definitive operative or endovascular management when major vascular injury is identified.
Foley catheter balloon tamponade is a temporising manoeuvre that may also be definitive treatment in selected venous and minor arterial injuries. Non-compressible haemorrhage remains a major cause of potentially preventable trauma death.
LITFL published a clinical update in Critical Care on 09 Apr 2026.
The item focuses on MacGyver the Foley.
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