- Resuscitate per advanced trauma life support.
- Rule out major thoracic trauma (CXR/EFAST/Bilateral chest tubes)
- Confirm abdominopelvic source of shock (FAST exam and Pelvic X-ray if blunt trauma)
- Confirm bilateral femoral pulses are present
- Establish arterial access with 7 Fr Sheath in an uninjured common femoral artery
- Measure balloon distance
- Evacuate the balloon
- Flush the arterial line
- Insert the catheter
- Inflate the balloon (Zone 1: start with 8ml; Zone 3: start with 2ml)
- Secure the catheter
- Control major bleeding
- Monitor the patient, hemodynamics, catheter, and sheath
- Resuscitate and deflate the balloon
- Complete damage control surgery
- Remove sheath when coagulopathy corrected
- Check distal pulses after sheath removal