Esmarch bandage was wrapped tightly around the arm from the most distal part to near the pneumatic tourniquet to further exsanguinate. The proximal cuff was inflated to 100 mmHg higher than the systolic blood pressure of patient.
This is because of the fact that the death of one twin will inevitably lead to the death of the other unless an attempt is made to separate them because the surviving twin will exsanguinate into the dead twin.
This presentation is known as the Chiari triad.(12,13,14) On CT, intravenous contrast does not need to be seen within the esophagus: Active bleeding through a fistula is acutely life-threatening as the patient can quickly exsanguinate. A more common CT appearance includes a focal outpouching of the aorta towards an area of esophageal wall thickening with extraluminal gas abutting the aortic wall (Figures 13 and 14).(15)
Alegre has unlocked this dark chamber of recall when he could not pull himself single-handedly from this emotional morass and had, perforce, to exsanguinate his undoctored feelings out in brutish and seemingly random layers of manic gesture.
Hemorrhage control is always the first priority as a person can exsanguinate within 90 seconds to three minutes from a severed femoral artery and vein, whereas a patient can survive several minutes with an obstructed airway.