Picture Quiz: Know your anatomy.

A 25 year old man was brought into the emergency<br/>department by ambulance. He was involved in a road<br/>traffic incident and had an obvious site of blood loss from<br/>a fracture of an upper limb. On his arrival at the<br/>emergency department, you are told that the ambulance<br/>paramedic was unable to gain intravenous access and<br/>are asked by the person in charge of resuscitation to try<br/>to gain access. You are unable to find any peripheral<br/>veins because he is hypovolemic. You attempt to put in a<br/>central line via the femoral vein (fig 1).