Tourniquet (extremity) - Revision history

Blsimpso at 00:50, 30 June 2021

2021-06-30T00:50:06Z

← Older revision		Revision as of 00:50, 30 June 2021
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	==See Also==		==See Also==
	*[[Tourniquet]]		*[[Tourniquet]]

			==External Links==

			===Videos===
			{{#widget:YouTube\|id=pFABs0O6-Qk}}

	==References==		==References==

Rossdonaldson1: /* Background */

2021-05-08T05:41:46Z

Background

← Older revision		Revision as of 05:41, 8 May 2021
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	==Background==		==Background==
			[[File:Tourniquet.jpeg\|thumb\|A combat tourniquet commonly used by combat medics (military environment) and EMS (civilian environment).]]
	*Tourniquets have been used in military dating back to the Roman army although the term was not coined until 1718.		*Tourniquets have been used in military dating back to the Roman army although the term was not coined until 1718.
	*In the US military, tourniquets were issued to soldiers from the time of the American Civil War up till World War I. However, tourniquets fell out of favor during World War II.		*In the US military, tourniquets were issued to soldiers from the time of the American Civil War up till World War I. However, tourniquets fell out of favor during World War II.

ClaireLewis at 20:22, 1 October 2019

2019-10-01T20:22:28Z

← Older revision		Revision as of 20:22, 1 October 2019
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	==Indications==		==Indications==
	*Severe extremity hemorrhage not able to be rapidly controlled by other means		*Severe extremity [[hemorrhage]], not able to be rapidly controlled by other means

	==Contraindications==		==Contraindications==
	*None		*None

	==Properties of a Good Tourniquet==		==Properties of a Good Tourniquet (Military Use)==
	*When tightened ~~should eliminate~~ arterial blood flow completely as evidenced by ~~Doppler Ultrasound~~		*When tightened, eliminates arterial blood flow completely (as evidenced by doppler)
	*~~Capable of being easily~~ released and re-applied		*Easily released and re-applied
	*~~Capable of being~~ applied to self on handed		*Can be applied to self one-handed
	*Application time ~~should be around 60 seconds~~		*Application time <60s
	*~~Application should be simple and require~~ minimal familiarization		*Simple application that requires minimal familiarization
	*~~Able to~~ be used in dark, cold, hot, wet, sandy, muddy, icy environments equally well		*Can be used in dark, cold, hot, wet, sandy, muddy, icy environments equally well
	*No assembly required, no batteries needed		*No assembly required, no batteries needed
	*Shelf life for 10 years or longer		*Shelf life for 10 years or longer
	*Width ~~of tourniquet should be~~ > 1"		*Width > 1"
	*Size should be such that it can fit circumferentially around the thigh of 95% of service members (26.7 cm)		*Size should be such that it can fit circumferentially around the thigh of 95% of service members (26.7 cm)
	*Weight should be < 8 oz. (250 g)		*Weight should be < 8 oz. (250 g)

	==Application of Tourniquet==		==Application of Tourniquet==
	*~~Apply directly~~ to ~~skin 2-3 inches above wound~~		*Place as soon as possible, ideally prior to onset of [[shock]]
	*Remove clothing ~~ensuring~~ TQ ~~is not obscured~~ and ~~remains~~ in full view		*Remove clothing so that TQ can be applied directly to skin and remain in full view
			*Apply 2-3 inches above wound
	*Tighten until bleeding is controlled and distal pulse is eliminated		*Tighten until bleeding is controlled and distal pulse is eliminated
	*Document time of placement on medical tag -- consider writing time of placement on patient with indelible marker		*Document time of placement on medical tag -- consider writing time of placement on patient with indelible marker
	*If bleeding is not controlled and distal pulse not eliminated with first TQ ~~- use a second one~~ just proximal to the first ~~one.~~ Increasing the tourniquet WIDTH with a second TQ controls bleeding more effectively and reduces complications versus over-tightening initial TQ.		*If bleeding is not controlled and distal pulse not eliminated with first TQ:
	*~~Place tourniquet on BEFORE onset of shock~~ as ~~mortality is very high if casualty already in shock before tourniquet applied~~		**Apply 2nd tourniquet just proximal to the first
	*Consider pain medication after ~~TQ is placed~~		**Increasing the tourniquet WIDTH with a second TQ controls bleeding more effectively and reduces complications versus over-tightening initial TQ.
			*[[Analgesia]] as needed after placement

	==Precautions==		==Precautions==
	*Do ~~Not place~~ directly over joint ~~such as knee~~ or ~~elbow~~		*Do not apply directly over joint or impaled object
	*Do Not place over impaled object		*Do ''not'' periodically loosen
	*Do ~~Not~~ periodically loosen ~~TQ -- there is no benefit only harm from additional blood loss~~
	*Observe for bleeding as patient is resuscitated and blood pressure increases		*Observe for bleeding as patient is resuscitated and blood pressure increases
	*Do Not Remove TQ if:		*Do Not Remove TQ if:
	**~~The casualty will arrive at a medical~~ treatment ~~facility~~ within 2 hours after time of application		**Definitive treatment to be initiated within 2 hours after time of application
	**The extremity distal to the tourniquet has been traumatically amputated		**The extremity distal to the tourniquet has been traumatically amputated
	**~~The casualty~~ is in shock		**Patient is in shock
	**The tourniquet has been on for more than 6 hours		**The tourniquet has already been on for more than 6 hours

	==Proper Removal at Medical Treatment Facility==		==Proper Removal at Medical Treatment Facility==
	*Place pressure dressing over wound		*Place pressure dressing over wound
	*Loosen TQ slowly observe for bleeding		*Loosen TQ slowly observe for bleeding
	*If bleeding controlled then leave TQ loosely in place in case of recurrent bleeding		*If bleeding controlled, then leave TQ loosely in place in case of recurrent bleeding
	*If bleeding is not controlled without the TQ then re-tighten it		*If bleeding is not controlled without the TQ then re-tighten it

Gregtong: /* Background */

2019-08-21T03:03:01Z

Background

← Older revision		Revision as of 03:03, 21 August 2019
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	*Based on experience from use over the last decade, tourniquets have been shown to be safe and life-saving. The reason tourniquets fell out of favor with the US military was due to poor patient transport out of no man's land in WWI which lead to ischemic complications.		*Based on experience from use over the last decade, tourniquets have been shown to be safe and life-saving. The reason tourniquets fell out of favor with the US military was due to poor patient transport out of no man's land in WWI which lead to ischemic complications.
	*Extremity hemorrhage is the most frequent cause of preventable battlefield deaths thus early control of severe hemorrhage is critical.		*Extremity hemorrhage is the most frequent cause of preventable battlefield deaths thus early control of severe hemorrhage is critical.
	*Tourniquets are a proven effective means of controlling extremity hemorrhage		*Tourniquets are a proven effective means of controlling extremity hemorrhage <ref> Smith AA. et al. Prehospital tourniquet use in penetrating extremity trauma: Decreased blood transfusions and limb complications. J Trauma Acute Care Surg. 2019;86(1):43-51. </ref>
	*Damage to extremity is rare if tourniquet is left on for < 2 hours (recall that TQ are frequently used in surgeries which last several hours). This risk of damage to the limb is considered acceptably small rather than having the casualty expire due to exsanguination.		*Damage to extremity is rare if tourniquet is left on for < 2 hours (recall that TQ are frequently used in surgeries which last several hours). This risk of damage to the limb is considered acceptably small rather than having the casualty expire due to exsanguination.

Mholtz at 06:04, 20 February 2018

2018-02-20T06:04:28Z

Rossdonaldson1: Rossdonaldson1 moved page Tourniquet, extremity to Tourniquet (extremity)

2018-02-16T06:15:36Z

Rossdonaldson1 moved page Tourniquet, extremity to Tourniquet (extremity)

← Older revision	Revision as of 06:15, 16 February 2018
(No difference)

Rossdonaldson1: /* References */

2018-02-16T06:14:42Z

References

← Older revision		Revision as of 06:14, 16 February 2018
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	* If bleeding controlled then leave TQ loosely in place in case of recurrent bleeding		* If bleeding controlled then leave TQ loosely in place in case of recurrent bleeding
	* If bleeding is not controlled without the TQ then re-tighten it		* If bleeding is not controlled without the TQ then re-tighten it

			==See Also==
			*[[Tourniquet]]

	==References==		==References==

Rossdonaldson1: /* References */

2018-02-16T06:14:12Z

References

← Older revision		Revision as of 06:14, 16 February 2018
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	[[Category:EMS]]		[[Category:EMS]]
	[[Category:Procedures]]		[[Category:Procedures]]
			[[Category:Trauma]]

Rossdonaldson1: /* References */

2018-02-16T06:11:33Z

References

← Older revision		Revision as of 06:11, 16 February 2018
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	[[Category:Military]]		[[Category:Military]]
	[[Category:EMS]]		[[Category:EMS]]
			[[Category:Procedures]]

Mholtz at 03:00, 22 January 2018

2018-01-22T03:00:35Z

← Older revision		Revision as of 03:00, 22 January 2018
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	==References==		==References==
	<references/>		<references/>
	~~# Beekley AC, Sebesta JA, Blackbourne LH, et al: Prehospital tourniquet use in Operation Iraqi Freedom: Effect on hemorrhage control and outcomes. ''Journal of Trauma'' 64(2):S28–37, 2008.~~
	~~# Doyle GS, Taillac PP: Tourniquets: a review of current use with proposals for expanded prehospital use. ''Prehospital Emergency Care'' 12(2):241-56, 2008.~~
	~~# Kragh JF Jr, Walters TJ, Baer DG, et al: Survival with Emergency Tourniquet Use to Stop Bleeding in Major Limb Trauma. ''Annals of Surgery'' 249:1-7, 2009.~~
	~~# Prehospital Trauma Life Support, Sixth Ed. Mosby. 2007.~~
	~~# Taillac PP, Doyle GS: Tourniquet First! ''Journal of Emergency Medical Services'' October 2008 (suppl).~~

	[[Category:Military]]		[[Category:Military]]
			[[Category:EMS]]

← Older revision		Revision as of 06:04, 20 February 2018
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	==Background==		==Background==
	* Tourniquets have been used in military dating back to the Roman army although the term was not coined until 1718.		*Tourniquets have been used in military dating back to the Roman army although the term was not coined until 1718.
	* In the US military, tourniquets were issued to soldiers from the time of the American Civil War up till World War I. However, tourniquets fell out of favor during World War II.		*In the US military, tourniquets were issued to soldiers from the time of the American Civil War up till World War I. However, tourniquets fell out of favor during World War II.
	* During WWI four recommendations regarding the use of tourniquets were given. 1) Never cover a tourniquet 2) Write that a tourniquet was applied on the medical tag 3) If conscious tell the service member to verbally inform medical providers that a tourniquet was applied 4) Leave a tourniquet in place for up to 6 hours only		*During WWI four recommendations regarding the use of tourniquets were given. 1) Never cover a tourniquet 2) Write that a tourniquet was applied on the medical tag 3) If conscious tell the service member to verbally inform medical providers that a tourniquet was applied 4) Leave a tourniquet in place for up to 6 hours only
	* During the Vietnam conflict, 2500 US casualties were noted to have perished because of hemorrhaging from an extremity wound alone that is no other significant injuries were noted on the casualty.		*During the Vietnam conflict, 2500 US casualties were noted to have perished because of hemorrhaging from an extremity wound alone that is no other significant injuries were noted on the casualty.
	* Based on experience from use over the last decade, tourniquets have been shown to be safe and life-saving. The reason tourniquets fell out of favor with the US military was due to poor patient transport out of no man's land in WWI which lead to ischemic complications.		*Based on experience from use over the last decade, tourniquets have been shown to be safe and life-saving. The reason tourniquets fell out of favor with the US military was due to poor patient transport out of no man's land in WWI which lead to ischemic complications.
	* Extremity hemorrhage is the most frequent cause of preventable battlefield deaths thus early control of severe hemorrhage is critical.		*Extremity hemorrhage is the most frequent cause of preventable battlefield deaths thus early control of severe hemorrhage is critical.
	* Tourniquets are a proven effective means of controlling extremity hemorrhage		*Tourniquets are a proven effective means of controlling extremity hemorrhage
	* Damage to extremity is rare if tourniquet is left on for < 2 hours (recall that TQ are frequently used in surgeries which last several hours). This risk of damage to the limb is considered acceptably small rather than having the casualty expire due to exsanguination.		*Damage to extremity is rare if tourniquet is left on for < 2 hours (recall that TQ are frequently used in surgeries which last several hours). This risk of damage to the limb is considered acceptably small rather than having the casualty expire due to exsanguination.

	==Indications==		==Indications==
	* ~~Use for profuse/life threatening~~ extremity hemorrhage ~~that cannot~~ be controlled ~~with either dirct pressure or a pressure dressing~~		*Severe extremity hemorrhage not able to be rapidly controlled by other means
	* Use when circumstances prevent quick application of direct pressure or a pressure dressing or when direct pressure/pressure dressing cannot be effectively placed such as entrapped limb

	==Contraindications==		==Contraindications==
	* ~~DO NOT use for venous bleeding or hemorrhage which is easily controlled with pressure dressing~~		*None

	==Properties of a Good Tourniquet==		==Properties of a Good Tourniquet==
	* When tightened should eliminate arterial blood flow completely as evidenced by Doppler Ultrasound		*When tightened should eliminate arterial blood flow completely as evidenced by Doppler Ultrasound
	* Capable of being easily released and re-applied		*Capable of being easily released and re-applied
	* Capable of being applied to self on handed		*Capable of being applied to self on handed
	* Application time should be around 60 seconds		*Application time should be around 60 seconds
	* Application should be simple and require minimal familiarization		*Application should be simple and require minimal familiarization
	* Able to be used in dark, cold, hot, wet, sandy, muddy, icy environments equally well		*Able to be used in dark, cold, hot, wet, sandy, muddy, icy environments equally well
	* No assembly required, no batteries needed		*No assembly required, no batteries needed
	* Shelf life for 10 years or longer		*Shelf life for 10 years or longer
	* Width of tourniquet should be > 1"		*Width of tourniquet should be > 1"
	* Size should be such that it can fit circumferentially around the thigh of 95% of service members (26.7 cm)		*Size should be such that it can fit circumferentially around the thigh of 95% of service members (26.7 cm)
	* Weight should be < 8 oz. (250 g)		*Weight should be < 8 oz. (250 g)

	==Application of Tourniquet==		==Application of Tourniquet==
	* Apply directly to skin 2-3 inches above wound		*Apply directly to skin 2-3 inches above wound
	* Remove clothing ensuring TQ is not obscured and remains in full view		*Remove clothing ensuring TQ is not obscured and remains in full view
	* Tighten until bleeding is controlled and distal pulse is eliminated		*Tighten until bleeding is controlled and distal pulse is eliminated
	* Document time of placement on medical tag -- consider writing time of placement on patient with indelible marker		*Document time of placement on medical tag -- consider writing time of placement on patient with indelible marker
	* If bleeding is not controlled and distal pulse not eliminated with first TQ - use a second one just proximal to the first one. Increasing the tourniquet WIDTH with a second TQ controls bleeding more effectively and reduces complications versus over-tightening initial TQ.		*If bleeding is not controlled and distal pulse not eliminated with first TQ - use a second one just proximal to the first one. Increasing the tourniquet WIDTH with a second TQ controls bleeding more effectively and reduces complications versus over-tightening initial TQ.
	* Place tourniquet on BEFORE onset of shock as mortality is very high if casualty already in shock before tourniquet applied		*Place tourniquet on BEFORE onset of shock as mortality is very high if casualty already in shock before tourniquet applied
	* Consider pain medication after TQ is placed		*Consider pain medication after TQ is placed

	==Precautions==		==Precautions==
	* Do Not place directly over joint such as knee or elbow		*Do Not place directly over joint such as knee or elbow
	* Do Not place over impaled object		*Do Not place over impaled object
	* Do Not periodically loosen TQ -- there is no benefit only harm from additional blood loss		*Do Not periodically loosen TQ -- there is no benefit only harm from additional blood loss
	* Observe for bleeding as patient is resuscitated and blood pressure increases		*Observe for bleeding as patient is resuscitated and blood pressure increases
	* Do Not Remove TQ if:		*Do Not Remove TQ if:
	** The casualty will arrive at a medical treatment facility within 2 hours after time of application		**The casualty will arrive at a medical treatment facility within 2 hours after time of application
	** The extremity distal to the tourniquet has been traumatically amputated		**The extremity distal to the tourniquet has been traumatically amputated
	** The casualty is in shock		**The casualty is in shock
	** The tourniquet has been on for more than 6 hours		**The tourniquet has been on for more than 6 hours

	==Proper Removal at Medical Treatment Facility==		==Proper Removal at Medical Treatment Facility==
	* Place pressure dressing over wound		*Place pressure dressing over wound
	* Loosen TQ slowly observe for bleeding		*Loosen TQ slowly observe for bleeding
	* If bleeding controlled then leave TQ loosely in place in case of recurrent bleeding		*If bleeding controlled then leave TQ loosely in place in case of recurrent bleeding
	* If bleeding is not controlled without the TQ then re-tighten it		*If bleeding is not controlled without the TQ then re-tighten it

	==See Also==		==See Also==