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View Full Version : Tourniquets. Are they worth it and how to apply if necessary



77 wolfpack
02-09-2018, 03:22 AM
Tourniquets

I am going to break this thread up into two parts. First I want to go over what a tourniquet is and to voice my concern over them.
One of the most commonly thought of medical practices in terms of heavy bleeding is the tourniquet. Over the years, this has been a major subject of debate on when or if you use one, or if they are even worth it.

The truth is they DO serve a purpose, but they are NEVER the initial treatment unless the wound is THAT severe and critical to save a person from IMMEDIATE LOSS OF LIFE. There are different treatments to use beforehand; for example: direct pressure and/or elevation

The biggest concern with the use of a tourniquet is the risk of ISCHEMIA (an inadequate blood supply to an organ or part of the body.)
The concern is tissue damage due to a loss of circulation. Continuous application for longer than 2 hours can result in permanent nerve injury, muscle injury, vascular injury and skin necrosis. Muscle damage is nearly complete by 6 hours (it can happen sooner).

COMPARTMENT SYNDROME: The more problematic issue is known as compartment syndrome. Basically raised pressure within the arm, leg (or any enclosed space within the body) leads to tissue & muscle damage because of the lack of blood supply/pressure within the cavity. Prolonged or inappropriate use of a tourniquet can lead to this complication (muscle necrosis). [It should also be noted this can cause kidney damage due to rhabdomyolysis (muscle destruction) because your body is trying to process dead tissue, toxins and everything else that is breaking down inside the body]

PAIN: There will be some pain. A properly applied tourniquet is painful; a person may require significant pain relief to apply the tourniquet to the appropriate pressure. This is the concern of many arguments on this topic. Yes, tourniquets are effective and appropriate but only if their use is warranted and the person applying the tourniquets understands what they are doing, how to do it and why.


If a situation DOES happen and you are considering the use for a tourniquet always be knowledgeable of what you are doing
If it is deemed necessary to apply a tourniquet either because the necessity of the situation dictates or because the simple measures are not sufficient; it is imperative the tourniquet is applied appropriately.



Use a dedicated tourniquet if one is available - if not, improvise. Improvised tourniquets have been proven to be as effective as some prefabricated devices. The issue with improvised tourniquets is you never know what you might have available, and you don't want to use something which will cause the situation to expand. Belts are often thought of as a good improvised tourniquet, being strong but they are too stiff to apply effectively.
The design of any tourniquet improvised or otherwise requires a broad band to provide adequate compression. NEVER USE CORDING OR WIRE!!!! This will cut into the body and you will have additional issues.
The tourniquet should be applied onto bare skin to prevent slipping.
The tourniquet can be applied on single or double bone limb (such as the forearm).

Traditional teaching has avoided placement of a tourniquet over a double bone compartment (lower leg or lower arm) as the twin bones in these areas may protect the blood vessels from adequate compression from a tourniquet. This is a subject of debate with some battlefield injuries contesting it.
The tourniquet should be applied just above the injury. 2 or 3" is fine
Tighten the strap fully before tightening the windlass.
The tourniquet should be tightened until bleeding stops. I've been taught when using the Phalanx style pre-made tourniquets; you only need to twist the rod three or four times. Any more and you could pop the stitches. I cannot attest to this since I have never had to use one of them.
If it is ineffective, the tourniquet should be tightened or re-positioned. With that said, NEVER REMOVE AN EXISTING TOURNIQUET ONCE PROPERLY APPLIED. Only a doctor should remove a tourniquet due to the complications which can occur.
Slight oozing at the wound site may occur due to some blood flow from the exposed medullary bone end
Write the Time and Date on the tourniquet and mark the casualty with a T on their cheek (for those of us deployed, it's easier to see than on the forehead if they are wearing a helmet and more likely to remain clear because of less sweat).
The time and date of the tourniquet application should be mentioned in the communication and handover to arriving medical EMTs/Paramedics. This is very important because an ambulance crew normally has a different set of protocols due to patient classifications.


I know this is a very long thread and a lot of information has been put here. Other than my military sources of information, I also found this website to be full of information: http://www.realfirstaid.co.uk/tourniquets/

sasquatch
02-09-2018, 04:34 PM
Looking good so far, good info.

Looking forward to part 2. :0Thumbs_Up_Hand_Sig

77 wolfpack
02-10-2018, 01:48 AM
If i am able to get a good "Part 2", i will include pictures. Tourniquets are not something i like to play with because to use one, it means some kind of catastrophic injury has occurred and time is of the essence. There are some amazing products out there, such as "QuikClot". Now, quikclot does have a rather short shelf life of around 2 years according to what i have been issued in the past, but we dont use it in the powder form anymore due to people burning their mouths. Ripping it open with your teeth in the heat of battle is not advised, however the quikclot bandages where you are basically packing a wound with it i hear is a better product.

sasquatch
02-10-2018, 02:05 AM
If i am able to get a good "Part 2", i will include pictures. Tourniquets are not something i like to play with because to use one, it means some kind of catastrophic injury has occurred and time is of the essence. There are some amazing products out there, such as "QuikClot". Now, quikclot does have a rather short shelf life of around 2 years according to what i have been issued in the past, but we dont use it in the powder form anymore due to people burning their mouths. Ripping it open with your teeth in the heat of battle is not advised, however the quikclot bandages where you are basically packing a wound with it i hear is a better product.


Yeah, they have the QuikClot bandages and sponges now. I actually stock them in my first aid kits.
I've used both and they work well.
But a properly placed tourniquet can save a life, read many stories of them doing so.
So lay out the proper procedure for using one because knowing how to use one is an important skill to have.

Souldat
02-20-2018, 10:06 PM
This is really good and informative. Thank you for taking the time to share this with the community Wolf!