Did you ever use a tourniquet?

[Chief1C]

"as it's needed"

Meaning, in my terms, Pro Re Nata; as needed, as the circumstance requires, et al.

[Bernhard]

Meaning, in my terms, Pro Re Nata; as needed, as the circumstance requires, et al.

So, one circle round again, because exactly that expression again rises my question. In other words: which circumstances do you see that requires to lift the legs for shock management?

[Chief1C]

I've raised the feet of a lower GI bleeders who waited too long. However, in twelve years, I've yet to raise the feet of a traumatic hypotensive patient. I have put the MAST on them though.

I'm not going to directly answer your question. I'm not interested in interacting with new members that are difficult to please.

[Bernhard]

Sorry, 2c4 I totally missed your reply somehow, not wanting to ignore you. I'm really sorry.

I've raised the feet of a lower GI bleeders who waited too long. However, in twelve years, I've yet to raise the feet of a traumatic hypotensive patient. I have put the MAST on them though.

Well, I would argue the same way with the MAST (never saw one in real use and knowing it seems to be deprecated now anyway) and would be interested, what the real reason of the GI bleed was and if the leg raising really helped there.

But, unfortunately, you stated this:

I'm not going to directly answer your question. I'm not interested in interacting with new members that are difficult to please.

Beeing (still) a new member here does not necessearily imply I'm totally new to EMS or EMS-related internet discussions. In both fields I have a good chance to outnumber several valued members of the EMS & the internet community. Which, in itself, doesn't imply that there is some value in what I write (it sure only implies that I'm rather old...). The value comes from the content and it's up to the reader (you) to judge it. So I would feel more comfortable If I could read your judgement and answer my direct question but I'm OK with not having the chance.

Maybe as a non-native english reader I misunderstood some of your statements but I'm still not yet convinced of raising some legs for shock treatment, I still don't see any exceptions to this rule (simply due to functional reasons) and I think this thread won't get the job done. See you in another discussion...

[Asysin2leads]

Really only one patient springs to mind who I could say honestly would have benefited from the use of a tourniquet. He was a male in his mid 20's who had gone through a 1/4 inch think pane of exterior glass, and not the tempered kind. His right arm had a circumferential laceration approximately halfway down the humerus which transected all of the structures down to the bone. He was in stage III hemmorhagic shock and we were on scene only about 10 minutes after the incident. There was absolutely no way to hold direct pressure on this wound, it would have been like trying to hold Jell-o into place. Unfortunately our system was in the "off again" portion of the "on again off again" battle over tourniquets and they were contraindicated. Lucky for him it was a very short transport time to the hospital. I do think he would have benefited from a tourniquet.

The vast majority of cases of hemmorhagic shock cases I have seen have been due to internal injuries, and just about every other extremity injury I have encountered has done well in sealing itself off, even complete amputations. I'm not sure what it was about the glass injury that prevented the vasospasm that helps to control hemmorhage. This is also why I am skeptical of Quikclot devotees. Its not that I doubt its efficacy, its just the times I have had someone exsanguinating from a small, clean wound of a major vessel have been non-existent.

[Kiwiology]

We have the combat application tourniquet

[Tactical Spork]

Hello all,

I enjoyed reading the posts. I thought I would add my thoughts.

First, a few pages back, the consensus I gathered from posts was that you should apply a tourniquet to slow, but not stop blood flow. From my experience I would recommend against such practice as typically you are applying these devices to control deadly uncontrollable bleeding that cannot be stopped by other means.

I think, from a practical level, halting deadly bleeding yet maintaining distal flow in an attempt to maintain tissue viability would work, from a theoretical point of view, but in field application this would be almost impossible to achieve. Also, one could argue that such end tissue perfusion would eventually produce hemodynamic instability over time. This doesn't fit with the life over limb concept of tourniquet application as the blood supplying the tissue isn't coming back, so to speak.

Typically, the distal flow theory of tourniquet use is sometimes advocated for when there is significant post-injury tissue at risk. For example a mid-thigh GSW with arterial bleeding, or perhaps some sort of crushed a extremity. Anything other than a straight forward amputation would be another way of saying it. The concern is distal tissue death. If anything these are the cases where a loosely applied tourniquet will actually promote blood flow and loss through the venous side. After all we all put tourniquets on when starting IVs to 'puff out' the venous side. Well the same thing is going to happen to that messy extremity trauma. It will promote blood loss. I am a KISS guy. In trauma I see all blood loss as bad with the goal being to stop it.

Yes, over a prolonged time-line there is an increased risk of tissue/nerve damage or death, but in my humble opinion that is outweighed by risks of blood loss and death early on. It wasn't that long ago when the math added up differently: you had your head jumped on for applying a tourniquet for that very reason. I never understood why, as after all, many of these complex extremity injuries have surgical-tourniquets applied in the OR to help facilitate surgery as it is hard to see your work if it is covered in blood.

Look forward to people's thoughts.

TS

This is a certified 100% troll-free post

[robert_s]

I once used one for a coumadin pt who scraped her leg in the shower.......250 cc's of blood later...

[DFIB]

If direct pressure fails to stop bleeding "you should move to the use of a tourniquet without attempting pressure point control.If a tourniquet is deemed nessesary, it should be applied quickly and not released until a physician is present"

AAOS Emergency Care and Transportation of the Sick and Injured, Tenth Edition, Jones and Bartlett Publishers, Sudsbury, Massachusetts.

[Tactical Spork]

A nice podcast summary of current tourniquet research:

http://phtlspodcast....ity-trauma.aspx

Among other studies, it also mentions the one below.

Interesting topic's and quite dear to my heart, actually discussed in great depth before, not "have you ever used one" request for war stories but the EBM is:

http://www.dtic.mil/...df&AD=ADA480277

NB: The study is protected from reproduction therefore I highly suggest that one reads the full meal deal, noting the conclusions, it pretty clearly smashes the old school F.A. myths of:

1- It should only be considered "last ditch"

2- That it causes damage.

3- That it can be taught in a 16 hour First Aid course.

Conclusion: Tourniquet use before shock onset saves more lives than

after shock; use them before extraction or transport.