Did you ever use a tourniquet?

[DwayneEMTP]

Actually, they all seem like things that might be touched on but not covered in a first aid field guild for the novice.

And I'm not sure by what definition of a troll this poster would fit? Polite, respectful, responds directly to every statement directed at them without being an ass.....what about any of that is trollish?

For your question...yeah, I have used tourniquets, am positive that I will use them again in my career, but their use is very, very rare in EMS and a really bad idea for the novice. The problem with them for the novice is that there is so much adrenaline and so little education that a lot of damage can be done with a tourniquets. You see, you only want to stem the flow of blood, not stop it. If you twist a tourniquet tight enough to completely stop the flow of blood there is a decent chance that you'll damage the vessels under it as well as starve everything after it. In the earlier levels of first aid you often have people that can only see "Bleeding=Bad", therefore, anything that stops the flow of blood=Good, and that's not the case in most instances. Many, yes. Most, no.

At the paramedic level we have to worry not only about life, but limbs as well when we can. Saving a life while needlessly losing a limb is the worst kind of bad medicine. Dressings and bandages are good because they avoid rescuer added vascular damage that tourniquets can produce if put on in the wrong place or too tightly. Also, dressings protect the wound margins (The edges of the wounds that the smart people at the hospital may be able to use to close/repair the wound if we haven't damaged them in some way.) and keep them moist.

So, if you have a big wound, dressing and HARD pressure, if it bleeds through, more dressings WITHOUT EVER lifting the first, and then more. If you see someone with their arm cut clean off...dressings or tourniquets? Dressings if possible...we want the blood to continue to feed the wound ends without causing a significant continued loss of blood.

How about two legs and one arm amputated with blood spurting everywhere? (Reference 2c4s post above) Tourniquet, tourniquet, tourniquet. See what I mean? This dude is hosed anyway, but you just can't manage him with dressings on that many severe wounds.

If you're not sure if you should use a tourniquet or not? Don't......It's a good rule of thumb.

Dwayne

Edited to correct a typo. No other changes made.

Edited July 23, 2011 by DwayneEMTP

[tcripp]

If you're not sure if you should use a tourniquet or not? Don't......It's a good rule of thumb.

And, what's very interesting is that PHTLS and AHA First Aid are now both teaching the use of tourniquets. No more raising the limb or apply pressure to the closest artery...simply applying a tourniquet.

Me, not had the chance yet. Biggest bleed I've had so far was on the head, and I just couldn't figure out the best place to put it.

Toni

[Dustdevil]

When you approach the patient, and the first thing that comes to mind is:

• JESUS!
• HOLY S#!T!
• OH F##K!
• DO YOU HAVE ANY BLOOD LEFT
• I WISH I HAD TWO MORE HANDS
• WHERE'S THE REST OF IT
• ET AL, ETC...

You should probably use a tourniquet.

Big rep points for that excellent answer! That should be in the textbook!

I was using tourniquets for a good 20 years before it became the latest fashion. And getting yelled at for it too, of course. But -- as usual -- I turned out to be right.

[Good Samaritan]

A person whose sole purpose in life is to seek out people to argue with on the internet over extremely trivial issues. Such arguments can happen on blogs, Facebook, Myspace and a host of others.

The best thing you can do to fight an internet troll is to not answer..or report them.

Have I started any "arguments"? Do you see me arguing with anyone?

Regardless, you don't seem to be following the link's advice if you really think I am a troll.

A person who feeds off the anger of others as he enrages them over the internet.

If my goal was to enrage you, I never imagined asking first aid questions would be it! Wouldn't that make me the "worst troll ever"?

Seriously, please, I'd like to get on with the topic and see what others has to say?

Big rep points for that excellent answer! That should be in the textbook!

I believe so too. There should be like a "paramedic perspective in every textbook". Someone with experience actually talking, instead of only a linear text.

The search engine on EMT City is your best friend:

Actually, they all seem like things that might be touched on but not covered in a first aid field guild for the novice.

Exactly. Like I said only if my google search is unsuccessful do I post. I'd hate to waste people's time with something I can wiki. Besides, when starting a topic sometimes conversations roll and more knowledge, stories, etc are being added to the pile, so I wouldn't consider it a great sin even if, though people should definitely look it up first.

And I'm not sure by what definition of a troll this poster would fit? Polite, respectful, responds directly to every statement directed at them without being an ass.....what about any of that is trollish?

Thank you!

you see, you only want to stem the flow of blood, not stop it.

I'm not sure exactly what you mean by "stem", one of the dictionaries even gave me as a result that it could also mean "stop". But I guess you mean to make the blood flow really tiny/insignificant for the fear of not twisting it too tightly and causing damage?

Also, dressings protect the wound margins (The edges of the wounds that the smart people at the hospital may be able to use to close/repair the wound if we haven't damaged them in some way.) and keep them moist.

I didn't know that, but it makes perfect sense.

So, if you have a big wound, dressing and HARD pressure, if it bleeds through, more dressings WITHOUT EVER lifting the first, and then more. If you see someone with their arm cut clean off...dressings or tourniquets? Dressings if possible...we want the blood to continue to feed the wound ends without causing a significant continued loss of blood.

How about two legs and one arm amputated with blood spurting everywhere? (Reference 2c4s post above) Tourniquet, tourniquet, tourniquet. See what I mean? This dude is hosed anyway, but you just can't manage him with dressings on that many severe wounds.

I truly understand the logic of it now, that really clears it for me. Thank you!

" If you're not sure if you should use a tourniquet or not? Don't......It's a good rule of thumb."

Duly noted

" Me, not had the chance yet. Biggest bleed I've had so far was on the head, and I just couldn't figure out the best place to put it. "

Oh yes, I guess tourniquets are not for the head or the torso. That would also make sense.

Thank you so much everyone!

[DwayneEMTP]

Just passing through quickly, but....You're welcome.

Also, you are correct on 'stemming' the flow. I'm afraid I've always taken that to mean 'to make it really, really slow' but I've never actually looked it up I guess.

The main thing to remember is "Life over Limb." You don't want to worry about limbs until after we're confident that the life is saved, or as close as we can get. But at the higher levels of care you can often do both at the same time.

Good questions, amazing attitude, plus, as you can see, your 'simple' questions created debate even amongst professionals. Thank YOU.

Dwayne

[tniuqs]

Goggle search .. use of the big "T"

http://firstaid.about.com/od/bleedingcontrol/a/07_tourniquets.htm

Pretty much cover's it for a lay person.

[Dragoon]

I applied a few in the military. The injuries there were significant. At the same time I also applied several compression dressings to limbs with major injury where a tourniquet would've been applied if not for the compression dressings. (Note: I wasn’t a corpsman aka medic, just a grunt with good training.)

Since going to the civilian side I've applied three. The first patient was to an elderly female who was knocked down by a flatbed tractor-trailer that was backing up. Her legs were run over by the rear wheels of the trailer. Both legs were crushed. They looked like raw chicken legs that had been pulverized with a sledgehammer and felt like a tube sock full of marbles. Both legs were dressed with trauma dressings, splinted and elevated. There was no spurting blood; just continuous bleeding where skin was avulsed or at open fractures. She had begun to bleed through the dressings and I decided to apply a tourniquet to each leg. One was placed two inches distal knee and the other was about three inches proximal to the knee because her knee was twisted medially. Both tourniquets were improvised with cravats. I wrapped the cravats wide, twice around the leg and used a pen to twist and tighten. The intent was to stem the flow of bleeding.

The second time was for a bicycle deliveryman who was struck by a garbage truck and still underneath it. After the vehicle was secured, my partner and I crawled underneath the garbage truck to remove him. My partner immobilized his head as I assessed the patient. A rapid trauma exam revealed a conscious, Chinese speaking male with an amputation of the right leg distal to the knee. The leg was still attached by some muscle and skin. I decided that because of the amount of blood that was on the pavement and the location (under a truck) he was getting a tourniquet right then and there. It met 2c4's criteria for application. I wasn't going to play around under a truck with limited space trying to apply a direct pressure dressing and bandage. I'm sure if I did attempt it that the quality would have been sub-par. So I applied the tourniquet above the knee because the amputation was just distal to the knee. Again two inches above. This time I had a commercial tourniquet, the C.A.T. Application was extremely easy and I twisted again until I believed the bleeding had stopped. After the patent was extricated and in the back of the ambulance we were able to properly dress and bandage both stumps and perform a more detailed physical exam.

Each time was a different situation where a tourniquet was applied. After they were applied to the first patient, we did apply another trauma dressing to the ones already in place. On arrival at the hospital the injuries had not bleed through the additional dressings. The second patient never bleed through his dressings. On follow up with him the surgeon told me the tourniquet was left in place and the patient was taken to the OR with it. Application of tourniquet is flexible but you need to be educated on how to use it in addition to when.

[tniuqs]

<snip> Both legs were crushed. They looked like raw chicken legs that had been pulverized with a sledgehammer and felt like a tube sock full of marbles. Both legs were dressed with trauma dressings, splinted and elevated. There was no spurting blood; just continuous bleeding where skin was avulsed or at open fractures. She had begun to bleed through the dressings and I decided to apply a tourniquet to each leg.

This has been my experience as well (a downed little bird) pilot drove tib/fib into dirt, incomplete amp, these as you describe in the crush category are very insidious type hemmorrhage, many times unrecognised as life threatening in the field.

It met 2c4's criteria for application.

Herein after this thread to be referred as:

The 2c4 protocol

Well written mate, civy side has much to learn from the sandbox experience.

Dragoon what flag do you fly, the meatballs and marinara hint of Italian, maybe Portuguese ?

Edited July 24, 2011 by tniuqs

[chbare]

Used one on a guy who bisected his radial artery with an electric rose pruner. Used one on a guy who amputated his arm upon punching a glass window. Used one on a guy who was caught in a drug deal gone bad. They apparently attempted to shoot off his patella and ended up blowing out the popliteal artery instead.

Funny, the one place (Afghanistan), I though I'd use them, I never did. Even had a patient who took a 7.62*39 through the pelvis with massive haemorrhage and failed haemostats. Quick Clot was attempted without success by onsite providers. We just packed the wound, held manual pressure and flew the guy to a CSH for damage control and initial resuscitation before taking him out of country.

Take care,

chbare.

Edit: "taking."

Edited July 24, 2011 by chbare

[Bernhard]

To counter "The 2c4 protocol": Never when I thought something like this, I had to use a tourniquet.

Especially with this girl so smashed after an MVA that the first arriving fire chief just stated "she's dead", lying there completely covered with a blanket (the girl, not the chief). I just thought (and probably said) all of 2c4's sentences at once when I lifted the blanket from her head and found her still breathing. Without a tourniquet on any of her sub-partial amputated and multiple open fractured legs (the picture of "chicken legs" someone portrayed here just fits) but with e.t., analgetics and two i.v. lines she was helicoptered away 15 minutes later.

On another occasion I treated an under-aged boy who illegally and rather unsuccessfully tried to prepare for his drivers license exam on a motorbike. My assessment revealed an open fractured ankle joint and large lower leg flesh wounds with severe bleeding and shock. A rope around his thigh was all the bystanders did for him (they then left him laying alone and stood some metres away). I cut it against the first aiders protest and instantly the bleeding stopped.

The only time I really used a tourniquet was >20 years ago, when I had my very first call on my very first shift (!) as responsible medic. The patient stood at the sidewalk with a towel wrapped around his hand, constantly dropping blood. No indication for the 2c4 protocol...but the bleeding (severe cuts in the hand) couldn't be controled either way and he developed shock signs, so I (beside i.v. access) applied a sphygmomanometer to his upper arm for the ~10 minute transport time.

Since then, I never used or saw a tourniquet used even in severe trauma cases (see above).

However, we have triangular bandages in our disaster response group's mSTaRT triage equipment for this purpose. Just recently, a German Bundeswehr combat medic gave me a C.A.T. tourniquet. I find it quite useful, maybe we buy some for our disaster euqipment because in triage it's all about quickness and the C.A.T. is way faster to apply than a cravat. But personally my second use of a tourniquet in a real emergency still waits to happen...I would prefer the sphygmomanometer then again if possible.

P.S.: just found a warning about faked C.A.T.'s here.