BP cuff as turniquet

[zzyzx]

If you had, say, a serious lower leg injury that was bleeding heavily and you were having a hard time controlling the bleeding, would it be appropriate to use a thigh cuff as a tourniquet but to only pump it up part of the way so as to control the bleeding but not completely cut off circulation? By doing this could you cause blood clots that could then become emboli? I've never done this nor have I ever had a bleed where I needed a tourniquet, but I'm just wondering if this would be appropriate.

[alpha23958]

Supposing it is not an amputation, just a severe laceration; I'd cover it up really good and then either zip on an air splint or an elastic bandage to hold good firm pressure. If it needs a tourniquet, life or death, use a tourniquet or a cravat and a pair of scissors.. don't use a BP cuff.

[DwayneEMTP]

When I did my time in the ER for basic, we had a 12-14 yo boy with a 3 1/2 inch lac on the back of his hand through all tissue layers. Bleeding was stopped when his parents brought him in, but when the nurse pulled the rag off of his hand to examine it for triage it started to bleed badly and they couldn't get it to stop again with pressure and elevation...I'm not sure what the issue was....

I was a little surprised that the doctor was unable to stop the bleeding to suture it (thought they surely had some magic bullet) until finally, on the advice of the medic working in the ER (not sure of his job description) they used a bp cuff as a tourniquet (placed on the brachial artery as if taking a blood pressure). They both claimed it was the first time they had used one, but explained, that if the need arose that the cuff was pretty much ideal.

I'm not sure if that helps as I'm unsure of their skill levels or options at their disposal that might have been used instead...but there you have it!

One a side note, I haven't heard of uncontrolled bleeding that didn't involve blood thinners (cardiac meds, alcohol, etc.). Any idea why this would happen in a young boy? (I wasn't there for phx, but when asked, the nurse said it was unrelated to the issue)

Have a great day all!

Dwayne

[paramedicmike]

Not as a tourniquet, but I have used a disposable BP cuff to apply direct pressure to a wound. The wound was bandaged and wrapped. The BP cuff was wrapped around the wound and inflated only enough to keep direct pressure on the wound. The patient maintained pulses distal to the laceration. It works. You just need to watch what you're doing.

If you've got other things to do it can be a little difficult holding direct pressure in the back of a bouncing ambulance. This works well.

So, to answer your question, it could be appropriate for the situation.

-be safe.

[Doczilla]

It's absolutely appropriate to use a tourniquet to stop the bleeding once other methods (direct pressure, pressure points, pressure dressing) have failed. The thigh cuff makes a great tourniquet. Since it's wide, it will cause less tissue damage than a narrow piece of fabric, and you can control the pressure. Inflate until the serious bleeding stops (you'll still get a tiny bit, but just make sure it's not flowing). You may have to exceed the arterial pressure in order to do this, so don't be surprised if you have to inflate past 200 or 250 to get it stopped.

Tourniquets are getting more attention lately with our combat experience in Iraq and Afghanistan, and it has forced us to re-examine the "taboo" of tourniquet use that we're taught in EMT school. There are a fair number of people who bleed to death in this country from extremities, even in the care of EMS, and that just doesn't need to be so. Tourniquets, appropriately applied for a short period of time (less than 2 hours), do not lead to massive acidosis, hyperkalemia, and cardiac arrest like we've been taught, and they save lives.

'zilla

[medic_ruth]

I would use one, should the need arise, I just asked another medic on duty with me right now and she says she would too.

[etfink]

they work great when tryint to start a lone on pts with vety brittle viens. Much easier to avoid blowing them.

[ERDoc]

There is nothing really wrong with a tourniquet. As someone previously said the greater area you can spread it out the better. I use them all of the time to control bleeding from a wound that I am trying to suture. It stops the bleeding so that the wound can be explored (can be pretty difficult if blood keep filling your field). In the time it takes to get the pt to the ER a tourniquet probably will not do much damage. If they are in a position to need a tourniquet, they probably have much more serious things that will almost be guaranteed to kill them. Don't be too afraid to use one.

[fiznat]

+1 for this idea. I've never done it myself but I have seen it done.

Speaking of alternative uses for BP cuffs.. wrapping a cuff around your IV bag and inflating it makes a nice pressure bag so that fluid will still go in even when the bag isnt elevated. Works sweet for our service where we dont have poles on the stretchers.

[akroeze]

+1 for this idea. I've never done it myself but I have seen it done.

Speaking of alternative uses for BP cuffs.. wrapping a cuff around your IV bag and inflating it makes a nice pressure bag so that fluid will still go in even when the bag isnt elevated. Works sweet for our service where we dont have poles on the stretchers.

Just curious, what would be an appropriate pressure to put it at for your IV idea?