01-28-2005, 16:01
|
#1
|
|
Guerrilla Chief
Join Date: Jul 2004
Location: Phoenix, AZ
Posts: 880
|
How Tight to make a Tourniquet
I enjoy this subject because when the adrenaline is flowing in the thick of things, it is sometimes forgotten how tight is toooooooo tight.
Remember, just tight enough to slow/stop the bleeding!!! Generally, the artery spasms and shuts itself off but the vein stays wide open and flowing...the vein is a LOW pressure system therefore not much pressure is needed.
Picture #1 is an arm that another hospital wrapped up (pseudo-tourniquet) and sent to us..pt. had a badly lacerated brachial artery, significant hemorrhage and forgot their 'basic' skills
Picture #2 is the same arm, close up of the mottled hand...tooooo tight
*****pics too big, I'll shrink them and post later
__________________
'Revel in action, translate perceptions into instant judgements, and these into actions that are irrevocable, monumentous and dreadful - all this with lightning speed, in conditions of great stress and in an environment of high tension:what is expected of "us" is the impossible, yet we deliver just that.
(adapted from: Sherwin B. Nuland, MD, surgeon and author: The Wisdom of the Body, 1997 )
Education is the anti-ignorance we all need to better treat our patients. ss, 2008.
The blade is so sharp that the incision is perfect. They don't realize they've been cut until they're out of the fight: A Surgeon Warrior. I use a knife to defend life and to save it. ss (aka traumadoc)
|
|
swatsurgeon is offline
|
|
|
01-28-2005, 16:07
|
#2
|
|
Guerrilla Chief
Join Date: Jul 2004
Location: Phoenix, AZ
Posts: 880
|
here are the pics......
__________________
'Revel in action, translate perceptions into instant judgements, and these into actions that are irrevocable, monumentous and dreadful - all this with lightning speed, in conditions of great stress and in an environment of high tension:what is expected of "us" is the impossible, yet we deliver just that.
(adapted from: Sherwin B. Nuland, MD, surgeon and author: The Wisdom of the Body, 1997 )
Education is the anti-ignorance we all need to better treat our patients. ss, 2008.
The blade is so sharp that the incision is perfect. They don't realize they've been cut until they're out of the fight: A Surgeon Warrior. I use a knife to defend life and to save it. ss (aka traumadoc)
|
|
swatsurgeon is offline
|
|
|
01-28-2005, 16:12
|
#3
|
|
Gun Pilot
Join Date: Jan 2004
Location: Iowa and New Mexico
Posts: 2,143
|
Ouch!
That would leave a mark.
How long before permanent damage, given it's way too tight?
Terry
__________________
E7-CW3-direct commission VN
B model gunship pilot 65-66 Soc Trang, Cobra Pilot 68-69-70 Can Tho Life member 101st Airborne Association
|
|
CPTAUSRET is offline
|
|
|
01-28-2005, 16:59
|
#4
|
|
Guerrilla Chief
Join Date: Jul 2004
Location: Phoenix, AZ
Posts: 880
|
6 hours of warm ischemia leads to likely permanent damage to the nerve, muscle and other tissues
__________________
'Revel in action, translate perceptions into instant judgements, and these into actions that are irrevocable, monumentous and dreadful - all this with lightning speed, in conditions of great stress and in an environment of high tension:what is expected of "us" is the impossible, yet we deliver just that.
(adapted from: Sherwin B. Nuland, MD, surgeon and author: The Wisdom of the Body, 1997 )
Education is the anti-ignorance we all need to better treat our patients. ss, 2008.
The blade is so sharp that the incision is perfect. They don't realize they've been cut until they're out of the fight: A Surgeon Warrior. I use a knife to defend life and to save it. ss (aka traumadoc)
|
|
swatsurgeon is offline
|
|
|
01-28-2005, 17:33
|
#5
|
|
Quiet Professional
Join Date: Jan 2004
Location: LA
Posts: 1,653
|
I had a stud ask me on Monday if they should release and re-apply. He said he was taught 5 minutes for every 15 on. 
__________________
Somewhere a True Believer is training to kill you. He is training with minimal food or water, in austere conditions, training day and night. The only thing clean on him is his weapon and he made his web gear. He doesn't worry about what workout to do - his ruck weighs what it weighs, his runs end when the enemy stops chasing him. This True Believer is not concerned about 'how hard it is;' he knows either he wins or dies. He doesn't go home at 17:00, he is home.
He knows only The Cause.
Still want to quit?
|
|
NousDefionsDoc is offline
|
|
|
01-28-2005, 18:12
|
#6
|
|
Moderator
Join Date: Feb 2004
Location: Central Florida
Posts: 3,045
|
Quote:
|
Originally Posted by NousDefionsDoc
I had a stud ask me on Monday if they should release and re-apply. He said he was taught 5 minutes for every 15 on. |
I'd heard that too, in the past, but I think the release time was less than 5 min. I've also heard that at one time a tournaquet was no longer to be used.
Just repeating heresay
__________________
"Are you listening or just waiting to talk?"
Light travels faster than sound. This is why some people appear bright until you hear them speak.
"Fate rarely calls upon us at a moment of our choosing."
Optimus Prime
|
|
Kyobanim is offline
|
|
|
01-28-2005, 21:46
|
#7
|
|
Guerrilla Chief
Join Date: Jul 2004
Location: Phoenix, AZ
Posts: 880
|
the new dictum is no release because every drop of blood is precious and to release risks bleeding....hence why it is applied 'just tight enough' to slow then stop the blood flow. If you whip it tight there is a chance (a really good chance) it is toooooo tight.
We don't teach the apply and release trick anymore...I'll check TCCC from Frank Butler to see what they are teaching the active duty guys.
__________________
'Revel in action, translate perceptions into instant judgements, and these into actions that are irrevocable, monumentous and dreadful - all this with lightning speed, in conditions of great stress and in an environment of high tension:what is expected of "us" is the impossible, yet we deliver just that.
(adapted from: Sherwin B. Nuland, MD, surgeon and author: The Wisdom of the Body, 1997 )
Education is the anti-ignorance we all need to better treat our patients. ss, 2008.
The blade is so sharp that the incision is perfect. They don't realize they've been cut until they're out of the fight: A Surgeon Warrior. I use a knife to defend life and to save it. ss (aka traumadoc)
|
|
swatsurgeon is offline
|
|
|
01-28-2005, 23:07
|
#8
|
|
Quiet Professional
Join Date: Nov 2004
Location: Colorado
Posts: 754
|
Interesting swatsurgeon. For what is worth, when I was in and we were being crossed trained by our team medics, we were taught basically what I've read in this thread. That being apply the tourniquet (although, didn't look like the one in the pic. A rolled up piece of clothing or whatever and a stick or something similar). Anyway, just enough to stem the bleeding and we were taught, once applied, leave it alone til a medic or Dr took over. That was some 30 odd years ago, and I'm certainly not medic qualified. Merely relating some old training.
|
|
12B4S is offline
|
|
|
02-01-2005, 22:37
|
#9
|
|
Guerrilla
Join Date: Mar 2004
Location: Event Horizon...
Posts: 381
|
Ive always thought there were risks of reperfusion ie metabolic/gas exchange (increased lactate, potassium, and Co2) even the rare pulmonary embolism.
I did some checking and apparently this isnt as risky as I thought?
ccrn
|
|
ccrn is offline
|
|
|
02-02-2005, 09:50
|
#10
|
|
Guerrilla Chief
Join Date: Jul 2004
Location: Phoenix, AZ
Posts: 880
|
the metabolic 'washout', i.e., reperfusion injury gets worse the longer the tourniquet is on. This is why we release it in "controlled" circumstances, i.e., where there is plenty of equipment, meds, personnel, etc to resuscitate the patient from the effects of the reperfusion injury. ...best in a hospital, worst in the field
One thing Doc T and I learned about in our fellowship was how to attenuate/reduce the potential for the reperfusion injury. I have done it in the field when dealing with a trapped limb that sooner or later we'll get free but know the 'washout' of lactic acid, potassium, etc will be significant once we free them
I promised Bill Harsey I would show a leg I freed with his T-2 folder...I had to cut through the hamstrings to get a guy off of an auger/post hole digger....I forgot a scalpel and I forgot the Gigli saw blade (it's a pull type flexible blade held by two handles) for the field amputation. Our 'kit' was disassembled and I rushed to get out to the field. They flew me out there and thankfully the femor (thigh bone) was very broken but the muscle belly was still attached.
Thank goodness I always carry that knife!!!!!!!!!!!!
Pic 1 leg in bag, just cut him off
pic 2 tourniquet on thigh, where I cut was the bottom muscle under the thigh
pic 3 the amputated leg torn to shreads, foot torn up boot still on.
BTW he's going great, I'm going to skin graft the stump next week.
__________________
'Revel in action, translate perceptions into instant judgements, and these into actions that are irrevocable, monumentous and dreadful - all this with lightning speed, in conditions of great stress and in an environment of high tension:what is expected of "us" is the impossible, yet we deliver just that.
(adapted from: Sherwin B. Nuland, MD, surgeon and author: The Wisdom of the Body, 1997 )
Education is the anti-ignorance we all need to better treat our patients. ss, 2008.
The blade is so sharp that the incision is perfect. They don't realize they've been cut until they're out of the fight: A Surgeon Warrior. I use a knife to defend life and to save it. ss (aka traumadoc)
Last edited by swatsurgeon; 02-02-2005 at 09:52.
|
|
swatsurgeon is offline
|
|
|
02-02-2005, 11:51
|
#11
|
|
Bladesmith to the Quiet Professionals
Join Date: Feb 2004
Location: Oregon, Land of the Silver Grey Sunsets
Posts: 3,879
|
Swatsurgeon, Thanks for directing my attention here and sharing the story, I'm glad the knife did the job.
I wish your patient the best possible recovery.
|
|
Bill Harsey is offline
|
|
|
02-02-2005, 19:30
|
#12
|
|
Quiet Professional
Join Date: Jan 2004
Location: LA
Posts: 1,653
|
Outstanding work Doc. When I was a sprat, I saw a young man get his leg caught in an auger - not that bad, but impressive none the less. Great case of getting the job done with the tools at hand.
Mr Harsey, is that a first for one of your blades that you know of?
__________________
Somewhere a True Believer is training to kill you. He is training with minimal food or water, in austere conditions, training day and night. The only thing clean on him is his weapon and he made his web gear. He doesn't worry about what workout to do - his ruck weighs what it weighs, his runs end when the enemy stops chasing him. This True Believer is not concerned about 'how hard it is;' he knows either he wins or dies. He doesn't go home at 17:00, he is home.
He knows only The Cause.
Still want to quit?
|
|
NousDefionsDoc is offline
|
|
|
02-03-2005, 08:23
|
#13
|
|
Bladesmith to the Quiet Professionals
Join Date: Feb 2004
Location: Oregon, Land of the Silver Grey Sunsets
Posts: 3,879
|
Quote:
|
Originally Posted by NousDefionsDoc
Outstanding work Doc. When I was a sprat, I saw a young man get his leg caught in an auger - not that bad, but impressive none the less. Great case of getting the job done with the tools at hand.
Mr Harsey, is that a first for one of your blades that you know of?
|
Yes.
I also think that Swatsurgeon's skills would have allowed him to do the job with broken glass if needed.
|
|
Bill Harsey is offline
|
|
|
02-04-2005, 22:10
|
#14
|
|
Guerrilla
Join Date: Mar 2004
Location: Event Horizon...
Posts: 381
|
|
|
ccrn is offline
|
|
|
02-05-2005, 06:40
|
#15
|
|
Guerrilla Chief
Join Date: Jul 2004
Location: Phoenix, AZ
Posts: 880
|
that's the one....Harsey T-2 folder
__________________
'Revel in action, translate perceptions into instant judgements, and these into actions that are irrevocable, monumentous and dreadful - all this with lightning speed, in conditions of great stress and in an environment of high tension:what is expected of "us" is the impossible, yet we deliver just that.
(adapted from: Sherwin B. Nuland, MD, surgeon and author: The Wisdom of the Body, 1997 )
Education is the anti-ignorance we all need to better treat our patients. ss, 2008.
The blade is so sharp that the incision is perfect. They don't realize they've been cut until they're out of the fight: A Surgeon Warrior. I use a knife to defend life and to save it. ss (aka traumadoc)
|
|
swatsurgeon is offline
|
|
|
Currently Active Users Viewing This Thread: 1 (0 members and 1 guests)
|
|
|
Posting Rules
|
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts
HTML code is Off
|
|
|
All times are GMT -6. The time now is 09:14.
|
|
|
Linear Mode
