05-24-2011, 05:39
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#1
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Quiet Professional
Join Date: Feb 2008
Location: North Carolina
Posts: 51
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That's perfectly reasonable and in common practice. You don't have time to reevaluate the wound during CUF, so by placing it as proximal as possible, you avoid that little bullet fragment that traveled over 10" up the leg and shredded the popliteal artery. In this instance, if you placed a tourniquet just 2-3" above the GSW site, you would have stopped the visible bleeding, but you would be causing a massive compartment syndrome proximal to your tourniquet
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Priest is offline
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05-24-2011, 15:18
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#2
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Guerrilla Chief
Join Date: Jul 2004
Location: Phoenix, AZ
Posts: 880
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I agree...it does make perfect sense for CUF conditions.......once can evaluate the injury, place another and remove proximal one...common sense wins this one.
This is actually where the blackhawk ITS system (internal TQ system) was coming from...all 4 TQ's (2 UE, 2LE) were all very proximal to get control ASAP, then apply your second one closer to hemorrhage.
ss
__________________
'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)
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swatsurgeon is offline
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05-26-2011, 19:21
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#3
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Asset
Join Date: Aug 2009
Location: Station at Fort Carson, Deployed to Afghanistan
Posts: 6
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I really appreciate all the imput, but I'm just trying to get clarification on the deliberate placement. I even tried placing one on my forearm and my lower leg and sure enough I still had a radial pulse and a dorsalis pedis pulse, of course I could only make the soft-t so tight before I was afraid I was going to break my own bones. But I just need to know if there any documentation to support this so I can get this wanna be 18D to shut up.
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doc_robalt is offline
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05-26-2011, 20:53
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#4
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Guerrilla Chief
Join Date: Jul 2004
Location: Phoenix, AZ
Posts: 880
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placed appropriately but more importantly, a quality TQ (SWAT-T, CAT, SOFF-T, etc commercially available) used correctly, they will stop all arterial flow. I have used many of the commercially available ones and have had few not stop flow. Each one has its quirks and MUST be deployed as per instructions and not just used to the users discretion which can lead to non occlusion of artrial flow. Trust me, a medical provider or anyone without medical skills but proficient with a TQ who has adequate training on a quality TQ will stop your blood flow.....
ss
tell the wanna be....use it where ever they 'think' they should, then follow their medical direction and SOP to do it 'right'
__________________
'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)
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swatsurgeon is offline
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07-11-2011, 19:12
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#5
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Asset
Join Date: Aug 2009
Location: Station at Fort Carson, Deployed to Afghanistan
Posts: 6
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Ok so I can't find a BCT3 Manual or a SOCM manual to save my life but ironically the old FM 4-25.11 on First Aid even says that to have maximum effectiveness that a tourniquet should be placed above the knee and above the elbow. Is there any where I can get the Manuals for either BCT3, ALC or SOCM so I get this in writing and get this guy to shut up.
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doc_robalt is offline
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07-12-2011, 02:00
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#6
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Quiet Professional
Join Date: Jan 2004
Location: Tampa
Posts: 2,536
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Quote:
Originally Posted by doc_robalt
Ok so I can't find a BCT3 Manual or a SOCM manual to save my life but ironically the old FM 4-25.11 on First Aid even says that to have maximum effectiveness that a tourniquet should be placed above the knee and above the elbow. Is there any where I can get the Manuals for either BCT3, ALC or SOCM so I get this in writing and get this guy to shut up.
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Hey SGT,
How about you take a step back and take a deep breath. It is the principle of medicine that need not be violated. You seem HELL BENT on spotlighting yourself as Mr. Medical Sharpshooter.
CLS Guidelines teach 2-3 inches above. You have ample advice from current providers and recent graduates of BCT3 and TCCC above.
Once you have been in medicine awhile, you will find that it s a PRACTICE...meaning that things can, and are, done and taught differently in different arenas by different people but the principles remain the same.
Take the information you have been given and move out smartly.
Unless you have been through SFAS and even attempted the 18D Course, you really have exactly ZERO room to be chastising your "18D Wannabe"...
At least he stepped up to be assessed, and was selected. Though he failed - AT LEAST HE TRIED.
EDITED TO ADD
Looking in the most current CLS INSTRUCTORS MANUAL, ISO 0873, Chapter 4 " Combat Application Tourniquet" (Arm or Forearm) page 4-14, Step #2, it reads:
Position the CAT Tourniquet band two inches above the wound
You have your Reference, now man up and apologize to your "18D Wannabe"
__________________
Primum non Nocere
"I have hung out in dangerous places a lot over the years, from combat zones to biker bars, and it is the weak, the unaware, or those looking for it, that usually find trouble.
Ain't no one getting out of this world alive. All you can do is try to have some choice in the way you go. Prepare yourself (and your affairs), and when your number is up, die on your feet fighting rather than on your knees. And make the SOBs pay dearly."
The Reaper-3 Sep 04
Last edited by Eagle5US; 07-12-2011 at 02:17.
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Eagle5US is offline
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07-12-2011, 08:58
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#7
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Asset
Join Date: May 2011
Location: S. Florida
Posts: 40
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Quote:
Originally Posted by Eagle5US
Hey SGT,
Unless you have been through SFAS and even attempted the 18D Course, you really have exactly ZERO room to be chastising your "18D Wannabe"...
At least he stepped up to be assessed, and was selected. Though he failed - AT LEAST HE TRIED.
You have your Reference, now man up and apologize to your "18D Wannabe"
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Thank you Eagle,
I saw so many really good medics not make it thru the course. I would have been happy to have most if not all of them work on me. Just the way it is. People who have not been thru it should not ever call someone who tried and didn't make it a wannabe.
__________________
"Unless you do your best, the day will come when, tired and hungry, you will halt just short of the goal you were ordered to reach, and by halting you will make useless the efforts and deaths of thousands." - Gen. George S. Patton
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Shadow1911 is offline
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