In What Circumstance Would It Be Appropriate To Use A Tourniquet?

May 07, 2022

Matthew D. Sztajnkrycer, Chiliad.D., Ph.D., an emergency medicine specialist at Mayo Dispensary's campus in Rochester, Minnesota, says two common scenarios come to mind in which he's seen tourniquets save lives:

Motor vehicle or motorcycle crashes. Dr. Sztajnkrycer — oftentimes called Dr. Matt — reports that patients make it with tourniquets after farm and industrial incidents or automobile and motorcycle crashes have resulted in a partial or complete limb amputation. A tourniquet applied at a traumatic injury scene like this has saved the lives of patients he's treated in the Mayo Clinic emergency department.
'Household misadventures'. Dr. Sztajnkrycer indicates that emergency department patients who've experienced a household misadventure are prevalent as well. The near serious of these injuries — in terms of hemorrhaging — typically involve plate drinking glass windows.

"The brachial artery can sever; they're haemorrhage to death in their own habitation," says Dr. Sztajnkrycer. "Someone usually shoves them in the auto and drives them to the hospital. The car they rode in is often filled with blood."

In these circumstances, tourniquets are applied by emergency department staff, stemming the claret loss.

Tourniquets' critical role and training for apply

Tourniquets have been used in varying forms since the time of Sushruta, an Indian surgeon, in 600 B.C., according to Dr. Saied and colleagues in a February. 2015 issue of Iranian Carmine Crescent Medical Journal. Another instance of early on tourniquet utilise involved Dr. Etienne Morel in the 1674 Boxing of Flanders — considered the beginning of modern tourniquets — per a 2007 Emergency Medicine Journal publication by Dr. Lee and colleagues.

Tourniquets accept a long but also conflicting history. Some have called tourniquets "an instrument of the devil that sometimes saves a life," such every bit in a 2001 study to The Ruddy Cross by Dr. Coupland and colleagues. More than recently, tourniquets have been viewed as invaluable lifesavers provided they are applied appropriately and correctly.

A tourniquet's main purpose is to stop life-threatening external haemorrhage, says Dr. Sztajnkrycer. Virtually such bleeding situations are trauma induced. Emergency medical services regularly use tourniquets today alongside other bleeding control methods. He says tourniquets are useful because it's difficult to maintain consistent pressure for an extended time using simple pressure level; and tourniquets both avoid disrupting a forming clot and allow safer patient ship.

Tourniquets often are misunderstood and misapplied, says Dr. Sztajnkrycer, noting a contempo study published in Periodical of Trauma and Acute Intendance Surgery that suggests that they're misused upwards to 1-quarter of the fourth dimension.

"Having a tourniquet is corking," he says, "but knowing how to utilize it is way better."

Some tourniquet mishaps Dr. Sztajnkrycer has witnessed include:

Placing the tourniquet in the incorrect location
Using a tourniquet in the incorrect state of affairs
Applying the tourniquet'due south band too loosely
Breaking the windlass
Loosening the tourniquet after the bleeding is controlled

The big fearfulness with tourniquets is that limiting blood supply to the limb can event in amputation. This does non appear to be the case in most civilian tourniquet applications, notes Dr. Sztajnkrycer. Having a tourniquet in identify for 2 or fewer hours — the time in which most patients can get to a infirmary — should not accept any ill effects beyond those caused past the injury requiring the tourniquet. It typically takes at to the lowest degree 4 to vi hours for tourniquets to cause harm.

For correct tourniquet utilise, he says one must decide if:

The haemorrhage is life-threatening
The location is suitable for tourniquet employ
Another bleeding control method, such as hemostatic gauze, would amend fit the state of affairs

To aid equip the public to properly use haemorrhage control methods such as tourniquets to stop life-threatening haemorrhage, The American College of Surgeons (ACS) Committee on Trauma administers the Stop the Bleed program.

Improvised tourniquets

Unfortunately, sometimes an private may encounter massive haemorrhage and not have a modern commercial tourniquet on hand. Dr. Sztajnkrycer says he'due south often asked about improvised tourniquets, such as belts, scarves or neckties.

He indicates that a 2017 study on law enforcement tourniquet use published in Prehospital Disaster Medicine showed that improvised tourniquets failed six out of 7 times. Despite this depression success rate, Dr. Sztajnkrycer says improvised tourniquet use is worth learning, every bit it can save lives.

"An improvised tourniquet is ameliorate than nix, but you need to understand the physics," he says. "We demand to be meliorate about teaching improvised tourniquet techniques."

How to be prepared to utilize a tourniquet correctly

Tourniquet use requires training considering information technology isn't ever intuitive, per Dr. Sztajnkrycer. Spending a morning learning how to put on a tourniquet is probably not enough. It's non uncommon for lay providers to be taught how to apply them and then forget how to do so a couple of months later on. This is particularly true given that the tourniquet is well-nigh always used under stress and brains have difficulty processing under farthermost stress.

"Tourniquet application is not every bit piece of cake as people remember," he says. "Yous think it is a unproblematic device, but to get it right and tight, and use the windlass appropriately, there are nuances."

Dr. Sztajnkrycer suggests that reviewing tourniquet application at least quarterly is crucial for preparedness. He asserts that the best style to reinforce how to exercise something such equally using a tourniquet is to teach others and troubleshoot their mistakes.

"If you teach fifteen to 20 people tourniquet application regularly, training others to be strength multipliers, you reinforce it for yourself," he says.

Knowing how to downgrade from a tourniquet to hemostatic or pressure dressing also is crucial for treating hemorrhaging trauma patients, and he suggests that tourniquet training for medical providers — as opposed to the general public — should contain this skill.

Beyond preparation a facility'due south trauma team members, he encourages tourniquet training for others working near the trauma bay who don't have specialized trauma knowledge, such every bit phlebotomists, radiations technologists or emergency section desk representatives.

"Railroad train an extra pair of easily to put on tourniquets so yous tin can spend your fourth dimension on more-advanced skills," he says.

For more information

Saied A, et al. Tourniquet in surgery of the limbs: A review of history, types and complications. Iranian Ruby Crescent Medical Periodical. 2015;17(two):e9588.

Lee C, et al. Tourniquet employ in the civilian prehospital setting. Emergency Medicine Journal. 2007:24:584.

Coupland RM, et al. Care in the field for victims of weapons of war: A report from the workshop organized past the ICRC on "Pre-hospital care for state of war and mine wounded." International Committee of the Cerise Cross; 2001.

Stiles CM, et al. A descriptive analysis of tactical prey care interventions performed past law enforcement personnel in the state of Wisconsin, 2010-2015. Prehospital Disaster Medicine. 2017; 32:284.

Refer a patient to Mayo Clinic.