Procedure 48 Tourniquet Application 08/13/2019

Study Notes

Introduction to Tourniquets

Tourniquets are critical for controlling bleeding from severe hemorrhagic wounds when other methods fail.
They are especially vital in cases of significant extremity bleeding requiring urgent intervention.

Precautions

Incorrect tourniquet application can worsen blood loss and potentially lead to death.
Risk of severe nerve and tissue damage exists regardless of correct application.
Proper selection of patients for tourniquet use is essential to minimize risks.
If a tourniquet is removed by a physician within 2 hours, permanent damage is unlikely.
Prioritizing the avoidance of hypovolemic shock is crucial, even if it increases tissue damage risks.
Tourniquets should remain visible and not be obscured by clothing.

Procedure for Application

Initial attempts should focus on controlling bleeding through direct pressure or pressure dressings.
If unsuccessful, proceed to apply the Combat Application Tourniquet (C-A-T).
Position the tourniquet 2 to 4 inches above the wound on single-bone structures (humerus, femur) and avoid joints.
Route the band around the limb and thread it through the inside and outside slits of the buckle for secure application.
Tighten the band significantly and use the twisting rod to stop bright red bleeding and eliminate the distal pulse.
Secure the rod in place, check for continued bleeding and pulse; if necessary, apply a second tourniquet.
Document the time of application on both the tourniquet and the patient (e.g., "TK 20:30"), as well as on a triage tag if applicable.
Leave the tourniquet uncovered for ongoing monitoring of hemorrhage.
Maintain the tourniquet during transport, only to be removed by hospital staff.
Continuously monitor patient vitals and inform all receiving personnel about the tourniquet placement.
If ineffective, consider tightening the existing tourniquet or applying a second one.

Tourniquet Downgrade or Conversion

If evacuation is delayed by over two hours, consider downgrading or converting the tourniquet.
Four criteria for downgrade or conversion include:
- Patient is not in hemorrhagic shock.
- Wound can be monitored closely for bleeding.
- Tourniquet is not controlling bleeding from an amputated or partially amputated limb.
- No previous unsuccessful attempts to remove the tourniquet.
To downgrade, expose the wound, identify a new location above the injury to apply a new tourniquet while leaving the old one in place.
For conversion, expose the wound, pack it, apply a pressure dressing, and loosen the prior tourniquet while keeping it in place. Monitor for bleeding afterward.

Description

This quiz covers the essential aspects of tourniquet application, including when to use it for controlling fatal hemorrhagic wounds. It emphasizes the importance of correct application to prevent further complications such as nerve and tissue damage. Understand the precautions and proper patient selection for effective use.