Post Tourniquet application questions.

[seeth07]

Well I've learned that my wife and I are too quick going to the tourniquet from this thread. Once we have applied a tourniquet and it sounds like it wasn't necessary based on these posts but it was awhile ago and we honestly didn't know much better. I still don't feel like it hurt though. The first one we were in SE AK and right at the end of processing a blacktail, my knife slipped while cutting out the tenderloin and I hit my wrist really good. It was losing a lot of blood, at a rate of about as fast as you can say "drip...drip...drip". My wife says I never passed out but I don't remember much from it as I was dizzy and lightheaded. My recall of the event the next morning was that I did indeed pass out. She told me that she had put gauze on the wound and wrapped it tight and the blood kept coming through the bandage so she took a rope and used a stick with it to crank it as tight as she could located on my forearm. The bleeding stopped, she addressed the wound again and able to get some anti clot stuff in the wound better since there was no more blood and then later removed her homemade tourniquet and verified the bleeding didn't resume which it didn't. She applied some sutures the next morning to close up the wound that was about 3/4" long.

 

[kansasdad]

While holding retractors (residency training, USAF dentists end up as surgical assistants or anesthetists in war time scenarios) for the surgeon doing a breast reconstruction, there was a little arterial bleeder squirting me center mass with every heart beat. Neither the first or second surgeon notices this fountain.

I mention that I’m getting showered by this small streamer, and the surgeon with highly mischievous eyes showing above his mask says, “Oh, we only worry about bleeding that you can hear”.

It may have already been mentioned several times, but elevation of the wound, and keeping the cut surfaces together and still as possible to allow natural or applied clotting factors to work is important to add to the bleeding action checklist.

 

[4ohSick]

Well I've learned that my wife and I are too quick going to the tourniquet from this thread. Once we have applied a tourniquet and it sounds like it wasn't necessary based on these posts but it was awhile ago and we honestly didn't know much better. I still don't feel like it hurt though. The first one we were in SE AK and right at the end of processing a blacktail, my knife slipped while cutting out the tenderloin and I hit my wrist really good. It was losing a lot of blood, at a rate of about as fast as you can say "drip...drip...drip". My wife says I never passed out but I don't remember much from it as I was dizzy and lightheaded. My recall of the event the next morning was that I did indeed pass out. She told me that she had put gauze on the wound and wrapped it tight and the blood kept coming through the bandage so she took a rope and used a stick with it to crank it as tight as she could located on my forearm. The bleeding stopped, she addressed the wound again and able to get some anti clot stuff in the wound better since there was no more blood and then later removed her homemade tourniquet and verified the bleeding didn't resume which it didn't. She applied some sutures the next morning to close up the wound that was about 3/4" long.

I would say drip, drip, drip is not a heavy enough bleed for a tourniquet. Do you get squeamish at the sight of cuts/blood? It's possible the light-headedness or passing out was more of a nervous reaction than blood loss - it's like 15 to 30% of total blood volume lost before you start to have physiologic symptoms, so like a liter.

I've been a ski patroller for 7 years and our guidance has changed from being very cautious about when to apply a tourniquet to a more encouraging stance. However, like others have said, it's only considered after pressure and bandaging have failed unless it's spraying arterial bleed or amputation. And once it's on, we don't take if off under any circumstances. We're also only an hour from a hospital where a patient can be evaluated and the tourniquet removed if it's unnecessary. Like you've said, self evacuation becomes way harder once it's applied, but if the wound is serious enough to require a tourniquet, self evacuation was probably always going to be pretty much impossible.

I would also probably avoid practicing the tourniquet to full tightness... I don't know specific guidance against it, but I just feel like practicing to full tightness could cause some muscle or blood vessel damage.

Edit to add: never remove bandaging that's soaking with blood as that will break any clotting. Apply more bandage and pressure over top. Doesn't hurt to use a wrap to apply direct pressure, as long as you aren't losing perfusion/sensation downstream (check CMS).

 

[kansasdad]

@4ohSick excellent edit on your post above. I can imagine it can be quite difficult in a ski patrol injury situation to determine if pressure or cold is causing the purple toes or fingers!

Keep piling on more absorbent materials, and more direct pressure. (And aim added pressure on the heart side of the wound as well, but this isn't a tourniquet)

 

[Khunter]

I carry this around, in case I slip with the havalon. Not a tourniquet replacement but maybe help identify a wound that can be stopped without a tourniquet?




As for tourniquet, I presume I will just use my gun belt like they do in the western movies if my situation goes too western for a band aid.

 

[MaddH]

Apply tourniquet and don’t remove. Write on their forehead T time/ date that way when you reach care center they know how long it’s been on

 

[338win]

Make sure you “preflight” the CAT and have it situated where you can deploy it with one hand as necessary. A CAT and some combat gauze on hand is great insurance.

 

[vagabond]

I would venture to guess that Aaron Ralston would be pert near an expert at self tourniquet/amputation. Incredible feat of survival by this dude, though, I have heard that he has alienated many friends due to his lack of "common sense" when he plays in the backcountry!

 

[stk]

Agree with most except those saying tourniquets are only “after all else fails.” Sometimes the amount of bleeding is so obvious that you should go straight to tourniquet…the person might be dead by the time you try “all else.”

Put a tourniquet on when it seems like someone might die if you don’t. Leave it on until you get to a medical facility since they probably will die if you try to take it back off. But, better to use the tourniquet and not have needed to than the opposite.

 

[stk]

Well I've learned that my wife and I are too quick going to the tourniquet from this thread. Once we have applied a tourniquet and it sounds like it wasn't necessary based on these posts but it was awhile ago and we honestly didn't know much better. I still don't feel like it hurt though. The first one we were in SE AK and right at the end of processing a blacktail, my knife slipped while cutting out the tenderloin and I hit my wrist really good. It was losing a lot of blood, at a rate of about as fast as you can say "drip...drip...drip". My wife says I never passed out but I don't remember much from it as I was dizzy and lightheaded. My recall of the event the next morning was that I did indeed pass out. She told me that she had put gauze on the wound and wrapped it tight and the blood kept coming through the bandage so she took a rope and used a stick with it to crank it as tight as she could located on my forearm. The bleeding stopped, she addressed the wound again and able to get some anti clot stuff in the wound better since there was no more blood and then later removed her homemade tourniquet and verified the bleeding didn't resume which it didn't. She applied some sutures the next morning to close up the wound that was about 3/4" long.

Sounds like you did pretty ok, but you might be a little concerned about your wife trying to kill you if she’s stuffing anti clot in an open wound.

You probably could’ve gotten the wound to stop bleeding with more direct pressure instead of a home made tourniquet, but it worked. In all likelihood sounds like you passed out more from the anxiety than the actual blood loss. Most people can lose more than a pint of blood without noticing any physical side effects. Lose a quart and you’ll notice a change in heart rate and blood pressure. 3-4 pints and most will pass out. That’s a lot of blood, though. Thinking back…did you lose more than a quart of blood?

Put a tourniquet on if it looks like someone could fill a couple milk jugs if you don’t.

 

[davinski]

I'd echo what others have said, once a TQ goes on tight, like stopping arterial flow tight, only medical staff should take it off. Weird things can happen with that once-stopped blood suddenly moving around your system. It may not play well with heart, brain, other important things! In a pinch, a TQ can work as a makeshift pressure dressing which is not quite the same thing. I always figure, if I need to apply a TQ, once it's set, the next order of business is the SOS button on my beacon. Trip is over.

I'm a big fan of Mountain Man Medical. They have some free online training and great kits. See if you can get yourself some in-person training before you go. Local red cross, hospital facilities, etc. all offer them from time to time.

Other, non-TQ training is also good. Simple tricks like tying a small knot in the end of the gauze (or better yet, having it pre-tied) before you shove it into a bleeding hole can make a big difference in pinching off an artery or vein and keeping the red stuff in.

MMM emergency trauma response online course

Stop The Bleed Online Course