Views:69 Author:Site Editor Publish Time: 2020-05-27 Origin:Site
In the counterattack against Vietnam, most of the wounded were amputated due to the improper use of tourniquets due to non-professionals and insufficient training. So how to use a tourniquet is reasonable? Perhaps the tourniquet conversion proposal of the US military can give us some inspiration.
A tourniquet can save lives. In FireWire, the use of tourniquets for all limb-related bleeding is encouraged in a timely manner. At this stage, life-saving operations take precedence over diagnostic operations.
There is no evidence that proper use of a tourniquet for less than 2 hours can cause permanent tissue damage, permanent vascular damage, or permanent nerve damage.
Tourniquet switching refers to the process of trying to stop the hemostatic agent or pressure dressing to stop the tourniquet's hemostasis.
Since the Second World War and every stage of the TCCC's development, tourniquet conversion has been advocated, but the latest and formal scheme has not yet been formed.
Once the line of ambulance phase has stopped (or tactically, earlier as appropriate), a tourniquet switch should be initiated immediately.
Every time you reach the next level of care, you should try a tourniquet switch. Tourniquets that are used for more than 6 hours are generally not converted except in the final treatment facility.
Add a loose tourniquet to each limb to which a tourniquet has been applied (labeled "+1") for two reasons:
(1) If the tourniquet that has been applied is broken during the conversion, the added tourniquet can be used for emergency hemostasis. Tourniquets that have been exposed to the environment for a long time may be damaged.
(2) It is difficult to determine the position of the patient on the resuscitation curve. Administration of fluids (crystals, colloids, or blood) or ketamine may cause blood pressure to rise above the hypotension target. If the bleeding recurs suddenly, a second tourniquet can reduce bleeding time.
Loosen the first tourniquet labeled "+1". If the wound does not bleed, leave the two tourniquets in place, but do not tighten and apply pressure dressing to the wound.
If bleeding is found, use a hemostatic dressing and maintain pressure for 3 to 5 minutes. If you don't notice further bleeding, leave a loose tourniquet in place and bandage the wound.
If the hemostatic dressing does not control bleeding, tighten the second tourniquet as far as possible to the appropriate position on the proximal end to control bleeding. Relax the tourniquet labeled "+1" and approach the tightened tourniquet.
(1) How long can a tourniquet be applied before it is no longer attempted to switch?
There is no clear answer to this. Most complications in the literature are due to improper application. In one case, a total of 16 hours of application of the tourniquet was recorded, but the limb was exposed to the cold environment, and the tourniquet was placed in the proper position near the heart. The patient had motor and sensory defects but did not occur. Systemic complications of reperfusion.
(2) Should the tourniquet be loosened regularly to perfuse the distal tissue?
Absolutely not. This can lead to "progressive blood loss." The wounded will bleed to death within a short period of time. It is recommended that a tourniquet conversion be attempted as soon as possible each time it is transferred to the next level of treatment.
Due to the relationship between life-saving and disability, the tourniquet is like a double-edged sword. It was one of the most controversial issues in pre-hospital trauma emergency. Among the recommendations for the use of tourniquets in China, different versions have different suggestions for the application time of the tourniquet and the relaxation time of the tourniquet. Improper use of tourniquets can cause serious complications to the wounded. Therefore, we must learn to use tourniquets properly!