# Anyone heard of using a BP cuff as a tourniquet?



## lanceavil (Jul 10, 2013)

I understand that tourniquets should only be used as a last resort, such as a major arterial bleed or amputation. I heard from one of the medics that it's safer than using a belt or band because the surface area is more spread out and is less likely to injure the patient, and you can inflate it to exactly the point you need it. Agree or disagree?


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## TransportJockey (Jul 10, 2013)

lanceavil said:


> I understand that tourniquets should only be used as a last resort, such as a major arterial bleed or amputation. I heard from one of the medics that it's safer than using a belt or band because the surface area is more spread out and is less likely to injure the patient, and you can inflate it to exactly the point you need it. Agree or disagree?



Disagree on the last resort comment... agree that it can be a useful field expedient tq. But the problem with a lot of cuffs is maintaining that pressure. Some cuffs have pinhole leaks that will slowly let it deflate. Personally I tend to use a triangular bandage, kerlix, and a pen light or pair of trauma shears as a TQ


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## Mariemt (Jul 10, 2013)

They are now being brought back to be used for uncontrolled bleeding, not necessarily just last resort. Yes I've heard of bp cuffs being used but would rather use something else. Like a tourniquet


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## Wayfaring Man (Jul 10, 2013)

The BP cuff can be used as a last resort TK but obviously an actual TK or a field TK with cravats and a yankauer tube are preferred because they're more permanent.

As far as last resort goes, this is no longer the case a lot of places.  MD protocol allows us to tourniquet after direct pressure and two attempts to stop bleeding with conventional dressing.  With arterial bleeds we can go straight to the TK after direct pressure.  The old thinking that a tourniquet would cause possible limb death is no longer really the case with improvements in hospital care.  What is important though is to make sure you label the time that the TK was applied clearly and obviously.  Guys around here like to write it on the patient's forehead.


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## EpiEMS (Jul 10, 2013)

Nothing wrong with using a BP as a *field expedient* tourniquet. That's about as far as I'd go with it. Better off using an actual tourniquet (or two, if need be).


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## JustKeepSwimming (Jul 10, 2013)

I volunteer at an ER and a few months ago we had a dialysis patient come in with a burst stent in his arm and the crew that delivered him used a bp cuff as the tourniquet. Doc replaced it with a rubber band tie but the cuff worked and it was a good 2 hr drive from the hospital he was originally at.


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## MMiz (Jul 10, 2013)

I'm not sure why everyone says that they're only used as a last resort. I used one to stop bleeding when I had impaled my hand and blood was gushing everywhere.

Applying pressure to pressure points was in my EMT curriculum as a means of controlling bleeding. 

The only mistake I made (per the MD) was that I didn't inflate the BP cuff enough.  He suggested I inflate it to 200 mmHg or higher in the future.


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## NJEMT95 (Jul 10, 2013)

To avoid leaks, I've heard EMTs suggest tying the BP cuff tubes when using it as a TQ.


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## firecoins (Jul 10, 2013)

Not everyone says that. Those who are preaching the old doctrine. Tourniquets are back in.


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## Mariemt (Jul 10, 2013)

firecoins said:


> Not everyone says that. Those who are preaching the old doctrine. Tourniquets are back in.



Yep,  only time I have tried to avoid one was bleeding from an A/V fistula as I didn't want to damage it. 

Once it is on, you have to make sure you document exact time it was put on. Some people even write on the limb above it to make sure paperwork isn't lost while transferring care


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## patzyboi (Jul 10, 2013)

I had a question about this on the NREMT; never even heard of the idea before. 

dunno if I ever got the answer right though. lol


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## DrParasite (Jul 11, 2013)

I have seen a doctor use something similar to a BP cuff in the ER to apply direct pressure to a dialysis shunt that was bleeding uncontrollably. 

I have seen a BP cuff used as a tourniquet, but most of the time a tourniquet is used instead.

It is a good temporary device, but there are better devices to have permanent blood flow (permanent meaning until you get to the ER , without the cuff deflating while you are in transit).


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## Christopher (Jul 11, 2013)

lanceavil said:


> I understand that tourniquets should only be used as a last resort, such as a major arterial bleed or amputation.



Please use tourniquets early and often (like voting). They're not a last resort (at least not in the last 10 years).



lanceavil said:


> I heard from one of the medics that it's safer than using a belt or band because the surface area is more spread out and is less likely to injure the patient, and you can inflate it to exactly the point you need it. Agree or disagree?



Yes the wider the surface area the better.

I would caution with BP cuffs that the following does not happen:
- Getting blood on the bulb and release screw

If this does...man is it ever hard to undo.


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## EpiEMS (Jul 11, 2013)

DrParasite said:


> I have seen a doctor use something similar to a BP cuff in the ER to apply direct pressure to a dialysis shunt that was bleeding uncontrollably.
> 
> I have seen a BP cuff used as a tourniquet, but most of the time a tourniquet is used instead.
> 
> It is a good temporary device, but there are better devices to have permanent blood flow (permanent meaning until you get to the ER , without the cuff deflating while you are in transit).



Might be this one: the SAM Junctional Tourniquet


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## Brandon O (Jul 11, 2013)

NJEMT95 said:


> To avoid leaks, I've heard EMTs suggest tying the BP cuff tubes when using it as a TQ.



Inflate until bleeding is controlled, tie off both tubes, note pressure.


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## VFlutter (Jul 11, 2013)

EpiEMS said:


> Might be this one: the SAM Junctional Tourniquet



Looks like a Femostop. We frequently use them in the Cath lab. It is a decent device but I still prefer good old manual compression to obtain homeostasis. It is also limited by body size and anatomy. 







Or Anesthesia will use a pneumatic tourniquet for regional blocks, also know as a Bier block. It is connected to a pump that constantly adjusts pressure.


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## EpiEMS (Jul 11, 2013)

Chase said:


> Looks like a Femostop. We frequently use them in the Cath lab. It is a decent device but I still prefer good old manual compression to obtain homeostasis. It is also limited by body size and anatomy.



Yeah, the latter part is concerning...I wonder if the military style tourniquets are large enough for the largest sorts of patients. Haven't tried one on anybody much bigger than myself.


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## CritterNurse (Jul 11, 2013)

I'd be more likely to use a BP cuff to pad the lumbar region when someone needs to be boarded. Using a BP cuff as a tourniquets is a good way to make a BP cuff wear out faster. Besides, things like a cravat, a shirt, a belt, etc make better tourniquets in a pinch.


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## DPM (Jul 11, 2013)

CritterNurse said:


> I'd be more likely to use a BP cuff to pad the lumbar region when someone needs to be boarded. Using a BP cuff as a tourniquets is a good way to make a BP cuff wear out faster. Besides, things like a cravat, a shirt, a belt, etc make better tourniquets in a pinch.



How do you tighten a shirt? 

The CAT tourniquets that the military uses (not to be confused with the Metal SOF one that's a more expensive knock off) are pretty big. I've used them a bunch and never had any size issues... but then again most soldiers aren't obese. If I can find one I'll try and measure it.


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## TransportJockey (Jul 11, 2013)

DPM said:


> How do you tighten a shirt?
> 
> The CAT tourniquets that the military uses (not to be confused with the Metal SOF one that's a more expensive knock off) are pretty big. I've used them a bunch and never had any size issues... but then again most soldiers aren't obese. If I can find one I'll try and measure it.



You tie a windlass knot and tighten it that way


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## DesertMedic66 (Jul 11, 2013)

I've heard of it but have never needed to use one. We carry extra BP cuffs in the ambulances so we can use them. We also carry triangle bandages and CATs. 

The main issue with the BP cuffs is that they start to loose pressure so you have to constantly check the pressure and fill it back up. The main issues with the CATs that we have is that the stick that we turn is plastic and can break fairly easy. 

But once again I've never had to use a TQ on a call before.


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## Brandon O (Jul 11, 2013)

Effective tourniquets are surprisingly wide (and STAY that way despite tightening) and tough. The military is even finding that gnarly femoral injuries often need two tourniquets applied adjacent (place the second proximal to the first!).

I think a lot of people imagine it's easier to apply a tourniquet using improvised supplies than it really is. I encourage everyone to play around with this (try your own thigh) with the gear they have on hand; figure out a way that works now, before someone's bleeding out on your stretcher.


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## DPM (Jul 12, 2013)

TransportJockey said:


> You tie a windlass knot and tighten it that way



I'm not sure how this would make a better one though...

I've seen 5 used on one person before. 2 each per leg and one on an arm. Gnarly, but it did the trick.


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## mycrofft (Jul 12, 2013)

Brandon Oto said:


> Effective tourniquets are surprisingly wide (and STAY that way despite tightening) and tough. The military is even finding that gnarly femoral injuries often need two tourniquets applied adjacent (place the second proximal to the first!).
> 
> I think a lot of people imagine it's easier to apply a tourniquet using improvised supplies than it really is. I encourage everyone to play around with this (try your own thigh) with the gear they have on hand; figure out a way that works now, before someone's bleeding out on your stretcher.



*Money shot.*

BP cuff Velcro will sometimes not hold very well, especially if matted with blood, debris, or worn out from frequent use.  Tiny leaks from the hoses right by the metal nipples for the gauge and/or the bulb pump are the most common site of leakage (cut off the offending piece of hose and reconnect).

Remember that a subpressured TQ of any sort may actually promote bleeding from incompletely severed vascular regions due to closing the veins but not the arteries  (hence the penrose drain used in lab phlebotomy).


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## mycrofft (Jul 12, 2013)

DPM said:


> How do you tighten a shirt?
> 
> The CAT tourniquets that the military uses (not to be confused with the Metal SOF one that's a more expensive knock off) are pretty big. I've used them a bunch and never had any size issues... but then again most soldiers aren't obese. If I can find one I'll try and measure it.



You missed the obvious target, using a belt. Very hard to do properly. A web belt is better than a leather one and the buckle can do damage itself. Actually-woven leather belts are easier but may need retightening.

Shirt: use the sleeves, but they are usually quite short. If you have a moment, you can open the shirt out, slash a three inch wide ribbon out of the entire back superior to inferior, quickly roll it into a cravat and then proceed.

Baling wire: not recommended.


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## CritterNurse (Jul 12, 2013)

DPM said:


> How do you tighten a shirt?
> 
> The CAT tourniquets that the military uses (not to be confused with the Metal SOF one that's a more expensive knock off) are pretty big. I've used them a bunch and never had any size issues... but then again most soldiers aren't obese. If I can find one I'll try and measure it.



The same way you would tighten a cravat. Tie a knot, put something under the knot to twist it tight, tie in place when tight enough.



mycrofft said:


> You missed the obvious target, using a belt. Very hard to do properly. A web belt is better than a leather one and the buckle can do damage itself. Actually-woven leather belts are easier but may need retightening.



I was just listing off things that many people have on them that could be used in a pinch. Yes, I meant a fabric belt, not a leather one, and tied and twisted like a cravat. I just wouldn't trust the velcro to hold under the pressure needed to stop blood flow, and I have seen the air-chamber suddenly depressurize in a BP cuff when a seam came open under 'normal' use. Not something I would want to see happen when trying to use it as a tourniquet. And by normal use, the leak happened as it was being pumped up, somewhere between 140 and 160 mmHg.


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## mycrofft (Jul 12, 2013)

CritterNurse said:


> The same way you would tighten a cravat. Tie a knot, put something under the knot to twist it tight, tie in place when tight enough.
> 
> 
> 
> I was just listing off things that many people have on them that could be used in a pinch. Yes, I meant a fabric belt, not a leather one, and tied and twisted like a cravat. I just wouldn't trust the velcro to hold under the pressure needed to stop blood flow, and I have seen the air-chamber suddenly depressurize in a BP cuff when a seam came open under 'normal' use. Not something I would want to see happen when trying to use it as a tourniquet. And by normal use, the leak happened as it was being pumped up, somewhere between 140 and 160 mmHg.



Roger that.


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## lanceavil (Jul 12, 2013)

mycrofft said:


> *Money shot.*
> 
> BP cuff Velcro will sometimes not hold very well, especially if matted with blood, debris, or worn out from frequent use.  Tiny leaks from the hoses right by the metal nipples for the gauge and/or the bulb pump are the most common site of leakage (cut off the offending piece of hose and reconnect).
> 
> Remember that a subpressured TQ of any sort may actually promote bleeding from incompletely severed vascular regions due to closing the veins but not the arteries  (hence the penrose drain used in lab phlebotomy).


All the BP cuffs we have here are disposable, it's more sanitary, and the only thing that needs to be maintained is the bulb and gauge. It's kind of nice, it's like using a brand new cuff every time, and when you transfer care, just unclip it and leave the cuff on, and the ER staff use it on their machines.


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## Mariemt (Jul 13, 2013)

These rock


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## eonefireemt3 (Jul 13, 2013)

A few months ago, we just started carrying CAT tourniquets. In the past, we've used a cuff to start an IV if in a pinch. Honestly, if I did not have a tournaquet available and I had a hemorrhage patient going into shock, I would go for a cuff. Our system allows us to treat our patients on evidence based practices. As long as we can justify our reasons to our medical director, we're golden.


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## AnthonyM83 (Jul 14, 2013)

Yes I agree. BP makes a great TQ. Just be sure to keep it inflated as it'll start to deflate over time. At the ER the staff can slowly deflate it to see exactly what's bleeding and pump it back up immediately and easily if needed.


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## mycrofft (Jul 14, 2013)

*To prevent BP cuff opening up...*

Quickly throw a turn or two of tape all the way around it if velcro makes any sounds. Once the puffy cuff starts lifting the velcro (versus pulling it laterally) it can rapidly POP open and require deflation to reapply.


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## Brandon O (Jul 14, 2013)

Agreed with that. But just use it as a way to keep the velcro secured (just a couple turns), don't turn it into a cocoon -- someone eventually will need to get the thing off...


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## mycrofft (Jul 15, 2013)

Brandon Oto said:


> Agreed with that. But just use it as a way to keep the velcro secured (just a couple turns), don't turn it into a cocoon -- someone eventually will need to get the thing off...



Hah, right on.


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## wadford (Jul 19, 2013)

If you don't actually have a tourniquet or something that could be just as effective (triangle bangages work well) then you could use that. Inflate the cuff as much as you can and then you can use a clamp on the tubing. Just keep an eye on it because it will more than likely lose pressure. It's not a great way to stop bleeding.


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## Brandon O (Jul 19, 2013)

wadford said:


> Inflate the cuff as much as you can and then you can use a clamp on the tubing.



Locking hemostats work, but who's got one? I just knot both tubes tight. Leaks in the bladder itself are rare.


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## cusadiz (Jul 30, 2013)

EpiEMS said:


> I wonder if the military style tourniquets are large enough for the largest sorts of patients. Haven't tried one on anybody much bigger than myself.




TacMed tourniquets can be hooked together, it's the one (and only) benefit I found over Cat tourniquets.


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## medicdan (Jul 30, 2013)

Brandon Oto said:


> Locking hemostats work, but who's got one? I just knot both tubes tight. Leaks in the bladder itself are rare.



You'd be surprised how many people carry them... Whether for whackerdom or not, but they do have more purposes in EMS... (Kinking ETTs with high peep when swapping vents, keeping lines and tubes out of the way, improvised paperclip etc)


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## Fire51 (Jul 30, 2013)

My father had a 9 y/o girl fall through a sliding glass door and glass cut her brachial artery, they were both paramedics and decided to put a B/P cuff on the arm and it worked great because it also aloud them to do the other important things like IVs, fluid replacement, and so on.


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