Anyone heard of using a BP cuff as a tourniquet?

[DesertMedic66]

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.

 

[Brandon O]

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.

 

[DPM]

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.

 

[mycrofft]

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).

 

[mycrofft]

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.

 

[CritterNurse]

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.

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.

 

[mycrofft]

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.

 

[lanceavil]

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.

 

[Mariemt]

These rock

 

[eonefireemt3]

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.

 

[AnthonyM83]

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.

 

[mycrofft]

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.

 

[Brandon O]

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...

 

[mycrofft]

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.

 

[wadford]

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.

 

[Brandon O]

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.

 

[cusadiz]

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.

 

[medicdan]

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)

 

[Fire51]

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.