In-ED tourniquet removal

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OnceAnEMT

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We are told that once a tourniquet is placed it can only be removed by a physician. Fair enough, makes sense. But what is the actual process of tourniquet removal? Is it truly done by a physician over whatever amount of time is needed, or does the physician just say loosen it over X minutes and manage bleeding? Or even better, is it just done in OR? I don't work in a trauma-heavy facility, and never used one in the field, so I'm just curious if anyone here has any knowledge on the matter.

Thanks!
 
The very few times I saw one that had been previously applied before the ER it was removed in the OR. Come to think of it I generally dont seem them used very often at all. I suppose it would depend on MOI. I imagine you also have to worry about re-prefusion injuries and infection etc. One of the former military medics might be able to answer that better.
 
I was under the impression that they were generally removed in the OR. Then I used one a few weeks ago and had my eyes opened, so to speak.

I have a great deal of respect for the PAs at our receiving hospitals but one would expect a lacerated radial artery with two CAT tourniquets applied to be met by at least a doctor if not a surgeon as well. Instead we showed up and the PA said "oh my god his hand is gray, we need to get those things off." Then she took them off by tearing the velcro. Talk about a pain increase.

Predictably the bleeding was profuse and got the ERP pretty good when he entered the room. Their solution was to put a pressure dressing on and have the patient elevate his arm while cycling the tourniquet five minutes on five minutes off until he presumably went to the OR.
 
...cycling the tourniquet? I feel like that screams thrombus.

So it is an OR thing. Makes sense. Any ideas on how they go about doing it? Do they repair then release, or both at the same time to test for leaks?

Was working tonight and completely forgot to ask any of the ED docs. Next time.
 
Grimes said:
...cycling the tourniquet? I feel like that screams thrombus.

So it is an OR thing. Makes sense. Any ideas on how they go about doing it? Do they repair then release, or both at the same time to test for leaks?

Was working tonight and completely forgot to ask any of the ED docs. Next time.
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Honestly, The surgeon stands there with a scalpel, a Hemostat, and maybe some fancy tweezers, and some suction. They release the tourniquet depending upon the location of the bleed the surgeon will have someone maintain some pressure above the wound on the artery, then the surgeon goes to town suctioning and trying to clamp the artery in some fashion with a hemostat or anything else they have within reach. Usually the artery will not be locatable with the tourniquet still applied because it retracts so much. Once clamped you either have vascular surgery with you and they do the repair, or the artery is stitched closed and stitched to the surrounding skin so you don't "lose it" and then the wound is stapled shut very loosely (or stiched, staples are just faster) and the patient has rocephin given and gets put on a chopper or a critical care truck to haul *** to the closest vascular surgeon for repair.


Usually the initial clamping involves a lot of blood and suctioning and the surgeon just trying to get two fingers on the artery to pull and clamp
 
I was under the impression that tourniqueted limbs are often injected with sodium bicarb to reverse the acidosis prior to removing the TK?
 
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