Proper tourniquet use?

[d_miracle36]

I was working in the er the other night when we got a leg amputated pt. I believe it was from a crush injury. Anyway ER doc orderd fluid, rsi, and a bp cuff applied to the leg inflated and maintained at 300. The pt. was not bleeding prior to application so was his reasoning reperfusion injury?

 

[DrankTheKoolaid]

Possibly, but as the location of the amputation isnt clear AKA vs BKA he may have also been concerned with compartmentalized ongoing bleeding. Also as you give fluid your risk washout of forming clots.

 

[Shishkabob]

Possibly, but unable to tell for sure without knowing their thought process.


Why did you not ask the doctor when you had the chance?

 

[d_miracle36]

I'm going to next time I see him but it wasn't appropriate at the time

 

[Craig Alan Evans]

What part of the leg was amputated? Where did he put the cuff?

 

[d_miracle36]

It was amputated right below the knee joint and cuff was placed a few inched above joint on femur.

 

[Craig Alan Evans]

That's interesting. Reminds me of MAST trousers. Lol. Looking forward to hearing the docs view.

 

[Veneficus]

Seems like a reasonable treatment to me.

Most amputations do not bleed because of TXa2 vasoconstriction and formation of primary clot.

However, if you was that clot away with fluid, there is going to be bleeding.

If you dislodge the primary clot moving a patient around, the next one will not have as strong of txa2 reaction or the stability of the initial clot.

You also have to take into account the usage of clotting factors and what kind of fluid you are giving that can affect them one way or another.

A pneumatic TK is certainly appropriate.

It can help to stabilize the clot even further by reducing proximal circulation and pressure.

In the popliteal region, in addition the the named artery, there is considerable collateral arterial circulation. (otherwise your distal leg would go numb everytime you bent your knee)

If it never starts rebleeding, great.

If it does, you are prepared in adavance.

Besides, you can leave a tk in place for relatively 6 hours in many cases and more than one famous patient has died trying to save a limb where in the case of the everyday Joe, saving the life would have been the treatment of choice.

 

[Craig Alan Evans]

Ven is correct. They use TKs for hours everyday in the OR. You can have one on for up to two hours with zero ill effects. Anyone who has awakened with an arm asleep has experienced this first hand.

 

[Veneficus]

Depending on the circumstances, you can even "flush" them by allowing a few seconds of bleeding to allow circulation to distal tissue.

No different from opening a cross clamp, but I have to say, much nicer with a BP cuff than a forcep.

 

[d_miracle36]

All very good replies. I was just reading about that in the new issue of jems. I'll post further when I find out his reasoning.

 

[Veneficus]

i am compared to JEMS, oh for shame...

 

[RocketMedic]

Veneficis, the Army has been getting tourniquets on and off with no or minimal complications up to twenty four hours. Its one of the things we do right.

I believe in a tourniquet for every limb amputation. Trusting a clot is not a good idea.

 

[Veneficus]

Veneficis, the Army has been getting tourniquets on and off with no or minimal complications up to twenty four hours. Its one of the things we do right.

I believe in a tourniquet for every limb amputation. Trusting a clot is not a good idea.

What do you call a minimal complication?

Because many of the injuries I have seen in the modern military texts start out as traumatic amputation and are just refined with surgery, not reattached.

(not that many civillian injuries are reattachable or will be, but I have seen a handful, particularly fingers and a foot)

 

[RocketMedic]

What do you call a minimal complication?

Because many of the injuries I have seen in the modern military texts start out as traumatic amputation and are just refined with surgery, not reattached.

(not that many civillian injuries are reattachable or will be, but I have seen a handful, particularly fingers and a foot)

No or minimal loss of function to distal tissue.