Severe hemorrhage

[VFlutter]

Ever had a patient who was mentating normally enough to complain about pain from ischemia caused by a TQ? How'd you manage that?

I've only had one whom was awake enough to complain. Analgesia didn't touch him and he ended up getting heavily sedated after getting combative and attempting to remove the TQ. The patient was younger and may have been under the influence but I'm sure the pain is intense. Besides a nerve block I'm not sure what would really help.

Patient got 100mcg of Fentanyl x2, 0.25mg/kg Ketamine x2 before finally getting a 1mg/kg sedation dose of Ketamine.

 

[Tigger]

Ever had a patient who was mentating normally enough to complain about pain from ischemia caused by a TQ? How'd you manage that?

With difficulty. 400mcg of fent for one, didn't touch it. He managed to lacerate his radial artery tubing in a river but someone had the forethought to put a makeshift tourniquet right away. The pain and stress had him with a pressure of over 170 which required additional tourniquets. In retrospect we should have probably sedated him but this was 5 years ago and the guidelines were much tighter.

My last patient was drunk AF and combative and ended up getting a bunch of versed and fent to just keep him from taking it off.

 

[Carlos Danger]

Ever had a patient who was mentating normally enough to complain about pain from ischemia caused by a TQ? How'd you manage that?

It is difficult. Even under general anesthesia you’ll often see significant sympathetic discharge after some time with a tourniquet inflated, and it is typically relatively unresponsive to opioids.

 

[VFlutter]

It is difficult. Even under general anesthesia you’ll often see significant sympathetic discharge after some time with a tourniquet inflated, and it is typically relatively unresponsive to opioids.

Have you ever done a Beir block? Not that it would really help in this situation. Seems interesting tho.

 

[StCEMT]

Ever had a patient who was mentating normally enough to complain about pain from ischemia caused by a TQ? How'd you manage that?

Yes and I just said sorry dude. We were close enough that I didn't have any time to once I got the first things needed done.

 

[Carlos Danger]

Have you ever done a Beir block? Not that it would really help in this situation. Seems interesting tho.

I have done bier blocks, but they wont work for tourniquets already in place because the local can't get under the tourniquet.

Also, I wouldn't do one in a location (or vehicle) where I didn't have lipids available.

 

[EpiEMS]

@VFlutter, @Tigger, @Remi, @StCEMT

Appreciate the feedback! I had hoped for the medic I was with to at least try...something...
Patient wasn't profoundly hypotensive or tachy, far as I can recall.

 

[Peak]

Ever had a patient who was mentating normally enough to complain about pain from ischemia caused by a TQ? How'd you manage that?

Had one, cut his radial artery, intoxicated, pressures in the 60s sys on arrival, suicide attempt. Gave him 100 of fentanyl, told him that he was too unstable for anything more (that was a bit of an exaggeration, but we were also hanging blood and packaging him for transport), he did fine but definitely wasn't thrilled. They ended up him some very stout doses of fentanyl, dilaudid, and ketamine in the ED without good pain management.

Most of the tourniquets I've placed have been tolerated very well, but they were typically in mountain men type guys.

 

[EpiEMS]

Had one, cut his radial artery, intoxicated, pressures in the 60s sys on arrival, suicide attempt. Gave him 100 of fentanyl, told him that he was too unstable for anything more (that was a bit of an exaggeration, but we were also hanging blood and packaging him for transport), he did fine but definitely wasn't thrilled. They ended up him some very stout doses of fentanyl, dilaudid, and ketamine in the ED without good pain management.

Most of the tourniquets I've placed have been tolerated very well, but they were typically in mountain men type guys.

Pretty similar (+ ETOH 60s male, suicide attempt) to the patient I had. Of course, my transport time is 15 min...