Tourniquet questions

[DragonClaw]

Comments on a FB video of an ANTIFA dude grazed or got by a rubber bullet have me wondering.

Are TQs only for arterial bleeds?

Google says usually arterial, but if a venous bleed is serious, a TQ can be used.

If it is a venous bleed, place it distal to the wound and not proximal as is standard placement. The idea of attempted Venous return being limited because of its just gonna leave you, what's the point?

Have you ever TQd venous bleeds? Where did you place the TQ?

What if there's bleeding from both sources? Would 2 TQs be indicated?

This of course is after pressure and bandages fail to stop bleeding.

Typing this makes me think of another question.

Have you ever come across a scene where you immediately TQ no questions asked and say "screw direct pressure"? An amputated limb maybe?

EMT school doesn't cover this...

 

[Peak]

If there is a serious life threatening bleed the tourniquet should be placed proximal to the bleeding site.

A serious venous bleed can kill, however why pump the extremity full of blood if it cannot return? There is no reason to tourniquet distal to the wound.

Many groups are recommending early tourniquets for life threatening bleeds. Unless you have advanced training that has formally educated otherwise I wouldn’t do otherwise. Our reimplantation group has reattached amputations and extremities with far more than6 hours of time with lack of perfusion.

 

[VFlutter]

In the tactical environment a tourniquet may be placed on a venous bleed as a rapid fix until the patient is in a safe environment to convert to a pressure dressing.

If you have a patient with a massive venous bleed that you can not control by any other means than a tourniquet may be appropriate. I have once because it was impossible to hold effective direct pressure in the helicopter and the patient continued to profusely bleed through a pressure dressing. You still place it above the wound to abolish the arterial flow.

An amputation would likely have has some degree of arterial bleeding but yes a tourniquet would be appropriate.

 

[E tank]

For BLS folks....Strictly speaking, the purpose of a tourniquet is to cause a meaningful fall in intravascular blood pressure at the area of injury.

This means that the pressure the tourniquet provides must exceed the pressure in the vessel of interest. Arterial pressure is, for all practical purposes, always higher than venous pressure so an arterial tourniquet proximal to the vascular injury is effective for control of blood loss in either arterial or venous injury. If arterial blood can't reach the injured veins, there is no venous pressure and no bleeding.

A venous tourniquet ( defined as one that impedes venous flow but allows arterial flow) placed proximal to a venous injury will increase venous pressure and blood loss at the site of injury. If someone did decide to place a venous tourniquet for the purposes of stemming blood loss from a venous injury, he would place it distal to the injury to impede inflow toward the damaged veins.

All this said, I cant imagine a scenario where someone who was considering the use of a tourniquet in the first place (as opposed to simply direct pressure) would be able to rule out superimposed arterial injury.

My opinion...if the bleeding is bad enough for a tourniquet, it should be arterial regardless of where you think the injury is.